Med Surg Test 2

What is Celiac Disease?

gluten intolerance that damages small intestines

In pts with Celiac Disease

• gluten causes an _______________ ____________

• _______ are damaged in the small intestine leading to ____________________.

immune response, villi, malabsorption

Gluten contains ____________ which triggers an immune response in pts with Celiac Disease.

gliadin

Celiac Disease

• ________________

• believed to be ___________ predisposition

• CD4+ ______ play a role

• causes _________ _________ in small intestines

autoimmune, genetic, t-cells, villous atrophy

Celiac Disease appears several _______ after gluten is introduced and is usually noticed around ____-____ years.

months, 1,5

Major Signs of Celiac Disease

• diarrhea

• abd. ________

• anorexia

• ____________

• ________ ___________

• ________

• malnutrition/ __________ growth

distension, steatorrhea, muscle wasting, anemia, impaired

What is steatorrhea?

fatty greasy stools

Steatorrhea in Celiac Disease

• poor ___________ of ______.

• fat stays in ______

absorption, fat, stools

Main Treatment for Celiac Disease…

gluten free diet

What are 4 foods that those with celiac disease should AVOID?

wheat, barley, rye, oats

Foods allowed w/Celiac Disease

• _________ and _____ flours

• _____, corn, soy

• _________

• ______ and _______

buckwheat, nut, rice, potatoes, eggs, millet

Gluten can be hidden in processed foods like _____________ and ________.

thickener, filler

Those with celiac may need to restrict ________ along with gluten

lactose

Celiac can temporarily cause _____________ _____________.

lactose intolerance

Untreated Celiac Disease can cause…

• ______ ______

• lactose intolerance

• __________ deficiencies

• impaired ________

• ____________

• ___-________ ____________

celiac crisis, vitamin, growth, osteomalacia, non Hodgkin’s lymphoma

facial malformation occurring with embryotic development

cleft lip or palate

During first weeks ____-____ the maxillary/premaxillary processes fail to ________ __________. = CLEFT LIP/PALATE

4,10, come together

What is the biggest priority for babies born with cleft lip/palate or both?

feeding

Cleft lip makes _____________ difficult because lip cannot form __________ _______.

suction, anterior

Cleft palate makes ___________ difficult because _______ can escape through _______.

sucking, milk, nose

Feeding Teaching for Cleft lip/palate

• position infant _______

• use ___________ ___________

• ______ frequently

• breastfeeding may be possible

upright, special equipment, burp

Why should a cleft lip/palate baby be positioned upright for feedings? (3)

helps with swallowing, secretions, and aspiration risk

Special Equipment for Cleft lip/palate babies

• ________ ________ feeder

• __________ bottle

• _____-_________ cleft palate nurser

• _________ when appropriate

special needs, pigeon, mead Johnson, obturator

You must burp cleft lip/palate babies frequently bc they may…

swallow more air

What are 3 additional problems associated with cleft lip/palate babies?

teeth, speech, and hearing

Hearing issues can develop in kids with cleft lip/palate bc…

• there is improper damage of ________ ______.

• this causes _______ buildup and _______ _______.

middle ear, fluid, otitis media

How is a cleft lip/palate repaired?

cheiloplasty

When can a Cheiloplasty be done?

2-3 months

Pre-Op Priorities for Cheiloplasty

• ensure _________

• teach feeding techniques and equipment

• position upright/ burp frequently

• monitor ______ and _______.

nutrition, intake, growth

Post-Op priorities of Cheiloplasty

• protect surgical site ( ______ suture line and use ___________ ________ to keep moist)

• control ______

• monitor for _________

• protect the repair ( _______ __________)

• no ______ objects in mouth or oral cavity___________.

clean, petroleum jelly, pain, intake, growth

After Cheiloplasty resume feeds as tolerated at home within _____ hrs.

24

What is a cleft palate repair surgery called?

palatoschisis

When can a Palatoschisis be done?

6-12 months

Repair cleft ________ early to support appropriate speech development

palate

Palatoschisis Post-Op Priorities

• watch ________, and monitor for ______ ____________

• modify ___________ (most likely ________ feeds)

airway, resp. difficulties, feeding, syringe feeds.

What BMI is considered overweight?

>25

What BMI is considered obese?

>30

What BMI is considered extremely obese?

>40

What is the optimal waist to hip ratio?

<0.8

waist to hip ratio >8.0 indicates…

truncal fat

What waist circumference of a woman is considered obese?

>35in

What waist circumference of a man is considered obese?

>40in

Gynoid body type is considered…

pear shaped

Android body type has _______/_____ fat

truncal, abd

What are 4 methods used to identify obesity?

BMI, body shape, waist to hip, waist circumference

Primary obesity

• ______ ________

• calories consumed > calories used

most common

Secondary Obesity

• caused by a ___________

condition

Conditions that can cause Secondary Obesity

• ____ lesions/disorders

• meds

• __________ disorders

• ______________/genetic abnormalities

CNS, endocrine, chromosomal

What are 3 important hormones related to obesity?

neuropeptides Y, Leptin, and Ghrelin

Neuropeptide Y is an _____________ ____________ hormone.

appetite stimulant

Leptin is an _____________ _____________ hormone that increases ______ __________.

appetite suppressant, fat metabolism

Leptin deficiency or resistance can lead to…

obesity

Ghrelin

• produced in the _____

• ________ _______

• leads to _______ ________

gut, inhibits leptin, over eating

Gastric Bypass decreases ________ hormone.

Ghrelin

more fat cells = ______ ___________

more adipokines

Adipokines contribute to…

• disrupted __________ _______

• certain _________

• _________ ___________

• _____________

immune factors, cancers, insulin resistance, athlerosclerosis

Obesity can cause high _____, ____________, and low _______.

LDL, triglycerides, HDL

Health Risks of Obesity

• HTN, heart disease

• cellulitis

• _________

• varicose veins

• __________

• ______/__________ problems

• ____________ and _______ cancer

• _______________

osteoporosis, diabetes, liver, gallbladder, endometrial, breast, hyperlipidemia

Nurses should assess for what 4 underlying causes of obesity?

cushing’s, hypothyroidism, PCOS, hypothalamic tumor

Nurses should assess obese pts…

• ______ and _____________ system

• ______

• ______ circumference

• ________

• meds/drugs

resp, cardiovascular, BMI, waist, mobility

What 2 additional things are assessed for in obese men?

gynecomastia, and hyponadism

What are 4 Diagnostic tests for obesity?

glucose, cholesterol, triglycerides, and liver function tests

Goals of Therapeutic Care for Obese pts

• modify ________ _________

• regular _________

• achieve/maintain weight ______

• prevent/minimize associated health issues

• _________ ___________

eating patterns, activity, loss, lifelong management

Nursing Intv. for Obese pts

• motivational coaching

• ______ _______

• phone apps

• set ________ goals

group, realistic

Best diet for obesity is a diet the pt can _____ ______ that _________ _________ for energy used.

stick with, reduces calories

Nutrition of Obese pts

• have about _____-______ less calories a day to lose around ____-____lbs/week

500, 1000, 1,2

Advise Obese pts to stay away from…(3)

fad diets, alcohol, sugary drinks

Low calorie diets < ______ calories/day need to be carefully supervised.

800

Exercise for Obese pts

• ____ days/week

• ____-____mins/day

• _______ mins a week moderate OR _______ mins a week vigorous

5, 15,30, 150, 75

Behavior Modifications for obese pts

• self _______ in a food diary

• __________ control

• __________

• support groups

monitor, stimulus, incentives

What are 4 categories of weight loss medications for Obesity?

orlistat, bupropion, Phentermine, Semaglutide

Orlistat

• blocks ____ __________ and _____________

• side effects…(3)

fat breakdown, absorption, diarrhea, bloating, farts

Bupropion

• ______

• decreases __________

contrave, cravings

What are two kinds of Phentermine?

Qsymia, and Plenity

Qsymia

• Phentermine

• increases ________

• decreases _________

metabolism, appetite

Plenity

• Phentermine

• ________ stomach and intestines.

expands

What is an example of a semaglutide indicated for weightloss?

wegovy

Wegovy

• increases _____ with slow ________ _________

• side effects…(3)

saiety, gastric motility, GI distress, gastroparesis, and hypoglycemia

Wegovy can cause ___________ is used with other diabetes meds.

hypoglycemia

To receive Bariatric Surgery you must have a BMI >/= ____ OR BMI >/= _____ + severe obesity related ______________.

40, 35, complications

Bariatric Surgery cannot be done if someone has…

• ____________ _______

• ______/_______ disease

• _____________________ disease

advanced cancer, liver, kidney, cardiopulmonary

Before being able to get Bariatric Surgery pt must…

• be screened by a ___________

• be able to commit to lifelong changes

• screened for ___________ and ___________

• be assessed for ability to cope with ________ image change

psychologist, depression, addiction, body

Restrictive Procedures for Obesity work by…

reducing amount the stomach can hold.

What are 3 examples of Restrictive Procedures for Obesity?

gastric plication, Intragastric balloon, Gastric bypass

Gastric Plication

• stomach is _________ not cut

• __________

folded, reversible

Intragastric Balloon

• creates_______

• _____-_____mL of Saline used

fullness, 400, 700

Gastric Bypass

• combines _____________ with ____________

• decreases _______ hormone.

restriction, malabsorption, Ghrelin

With Dumping Syndrome gastric contents empty _____ _________ into the ________ __________.

too quickly, small intestines

What are 4 symptoms of Dumping Syndrome?

N/V/D and weakness

How does one avoid Dumping Syndrome?

• ______ meals ( ____/day)

• low _______ and low ______

• drink _________ meals not during

• _____ after meals

• 
  

small, 6, sugar, carbs., btwn, rest

Diet 0-1 day post Gastric Bypass

• ______ until _______ ________ return

• then ____mL ______, ________ rich liquid Q ____-____ mins

• avoid ___________ drinks

Goal= ____mL every ____mins by the end of day 1

NPO, bowel sounds, 15, clear protein, 10-15, 90, 30

Diet 7-10 days post Gastric Bypass

• __________ diet

Diet 10-14 days post Gastric Bypass

• __________ foods

pureed

Diet 15-30+ days Post Gastric bypass

• _______ foods like ground meat, rice, and eggs

soft

Diet 4-6 weeks post Gastric Bypass

• __________ diet

regular

A collection of risk factors that increase the risk of CVD, stroke, diabetes, etc.

metabolic syndrome

Metabolic syndrome

• belly fat, inc. _______ and ____ and bad _______

glucose, BP, lipids

Metabolic Syndrome Diagnosis (must have ___ or more)

• waist circumference (>40 men, >35 women)

• Triglycerides >/= ______mg/dl

• HDL (< ____ men, < ____ women)

• BP ( >129/84)

• Fasting Glucose >/= ______ mg/dl

3, 150, 40, 50, 110

What are 2 treatments for Metabolic Syndrome?

lifestyle modifications, medications