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EXAM 1 Flashcards

1
Q

Vagotomy

A

vagus nerve is cut to DECREASE gastric acid secretion (HCl)

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2
Q

Pyloroplasty

A

pylorus is widened to facilitate empting of stomach

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3
Q

Antrectomy/Billroth I (gastroduodenostomy)

A

removal of pyloric portion of stomach with anastomosis of duodenum to body of stomach

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4
Q

Billroth II (gastrojejunostomy)

A

removal of pyloric portion of stomach with anastomosis of jejunum to body of stomach
–> Pylorus is removed since this portion of GI tract contain parietal cells that secret gastrin

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5
Q

First complication of peptic ulcer disease

A

Hemorrhage

s/sx: bloody stool or emesis that is bright red or dark

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6
Q

Perforation and penetration

A

o Ulcer erodes through gastric serosa causing leakage of gastric contents  flow into peritoneum and cause peritonitis
o Signs/symptoms:
 Sudden, severe upper abdominal pain that gradually gets worse
 Pain may refer to R shoulder d/t irritation of phrenic nerve & diaphragm
 Vomiting
 LOC
 Extremely tender and rigid abdomen (board-like)
o *** Surgical emergency!!

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7
Q

gastric outlet obstruction

A

complication of peptic ulcer disease
o Occurs when area near pyloric sphincter becomes scarred and stenosed from spasms
o Scar tissue develops from healing ulcers overtime
o Signs/symptoms:
N/V
Epigastric fullness
o Treatment:
Insert NG tube for decompression
Stenosis/scarring of tissue may require dilation in order to relieve obstruction

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8
Q

Crohn’s Disease (type of IBD)

A

 Aka, regional enteritis
 Can occur in multiple segments of the GI system and is not contiguous
 Cobblestone appearance and is not contiguous
 Subacute and chronic inflammation of GI tract wall that spreads deep into all layers of affected bowel tissue
• Typically occurs in ileum & ascending colon but can be anywhere from mouth to anus

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9
Q

Ulcerative Colitis (type of IBD)

A

inflammation/ulceration that only involves colon and is contiguous (occurring one after the other in sequence)
 Recurrent, ulcerative and inflammatory disease of mucosal and submucosal layers of colon and rectum
 Lesions are connected together to form an unbroken sequence
 Characterized by periods of remission & exacerbation

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10
Q

clinical manifestations of constipation

A 
o	Straining 
o	Pain and pressure
o	Abdominal distension 
o	Sensation of incomplete evacuation 
o	Small, lumpy, dry, hard stools that are low in volume
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11
Q

causes of constipation

A

o Consuming low fiber diet
o Ignoring urge to defecate
o Inadequate fluid intake
o Sedentary lifestyle/lack of exercise
o Living fast-paced lifestyle usually marked by irregular eating patterns
o Medications (esp. anti-depressants & opioids)
o Chronic laxative use  causes bowel dependence
o Certain neuromuscular disorders (MS, Parkinson’s) and endocrine disorders

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12
Q

complications of chronic constipation

A 
o	Valsalva Maneuver--> decrease CO and BP 
o	Fecal impactions 
o	Hemorrhoids
o	Fissures
o	Rectal prolapse
o	Megacolon
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13
Q

Nursing Management for chronic constipation

A

o Assess onset and duration of constipation
o Explore current and past elimination patterns
o Establish the norm of BMs
o Current medications & laxative, enema use
• Goal = restoring or maintaining regular pattern of elimination based on patient’s input

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14
Q

clinical manifestations of diarrhea

A 
o	Urgency 
o	Perianal discomfort
o	Abdominal cramping/distension 
o	Intestinal rumbling
o	Anorexia
o	Thirst
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15
Q

causes of diarrhea

A 
o	Medications – stool softeners, antibiotics, chemotherapy 
o	Tube feeding formulas 
o	IBS 
o	Inflammatory bowel disease 
o	C. Diff
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16
Q

complications of diarrhea

A

o Cardiac dysrhythmias – d/t K+ loss
o Dehydration
o Altered skin integrity (esp. around perianal area)

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17
Q

nursing management for diarrhea

A

o Obtain health history
o Any recent travel to another geographic location?
o Education!!
 Foods to avoid – caffeine, carbonated beverages, hot/cold foods
 Restrict milk products, certain fatty foods
o IV hydration may be necessary
 Must monitor electrolyte levels
o Perianal care  excoriated skin
 Wet wipes
 Barrier cream

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18
Q

dyspepsia

A

indigestion- pain in the upper abdomen and fullness in stomach esp without eating

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19
Q

pyrosis

A

heartburn

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20
Q

sliding hiatal hernia

A

occurs when upper stomach (usually just lower esophageal sphincter) and gastroesophageal junction (where stomach and esophagus join) are displaced upward to slide into and out of thorax
o Most common types – comprise 90-95% of all hiatal hernias
o Hernia usually slides freely
o Upper part of stomach and esophageal junction become displaced to slide in and out of thorax

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21
Q

rolling hiatal hernia

A

MAIN CONCERN= STRANGULATION
(Paraesophageal): occurs when all or part of the stomach pushes through the diaphragm and sits beside the esophagus
o Esophageal junction remains in position
o But fundus of stomach rolls through hiatus and into thorax

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22
Q

Sliding hernia clinical manifestations

A

o Can be asymptomatic
o ** GERD-like symptoms  hallmark clinical manifestations
 D/t involvement of lower esophageal sphincter
 Pyrosis
 Regurgitation
 Dysphagia

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23
Q

Rolling hernia clinical manifestations

A 
- involve more tissue so more likely to see respiratory symptoms 
o	Can be asymptomatic
o	GERD-like symptoms
o	Breathlessness after eating
o	Chest pain that mimics angina
o	Feeling of suffocation
o	Worse lying down
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24
Q

Interventions for Crohn’s Disease

A

o Diet, activity and stressors
o Ready access
o Pain
o Fluid volume
o Daily weight
o Low residue diet  review handout **
 Foods that help to avoid overextending stomach and are easy to digest
 Limits high-fiber, undigested foods that make up stool
 Goal is to have fewer and smaller bowel movements a day
 THERE WILL BE EXAM QUESTION on foods allowed/to avoid ***
o Rest periods to conserve energy and reduce metabolic rate
o Anxiety and coping
o Skin
o Understanding and management of self-care
o Signs of complications and when to seek medication attention

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25
Goals for Irritable Bowel Disease
``` o Bowel elimination o Pain o Fluid volume o Maintenance of optimal nutrition and weight  Malnutrition = top priority ** o Avoid fatigue o Reduce anxiety o Coping  mind-gut connection!! o Assess skin and avoid skin breakdown o Knowledge o Self-health management o Avoid complications ```
26
Complications and Treatments for Irritable Bowel Disease
• Risks: o Greatest risk = between age of 15-30 o UC more common in ex-smokers o CD more common in smokers • Causes: unknown • Diagnostic: colonoscopy*** • Complications = Nutritional imbalance that can lead to malnutrition o Diarrhea and subsequent anorexia can lead to:  Weight loss  Dehydration  Electrolyte imbalances o Can overtime develop into cardiac dysrhythmias, osteoporosis • Treatment: o Surgery for UC  total colectomy  Curative b/c it only affects the colon  For CD not curative b/c lesions can occur anywhere from mouth to anus
27
Clinical Manifestations of irritable bowel syndrome
o Primarily constipation or diarrhea or both o Abdominal pain o Bloating o Abdominal distention
28
Interventions for irritable bowel syndrome
o Education o Dietary habits and avoidance of trigger foods o Chew and don’t drink fluids with meals  can cause distension o Stress management and exploring coping skills
29
What are the causes of Irritable Bowel Syndrome
``` o Psychological stress o Hormones o Genetics o Depression/anxiety o Trigger/fatty foods o Alcohol, smoking ```
30
surgical interventions for peptic ulcer disease
• If obstruction or perforation or ulcer won’t heal over 12-16 weeks** o 1) Vagotomy: vagus nerve is cut to decrease gastric acid secretion (HCl) o 2) Pyloroplasty: pylorus is widened to facilitate empting of stomach o 3) Antrectomy/Billroth I (gastroduodenostomy): removal of pyloric portion of stomach with anastomosis of duodenum to body of stomach o 4) Billroth II (gastrojejunostomy): removal of pyloric portion of stomach with anastomosis of jejunum to body of stomach  Pylorus is removed since this portion of GI tract contain parietal cells that secret gastrin
31
How can we diagnose someone with chronic gastritis?
Upper endoscopy an order to obtain fecal occult blood monitor H and H--> CBC lab work
32
Nursing Interventions for chronic gastritis
revolved around: 1) relief of pain 2) maintenance and balance of fluid and nutrition 3) reduce anxiety and provide education a) If they have H pylori: combo of antibiotics b) reduce NSAIDs and Alcohol c) Smoking cessation d) stress management e) Avoiding trigger foods
33
What are the four areas that peptic ulcers can occur?
1) Duodenum 2) stomach gastric 3) pylorus- opening between the stomach and duodenum 4) esophagus
34
What are the two main causes of peptic ulcer disease?
1) H. pylori 2) excessive excretion of HCl by parietal cells Also dx with an upper endoscopy just like for chronic gastritis
35
Clinical manifestations of Peptic Ulcer Disease
• Dull, gnawing, burning pain in mid epigastric area o Pain may manifest posteriorly into the thoracic or lumbar region (back) • Other symptoms: o Pyrosis (heartburn) o Vomiting o Constipation or diarrhea o Bloody stool or emesis  S/sx of anemia if bleeding is considerable
36
What are the treatments for peptic Ulcer disease?
• 1) IV antibiotics – Amoxicillin, Metronidazole • 2) Bismuth salts  to suppress H. pylori Pepto-bismol • 3) PPI --> to reduce gastric acid
37
Small Bowel Obstruction
o Most common causes = adhesions, hernias, neoplasms o Often develop quickly o More sharp pains than large bowel obstructions
38
Large Bowel Obstruction
o Most common causes = carcinoma, diverticulosis, IBD, benign tumors o Usually develop over months
39
Sigmoid colostomy
solid: water has been absorbed through ascending and transverse
40
Descending colostomy
semisolid; less irritating
41
Transverse colostomy
middle or right side of abdomen; mushy; effluent more irritating because rich in gastric enzymes
42
ascending colostomy
right side of abdomen; semi liquid- rich in digestive enzymes; irritating to skin
43
What is the number one complaint of esophageal cancer and the clinical manifestations?
o #1 complaint = dysphagia *** o Sensation that something is in throat or food gets stuck going down o Weight loss o Weakness
44
Treatment for esophageal cancer
Radiation and chemotherapy | resection of the esophagus
45
Community
a cluster of people that share at least one common characteristic
46
community health
• The meeting of collective needs by identifying problems and managing interactions within the community itself and between the community and the larger society
47
community health assessment
logical, systematic approach to identify community needs, clarify problems and identify community strengths and resources
48
Subjective data for Safety and Transportation
 Do you see buses, taxis, bicycles?  Are there sidewalks, bike trails?  Is getting around the area possible for people with disabilities?  What are the roads like?  Do people feel safe? Does the county look safe?  Do you see protective service personnel around (i.e., police, fire, EMS)?
49
Objective data for Safety and transportation
```  Use of transportation  Average commute times  Types of crimes committed  Crime rates  Water source and treatment  Air quality monitoring ```
50
subjective data for education
```  Are there schools in the area?  How do they look?  What is the reputation of the schools?  Is there a school health service? How does that look?  What are the major education issues ```
51
Objective data for education
```  Graduation rates  Drop-out rates  Level of education  Number and types of schools including higher education  Extracurricular activities ```
52
Subjective data for physical environment
 How does the community look? Rural vs. urban  What does the landscape look like?  What do you note about air quality, flora, housing, zoning, space, green areas, animals, people, human made structures, natural beauty, water, climate?  Are the houses old? What condition are they in? What about sidewalks?
53
Objective data for physical environment
```  Map of the area  Size and location within the region  Waste disposal  Water supply  Type of housing  Average temperature  Average rain/snowfall  Pollution ```
54
Subjective data for politics and government
 Are there signs of political activity? Government agencies?  What party affiliation predominates?  Do you see evidence of people protesting?  What do the billboards tell you in terms of politics and gov’t?  Are there flags flying?
55
Objective data for politics and government
 Political parties (who predominates and how are they split?)  Top political issues  Governmental jurisdiction of the community (i.e., elected mayor, city council with single member districts)  Laws or policy that specifically relate back to the topic
56
Subjective data for Health and Social services
 What health care services are visible?  Are these services overused and/or busy?  What do the emergency departments look like?  Evidence of acute or chronic conditions?
57
Objective data for Health and Social Services
Stats regarding your project’s health-related topic…  Who is affected?  What are those stats?  Hospitals and other health care services
58
Communication
--> how community members receive and disperse information
59
Subjective data for communication
 Are there “common areas” where people gather?  What newspapers do you see in the stands?  Do you see billboards, posters around? What do they display in terms of your topic?
60
Objective data for communication
 Number and types of communication available |  How does the area communicate the types of resources available?
61
subjective data for economics | --> economic status of county concerned chiefly with production, consumption, and distribution of goods and services
 Is it a “thriving” or “seedy” community?  Who are the major employers?  Where do people shop?  Are there signs that food stamps are accepted/used?
62
objective data for economics
 Unemployment rates  Income data  # of households below the federal poverty level  Occupations
63
subjective data for recreation | --> what there is to do that is fun
 Where do children play?  What are the major forms of recreation? Are they costly? Are they well maintained?  What recreational facilities do you see?  Are there natural resources for recreation (trails, etc.)
64
Objective data for recreation
 Drug and alcohol use  Number and types of recreational facilities available  Funding  Organization of recreational activities
65
Central Line Potential Complications
• 1) *** Infection – entry for microorganisms with central line placement • 2) Pneumothorax • 3) Clotted or displaced catheter  must be diligent with flushing and care • 4) Hyperglycemia o Parenteral nutrition often has very high dextrose or sugar content o Must consistently monitor blood glucose levels • 5) Rebound hypoglycemia – once parenteral nutrition gets discontinued o When discontinued, must wean patient slowly off TPN and lipids
66
Bolus
type of enteral nutrition that resembles normal feeding patterns over short period of time by gravity or drip NEED 30 ML OR LARGER SYRINGE
67
Gravity bolus
infused through large syringe | - you can lower or raise the syringe to increase or decrease the rate
68
drip bolus
boluses delivered over 30 minutes | -enteral bag with roller clamp that aids in a MORE PRECISE drip
69
Ileoanal resevoir
functions as a new rectum and anal sphincter control of elimination is retained -large intestine is removed but the anus remains intact and disease- free requires two surgeries 1) temporary ileostomy (3-4 months) to give the pouch time to stretch and heal 2) connect ileum to anus and completely remove colon and rectal mucosa - stool eventually collects in the ileoanal reservoir and then exits the body though the anus during a bowel movement
70
What are the outcomes of the ileoanal resevoir
1) diseased colon and rectum are removed 2) voluntary defecation is maintained 3) anal continence is preserved
71
Main benefit of continent ileostomy (Kock pouch)
eliminates the need for external fecal collection bag because the patient can drain the k pouch by inserting a catheter into a valve (at the end of stoma)
72
Who would we recommend a continent ileostomy to?
for patients who are not good candidates for ileoanal resevoir surgery because of damage to the rectum or anus but DO NOT want to wear an OSTOMY POUCH
73
what is being removed with a continent ileostomy?
large intestine, rectum and, diseased anus
74
What is the #1 complaint of esophageal cancer
dysphagia - also sensation that something is in throat or food is going down - weight loss - weakness
75
What is the purpose of the blue port in the Salem Sump?
blue port vents the large suction tube to the atmosphere and when kept above the patient's waist it prevent backflow of gastric contents
76
What are the two reasons we give enteral feeds using a nasoduodenal or jejunal feeding?
1) if the stomach has to be bypassed | 2) if the patient has a high aspiration risk
77
Who has a greater risk between bolus or continuous feedings?
continuous feedings may lead to a higher risk of aspiration, abdominal distension and intolerance
78
How big of syringe do we use for a bolus feeding
30 ml or larger | can be given drip or gravity
79
delivery of open systems
push, gravity, pump
80
uses of open systems
bolus, intermittent, continuous drip feedings
81
delivery of closed systems
ALWAYS A PUMP
82
General Nursing Role in Disability
* Majority live at home independently or mostly independently * Preferences * Assistive devices should be readily available * Patient safety * Communication strategies * Teaching – must be tailored to individual * Promote independence
83
Pre-Trajectory Phase
genetic factors or lifestyle behaviors that place a person or community at risk for a chronic condition - person doesn't have the disease yet but is headed that way based on RISK FACTORS
84
what level of prevention is the pre-trajectory phase
secondary prevention because the patient has been screen for risk factors ex) someone who is pre-diabetic with elevated HBA1c
85
What is the nursing process during the pre-trajectory phase?
-->goals and interventions revolve around testing o 1- Testing – labs and diagnostic testing o 2- Counseling – applies to both patient and family o 3- Education
86
Trajectory phase
development of signs and symptoms of the chronic illness | includes the FORMAL DIAGNOSIS
87
What is the nursing process during the trajectory phase?
- ---> patient and family may begin to feel uncertainty for dx 1) explanation/educate 2) emotional support
88
Stable phase
signs and symptoms are under control and managed by medications • Illness management centered in the home • Any disabilities are adapted into the ADLs • Family may feel relieved if loved one is stabilized especially if during an acute attack o May play role in treatment regimen or not
89
What is the nursing process during the stable phase
o 1- Positive behaviors o 2- Health promotion & education o 3- Health promoting behaviors
90
Unstable phase
patient experiences setback when the chronic illness exacerbates -the disease "reactivates" • Period of inability to keep symptoms under control or reactivation of illness • Difficulty carrying out ADLs • Individual may require more diagnostic testing or change in treatment plan
91
Nursing Process during unstable phase
GUIDANCE AND SUPPORT** ---May need reiteration of previous teaching and details behind exacerbation o 2- Education – cause of exacerbation and how to prevent it from happening again
92
Acute Phase
severe and unrelieved sx or the development of illness complications requiring hospitalization or interruption of the person’s usual activities to bring illness course under control • Sudden, severe onset of symptoms • Family is fearful – may have long-term concerns o Risk for active caregiver role strain
93
Nursing Process of the acute phase
1) direct care | 2) support to patient and family
94
crisis phase
critical or life-threatening situation requiring emergency treatment or care • Complete suspension of ADLs until the crisis has passed • Family in crisis mode – may begin to grieve at thought of losing loved one o Family dynamic in state of suspension
95
Nursing process during the crisis phase
1) direct care 2) collaboration with healthcare team 3) stabilize physiological state of patient
96
comeback phase
gradual recovery after an acute or crisis phase • Learning to live with or overcome disabilities and return to acceptable way of life • May be new or worsened disabilities • Patient may need some sort of rehab • Family may be relieved or hopeful but caregiver role strain may still persist
97
nursing process during comeback phase
o 1- Coordination of care  Arranging of services necessary to help patient restore function and/or adapt to newly acquired disabilities into ADLs o 2- Adaptation
98
Downward phase
rapid or general worsening of illness, physical decline and increase in disability • Alteration in ADLs depend on each downward step • Patients can linger in this phase for a long time • If patient is to die within the next 6 months  hospice can step in to help provide comfort measures • Family likely to be grieving and reminiscing on past o Concern regarding keeping patient comfortable and will participate in family meeting to discuss options such as hospice • Uncertainty as to when death will arrive
99
nursing process during downward
o 1- Home care • Once hospice steps in, home-care steps out 2- New treatment plan 3- End of life planning
100
dying phase
death is imminent (weeks or days) • Gradual loss of functions, withdrawals from ADLs • If hospice is involved, likely that visits are more frequent • Family is probably in throws of grieving – keep them in mind and look for deterioration as this is stressful for many families  prime focus = comfort and dignity = hallmark of this phase!!
101
Nursing Process during the dying phase
1) direct care 2) comfort 3) support
102
Policy development
1) advocacy 2) social marketing 3) policy development and enforcement
103
Community collaboration
1) community organizing 2) coalition building 3) collaboration
104
health teaching
1) consultation 2) counseling 3) health teaching
105
case management
1) delegated functions 2) case management 3) referral and follow-up
106
screening and disease investigation
1) surveillance 2) disease and health event investigation 3) outreach 4) screening
107
florence nightingale
* pioneer in use of statistics and policy | * devoted life to prevention of needless illness and death
108
Who coined the term public health nursing?
Lilian Wald
109
• MASSACHUSETTS AND THE LEMUEL SHATTUCK REPORT
o Monumental 1850 report that established permanent boards of health in MA o Began collecting and recording vital statistics and promoted sanitary measures to prevent disease o Movement spread to other localities
110
Mary Breckenridge
o Established the Frontier Nursing Service in 1925 to provide nursing for underserved populations in remote mountains of Kentucky  A lot of work done using horses to get to underserved populations

NURS 363 (3 decks)

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