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NURS 363 > EXAM 1 > Flashcards

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
Q

Goals for Irritable Bowel Disease

A 
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
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26
Q

Complications and Treatments for Irritable Bowel Disease

A

• 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

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27
Q

Clinical Manifestations of irritable bowel syndrome

A

o Primarily constipation or diarrhea or both
o Abdominal pain
o Bloating
o Abdominal distention

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28
Q

Interventions for irritable bowel syndrome

A

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

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29
Q

What are the causes of Irritable Bowel Syndrome

A 
o	Psychological stress
o	Hormones
o	Genetics
o	Depression/anxiety
o	Trigger/fatty foods
o	Alcohol, smoking
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30
Q

surgical interventions for peptic ulcer disease

A

• 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

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31
Q

How can we diagnose someone with chronic gastritis?

A

Upper endoscopy
an order to obtain fecal occult blood
monitor H and H–> CBC lab work

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32
Q

Nursing Interventions for chronic gastritis

A

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

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33
Q

What are the four areas that peptic ulcers can occur?

A

1) Duodenum
2) stomach gastric
3) pylorus- opening between the stomach and duodenum
4) esophagus

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34
Q

What are the two main causes of peptic ulcer disease?

A

1) H. pylori
2) excessive excretion of HCl by parietal cells
Also dx with an upper endoscopy just like for chronic gastritis

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35
Q

Clinical manifestations of Peptic Ulcer Disease

A

• 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

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36
Q

What are the treatments for peptic Ulcer disease?

A

• 1) IV antibiotics – Amoxicillin, Metronidazole
• 2) Bismuth salts  to suppress H. pylori
Pepto-bismol
• 3) PPI –> to reduce gastric acid

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37
Q

Small Bowel Obstruction

A

o Most common causes = adhesions, hernias, neoplasms
o Often develop quickly
o More sharp pains than large bowel obstructions

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38
Q

Large Bowel Obstruction

A

o Most common causes = carcinoma, diverticulosis, IBD, benign tumors
o Usually develop over months

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39
Q

Sigmoid colostomy

A

solid: water has been absorbed through ascending and transverse

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40
Q

Descending colostomy

A

semisolid; less irritating

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41
Q

Transverse colostomy

A

middle or right side of abdomen; mushy; effluent more irritating because rich in gastric enzymes

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42
Q

ascending colostomy

A

right side of abdomen; semi liquid- rich in digestive enzymes; irritating to skin

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43
Q

What is the number one complaint of esophageal cancer and the clinical manifestations?

A

o #1 complaint = dysphagia ***
o Sensation that something is in throat or food gets stuck going down
o Weight loss
o Weakness

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44
Q

Treatment for esophageal cancer

A

Radiation and chemotherapy

resection of the esophagus

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45
Q

Community

A

a cluster of people that share at least one common characteristic

46
Q

community health

A

• The meeting of collective needs by identifying problems and managing interactions within the community itself and between the community and the larger society

47
Q

community health assessment

A

logical, systematic approach to identify community needs, clarify problems and identify community strengths and resources

48
Q

Subjective data for Safety and Transportation

A

 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
Q

Objective data for Safety and transportation

A 
	Use of transportation
	Average commute times
	Types of crimes committed
	Crime rates
	Water source and treatment
	Air quality monitoring
50
Q

subjective data for education

A 
	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
Q

Objective data for education

A 
	Graduation rates
	Drop-out rates
	Level of education
	Number and types of schools including higher education
	Extracurricular activities
52
Q

Subjective data for physical environment

A

 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
Q

Objective data for physical environment

A 
	Map of the area
	Size and location within the region
	Waste disposal
	Water supply
	Type of housing
	Average temperature
	Average rain/snowfall
	Pollution
54
Q

Subjective data for politics and government

A

 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
Q

Objective data for politics and government

A

 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
Q

Subjective data for Health and Social services

A

 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
Q

Objective data for Health and Social Services

A

Stats regarding your project’s health-related topic…
 Who is affected?
 What are those stats?
 Hospitals and other health care services

58
Q

Communication

A

–> how community members receive and disperse information

59
Q

Subjective data for communication

A

 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
Q

Objective data for communication

A

 Number and types of communication available

 How does the area communicate the types of resources available?

61
Q

subjective data for economics

–> economic status of county concerned chiefly with production, consumption, and distribution of goods and services

A

 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
Q

objective data for economics

A

 Unemployment rates
 Income data
 # of households below the federal poverty level
 Occupations

63
Q

subjective data for recreation

–> what there is to do that is fun

A

 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
Q

Objective data for recreation

A

 Drug and alcohol use
 Number and types of recreational facilities available
 Funding
 Organization of recreational activities

65
Q

Central Line Potential Complications

A

• 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
Q

Bolus

A

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
Q

Gravity bolus

A

infused through large syringe

- you can lower or raise the syringe to increase or decrease the rate

68
Q

drip bolus

A

boluses delivered over 30 minutes

-enteral bag with roller clamp that aids in a MORE PRECISE drip

69
Q

Ileoanal resevoir

A

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
Q

What are the outcomes of the ileoanal resevoir

A

1) diseased colon and rectum are removed
2) voluntary defecation is maintained
3) anal continence is preserved

71
Q

Main benefit of continent ileostomy (Kock pouch)

A

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
Q

Who would we recommend a continent ileostomy to?

A

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
Q

what is being removed with a continent ileostomy?

A

large intestine, rectum and, diseased anus

74
Q

What is the #1 complaint of esophageal cancer

A

dysphagia

  • also sensation that something is in throat or food is going down
  • weight loss
  • weakness
75
Q

What is the purpose of the blue port in the Salem Sump?

A

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
Q

What are the two reasons we give enteral feeds using a nasoduodenal or jejunal feeding?

A

1) if the stomach has to be bypassed

2) if the patient has a high aspiration risk

77
Q

Who has a greater risk between bolus or continuous feedings?

A

continuous feedings may lead to a higher risk of aspiration, abdominal distension and intolerance

78
Q

How big of syringe do we use for a bolus feeding

A

30 ml or larger

can be given drip or gravity

79
Q

delivery of open systems

A

push, gravity, pump

80
Q

uses of open systems

A

bolus, intermittent, continuous drip feedings

81
Q

delivery of closed systems

A

ALWAYS A PUMP

82
Q

General Nursing Role in Disability

A
  • 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
Q

Pre-Trajectory Phase

A

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
Q

what level of prevention is the pre-trajectory phase

A

secondary prevention because the patient has been screen for risk factors
ex) someone who is pre-diabetic with elevated HBA1c

85
Q

What is the nursing process during the pre-trajectory phase?

A

–>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
Q

Trajectory phase

A

development of signs and symptoms of the chronic illness

includes the FORMAL DIAGNOSIS

87
Q

What is the nursing process during the trajectory phase?

A
  • —> patient and family may begin to feel uncertainty for dx
    1) explanation/educate
    2) emotional support
88
Q

Stable phase

A

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
Q

What is the nursing process during the stable phase

A

o 1- Positive behaviors
o 2- Health promotion & education
o 3- Health promoting behaviors

90
Q

Unstable phase

A

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
Q

Nursing Process during unstable phase

A

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
Q

Acute Phase

A

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
Q

Nursing Process of the acute phase

A

1) direct care

2) support to patient and family

94
Q

crisis phase

A

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
Q

Nursing process during the crisis phase

A

1) direct care
2) collaboration with healthcare team
3) stabilize physiological state of patient

96
Q

comeback phase

A

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
Q

nursing process during comeback phase

A

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
Q

Downward phase

A

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
Q

nursing process during downward

A

o 1- Home care
• Once hospice steps in, home-care steps out
2- New treatment plan
3- End of life planning

100
Q

dying phase

A

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
Q

Nursing Process during the dying phase

A

1) direct care
2) comfort
3) support

102
Q

Policy development

A

1) advocacy
2) social marketing
3) policy development and enforcement

103
Q

Community collaboration

A

1) community organizing
2) coalition building
3) collaboration

104
Q

health teaching

A

1) consultation
2) counseling
3) health teaching

105
Q

case management

A

1) delegated functions
2) case management
3) referral and follow-up

106
Q

screening and disease investigation

A

1) surveillance
2) disease and health event investigation
3) outreach
4) screening

107
Q

florence nightingale

A
  • pioneer in use of statistics and policy

* devoted life to prevention of needless illness and death

108
Q

Who coined the term public health nursing?

A

Lilian Wald

109
Q

• MASSACHUSETTS AND THE LEMUEL SHATTUCK REPORT

A

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
Q

Mary Breckenridge

A

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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