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MDC2 Final Exam Blueprint WHAT IS THE MASTER GLAND = pituitary gland CH: 56: Noninflammatory Intestinal Disorders Diagnostics for
- Fecal occult blood test - Stool culture - Barium - Colorectal study - CT - Colonoscopy - Endoscopic retrograde cholangiopancreatography (ERCP)
➢ Mechanical Intestinal Obstruction vs. a Non-Mechanical Intestinal Obstruction- there is a link and video on this in the course materials if you are still unsure of the difference.
1. Mechanical ▪ Adhesions ▪ Tumors ▪ Fibrosis ▪ Strictures ▪ Diverticulitis ▪ Fecal impaction ▪ Hernia ▪ Volvulus 2. Nonmechanical ▪ Paralytic ileus ▪ Neurogenic disorder ▪ Vascular disorder ▪ Electrolyte imbalance ▪ Inflammatory response ➢ What is…
- Intussusception – telescoping of the bowel, when a segment of bowel pushes into another segment causing it to collapse. Common in kids. 2. Signs and Symptoms a. Stool mixed with blood and mucus (currant jelly) b. Vomiting c. Lump in abdomen d. Lethargy e. Diarrhea f. Fever
lower GI include?
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➢ Irritable Bowel Syndrome
1. Signs and Symptoms: what will you see on presentation a. IBS-D = Diarrhea i. Abdominal cramping ii. Diarrhea iii. Change in stool frequency or consistency iv. Flatulence v. Passing mucus from rectum vi. Bloating vii. Abdominal distension b. IBS-C - constipation i. Abdominal pain/discomfort ii. Changes in bowel function iii. Bloating/gas iv. Straining v. Infrequent stools vi. Hard/lumpy stools vii. Feeling that bowel does not empty completely c. IBS-A (Alternating) i. Inconsistent bowl habit ii. All symptoms of typical IBS iii. Diarrhea and constipation d. IBS-M (Mixed) i. Increased belly pain ii. Both diarrhea and constipation 2. Health Promotion and maintenance (Patient education) a. Avoid foods that trigger exacerbation i. Dairy ii. Wheat iii. Corn iv. Fried foods v. Alcohol vi. Spicy foods vii. Aspartame b. Avoid alcoholic and caffeinated beverages, and other fluids containing fructose and sorbitol c. Consume 2 to 3 L fluid per day from food and fluid sources d. Increase fiber intake (approximately 30 to 40 g/day)
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- When peristalsis returns, the NGT is clamped for a period of time, and if the client does not have nausea, remove the tube. ii. Colon Resection w/ colostomy (Include collaborative roles in management)
- What discipline will you collaborate with to lead care of the ostomy. What specialty? (Yes these people are nurses, but they are a specific kind with a certification…….) = = Certified Wound Ostomy and Continence Nurse
iii. Complications of Colon Resection dehiscence (incision breaking open), infection, incisional hernia, scar tissue forming blockage (stricture), leakage between joined sections CH: 57: Inflammatory Intestinal Disorders ➢ Appendicitis
- Signs/Symptoms a. Nausea b. Loss of appetite c. Constipation/diarrhea d. Fever e. Right side of lower abdomen ➢ Ulcerative Colitis: Define: What is it? Remember the name of this Chapter
- Signs and Symptoms a. Diarrhea with blood or pus b. Abdominal pain/cramping c. Rectal pain d. Rectal bleeding e. Urgency to defecate f. Weight loss g. Fatigue
- Risk factors a. Age b. Race/ethnicity c. Family history ➢ Anal Fistula/Anorectal abscess
- Signs and Symptoms a. Skin irritation around anus b. Tunnel that develops between skin and anus c. Constant, throbbing pain that may be worse when you sit or cough d. Smelly discharge from your anus e. Passing blood or pus in stool
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f. Swelling and redness around your anus g. Fever
- Management (Comfort and promote healing) a. Maintain fluid and electrolytes b. Control of infection c. Nutritional support d. Skin protection and containment CH: 59: Care of Patients with Problems of the Biliary System and Pancreas ➢ **Cholecystitis (Consider the 4 Fs)
- Forty or over
- Female
- Fertile
- Fat**
- Presentation signs and symptoms (Pain local/abnormal vitals/other symptoms): What is unique about the presentation of this condition? a. Sharp pain in right upper quadrant, often radiating to the right shoulder b. Pain with deep inspiration during right subcostal palpation (Murphy sign)
➢ Pancreatitis
- Signs and symptoms a. Upper abdominal pain b. Abdominal pain that radiates to your back c. Fever d. Rapid pulse e. Nausea/vomiting f. Tenderness
- Causes a. Abdominal surgery b. Alcoholism c. Medications d. Cystic fibrosis e. Gallstones f. Hypercalcemia/hyperparathyroidism g. Hypertriglyceridemia h. Infection i. Injury to abdomen j. Obesity k. Pancreatic cancer
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iii..
- Hypoglycemia a. Signs and Symptoms b. Complication (what system can’t store glucose to function) c. Intervention for hypoglycemia i. Responsive patient ii. Not responsive patient/NPO = Responsive patient: take 15 to 20g of an absorbable carb. This includes 4 to 6oz of juice, glucose tablet/gel, 6 to 10 hard candies, or 1 tbsp of honey. Recheck glucose in 15 minutes
Not responsive patient/NPO: Admin glucose IM or subcut and repeat in 10 minutes if still unconscious. Place in lateral position to reduce aspiration and notify provider
- Complications of Diabetes/list the terms/who do you monitor for each of these a.? (feet): Discuss foot care b.? (kidneys) c.? (eyes) d.? (vascular) feet : Inspect and wash feet daily (mild soap/warm water), pat dry, no lotion between toes, use mild powder, avoid open toe shoes, avoid barefoot, avoid prolonged sitting/standing/crossing feet Kidneys : Monitor hydration and kidney function (I&O, creatinine), report output of <30ml/hr, monitor blood pressure Eyes : have yearly eye exams and manage blood glucose Vascular : Monitor blood pressure.
- Patient education and foot care = Clean & insect feet daily, avoid walking barefoot, report non-healing wounds, wear proper fitting shoes, trim toenails properly, check shoes for foreign objects.
- Interventions to improve compliance with Multidimensional care = different members of care team CH: 63: Care of Patients with Problems of the Thyroid and Parathyroid Glands ➢ Hyperthyroidism
- What is the HALLMARK sign? a. Heat intolerance
- Signs and symptoms
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Skin : diaphoresis, fine silky hair, smooth warm moist skin, thinning scalp hair Cardiopulmonary : palpitations, chest pain, increased systolic BP, tachycardia, dysrhythmias, rapid shallow respirations GI : weight loss, increased appetite, increased stools Neurologic : blurred doubled vision, eye fatigue, increased tears, red conjunctive, photophobia, exophthalmos, eyelid retractions/lag, globe lag, hyper DTR, insomnia, tremors Metabolic : increased metabolism, heat intolerance, low grade fever, fatigue Psychosocial : reduced attention, restless, irritable, emotionally unstable, manic Reproductive : Amenorrhea, reduced libido Other : goiter, enlarged spleen, muscle weakness/wasting, pretibial myxedema
- Causes Autoimmune : Antibodies are developed that attach to TSH receptors which increases thyroid hormones (Graves’/toxic diffuse goiter) Toxic nodular goiter : Nodules from enlarged tissue or tumor on the thyroid increase thyroid hormone production Exogenous : Too much thyroid replacement hormone Secondary : pituitary gland tumor causing excess TSH
- What gland will you palpate = thyroid gland
- Abnormal labs (Indicated expected values consistent with diagnosis) Indicate with arrows a.? = TSH low b.? = T3 high c.? = T4 high
- Complication if left untreated = thyroid storm/thyroid crisis
- Treatment a. Non-surgical b. Surgical i. Post-op monitoring ii. Complications
➢ Hypothyroid
- What is the Hallmark sign of hypothyroidism?
- Signs and symptoms Skin : pale/yellowish, cool, dry/coarse/scaly, thick brittle nails, decreased brittle hair, poor wound healing Pulmonary : hypoventilation, pleural effusion, dyspnea
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= Iatrogenic (surgery), radiation, idiopathic/autoimmune, congenital, hypomagnesaemia
- Signs and Symptoms = Numbness, tingling, severe cramps, seizures, irritability/psychosis, Trousseau/Chvostek’s, pitting in teeth
- Abnormal Labs = low calcium, phosphorus increased, magnesium decreased, PTH decreased, vit D decreased, cAMP decreased.
- Diagnostics = EEG, blood tests, CT scan
- Patient education regarding nutrition (good/bad) = correct vit D, calcium, and mag deficit, Avoid foods high in phosphorus such as milk, yogurt, and processed cheese. Use supplements (lifelong). Wear a medical alert badge
CH: 62: Care of Patients with Pituitary and Adrenal Gland Problems ➢ Adrenal Hyperfunction/Excess/ Chronic hypercortisolism (Cushing’s): Define
- Signs and symptoms (Break down systems) Appearance : moon face, buffalo hump, truncal obesity, weight gain Cardio : Hypertension, dependent edema, bruising, petechiae Musculoskeletal : muscle atrophy, osteoporosis/fractures, decreased height, aseptic necrosis of femur head, slow or poor wound healing of fractures Skin : thin, striae, increased pigmentation, increased r/o pressure ulcers Immune : risk of infection, decreased inflammatory response, and decreased signs of infection
- Causes Endogenous : bilateral adrenal hyperplasia, pituitary adenoma, malignancies (lung, GI tract, pancreas), adrenal adenoma/carcinoma Exogenous : Use of glucocorticoids (for asthma, autoimmunity, organ transplant, cancer chemo, allergic response, chronic fibrosis).
- Diagnostics (labs) What are positive findings a. Blood = increased cortisol. Pituitary increased ACTH, adrenal decreased ACTH ACTH- elevated Increased glucose Decreased lymphocyte Decreased sodium b. Urine = levels of free cortisol and androgens, would be elevated in a 24-hour specimen norm 2.0 ng/ml)
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c. Salivary = increased cortisol and androgens, cortisol to creatinine ratio
25nmol/nmol
- Complications/Risks = Perforated viscera/ulceration: GI bleed Bone fractures due to hypocalcemia Infection due to immunosuppression Adrenal crisis (sudden drop in cortisol): due to sudden tumor removal, stress, dehydration, abruptly stopping steroid medication
➢ Adrenal Hypoperfusion/Addison’s/ Adrenocortical insufficiency
- Assessment (what might the patient present with look at Assessment noticing (common)
- Signs and Symptoms (Break down of symptoms) Neuromuscular : muscle weakness, fatigue, joint/muscle pain GI : anorexia, nausea, vomit, abdomen pain, constipation or diarrhea, weight loss, salt craving Skin : vitiligo (primary d/t destruction of melanocytes)/hyperpigmentation (primary d/t ACTH=MSH) Cardiovascular : anemia, hypotension, hyponatremia, hyperkalemia, hypercalcemia Endocrine : hypoglycemia
- Causes Primary : Autoimmunity, TB, metastatic cancer, AIDs, hemorrhage, gram-neg sepsis, adrenalectomy, abdomen radiation, drugs/toxins Secondary : Cessation of long-term GC therapy, pit tumor, postpartum pit necrosis, hypophysectomy, high dose pit/brain radiation
- Patient teaching indicated for drug therapy = Taper
- Prevention of Adrenocortical insufficiency: How do you prevent this? = report illness/stress
- What is the process for discontinuing corticosteroids? = Taper
- What will happen with abrupt discontinuation? = = Sodium falls while potassium rises and there is severe hypotension. Also, sudden inflammation
➢ Addisonian Crisis
- Intervention and expected response
