Exam 1 (3/1) Flashcards

Question

Cellulitis

Answer 1

S&S: localized swelling or redness, fever, chills, sweating Treat with oral or IV antibiotics based on severity Nursing interventions: Elevate affected area Warm, moist packs to site every 2 to 4 hours Educate regarding prevention of recurrence Reinforce education about skin and foot care look for points of entry

Answer 2

Tissue swelling due to increase lymph that results from obstruction of lymphatic vessels - Exercise - GCS - Manual lymphatic drainage - Diuretics - Surgery

Answer 3

``` Endothelial damage (trauma, surgery, central venous or dialysis catheters, pacing wires, local vein damage, repetitive motion injury) Venous stasis (bed rest/immobilization, obesity, spinal cord injury, age >65) Altered coagulation (cancer, pregnancy, oral contraceptives, sepsis, polycythemia, protein C or S deficiency, factor V leiden defect) ```

Answer 4

``` Swelling Throbbing pain Warm skin Red or darkened skin Swollen veins that are hard/sore when touched ```

Answer 5

``` Planning: Decrease Venous Congestion Medical/Nursing Management: Anti-gravity activities Graduated compression stockings Encourage walking Maintain tissue integrity ``` Diasgnosis: Ineffective Tissue Perfusion Duplex Ultrasonography Contrast Phlebography (Venography) Implementation Elevate extremities above the level of the heart Discourage standing or sitting for prolong periods Discourage constrictive clothing Avoid crossing legs evaluation: decreased edema

Answer 6

Elevate extremity, GCS, SCDs Warm, moist packs Anticoagulants: Monitor lab values Monitor for bleeding Know how to reverse anticoagulation effects Encourage walking AFTER anticoagulation therapy has been started Prophylactic medication- heparin, enoxaparin

Answer 7

``` Prevention: Identify high-risk patients—Endothelial damage (trauma, surgery, central venous or dialysis catheters, pacing wires, local vein damage, repetitive motion injury), venous stasis (bed rest/immobilization, obesity, spinal cord injury, age >65), altered coagulation (cancer, pregnancy, oral contraceptives, sepsis, polycythemia, protein C or S deficiency, factor V leiden defect. GCS Early ambulation Leg exercises Prophylactic medication Heparin, Enoxaparin ``` ``` Management: Elevate extremity, GCS, SCDs Warm, moist packs Anticoagulants Monitor lab values Monitor for bleeding Know how to reverse anticoagulation effects Encourage walking AFTER anticoagulation therapy has been started ```

Answer 8

Primary or essential (95%) secondary (5%) gestational

Answer 9

``` vague symptoms headaches shortness of breath nosebleeds flushing dizziness chest pain visual changes blood in the urine ``` ``` complications: Left ventricular hypertrophy Myocardial infarction Heart failure Transient ischemic attack (TIA) Cerebrovascular disease (CVA, stroke, or brain attack) Renal insufficiency and chronic kidney disease Retinal hemorrhage ```

Answer 10

1. try to change lifestyle, 2. if that does not work then add medication 3. if that doesnt work add or change med 4. add more meds older adults start taking meds if SBP 150mm HG or > or if DBP 90 mmHg or > interventions: Emphasize control, not cure. Emphasize medication compliance, for rest of life- Discuss consequences of noncompliance. Diet changes: Reduce salt & fat. Increase fruits & vegetables. Regular physical activity. Meds: Teach to identify, report, & minimize SE/AE: - Orthostasis, sexual dysfunction, dry mouth, frequent urination -Inform about rebound hypertension: Need adequate supply of meds available, esp. when traveling. Support groups: AHA, National Heart, Lung & Blood Institute Inform about need for regular follow-ups.

Answer 11

``` Symptoms: Neuro: ha, confusion, change in LOC blurred vision CV: tachycardia Resp: tachypnea & dyspnea ``` Assess: BP every 5-30 min. Hemodynamic monitoring I & O Have emergency equipment available. Slowly reduce BP: 20%-25% in first hr Over next 6 hr, reduce to goal 160/100 mm Hg Then further reduction Pharmacologic therapy: vasodilators (sodium nitroprusside, nicardipine, enalapril, NTG) HTN urgency: oral agents Position: bed rest, HOB 45 degrees Assess for hypotension r/t vasodilators Fluid replacement, if needed

Answer 12

Early R- restlessness A- anxiety T- tachycardia /tachypnea is late to B- bradycardia E- extreme restlessness D- dyspnea ``` (in prediatrics) F- feeding difficulty I- inspiratory stridor N- nares flare E- expiratory grunting S- sternal retractions ```

Answer 13

Pulmonary bronchial constriction possible foreign body pulmonary emboulus pump failure Pneumothorax: Do not have enough room for the lungs to expand. Pneumonia: Do not have enough capacity for air to get into lungs.

Answer 14

Normal breath sounds (vesicular, bronchovesicular, bronchial) Abnormal breath sounds: Crackles: Short, discrete, crackling or bubbling sounds Noted in pneumonia, bronchitis, CHF Wheezes: Continuous, musical sounds Heard in bronchitis, emphysema, asthma Rhonchi: Deep, low-pitched rumbling sounds heard primarily during expiration. Caused by air moving through narrowed tracheobronchial passages

Answer 15

``` Pulmonary Function Tests Cultures- throat, nasal, nasopharyngeal Sputum Studies Endoscopic Procedures Bronchoscopy: For invasive procedures we need consent, nothing by mouth, pre and post procedure considerations. Thoracoscopy Thoracentesis ``` ``` Imaging studies: Chest X-Ray Computed tomography (CT) Magnetic resonance imaging (MRI) VQ Scan Preparation, consent, NPO, Pre & Post-procedure considerations Pulmonary angiography- To diagnose a PE ```

Answer 16

Assessment: H&P ``` Nursing Diagnoses: Ineffective airway clearance Impaired verbal communication Imbalanced nutrition Risk for aspiration ``` Plan: Airway Alternative means of communication Nutrition and hydration ``` Interventions: Monitor respiratory status Position in semi-fowler or Fowler’s Perform laryngectomy/tracheostomy tube care Provide humidification Utilize writing, hand gestures Administer IV fluids, enteral (NG or GT), and/or parenteral nutrition Obtain swallow study before PO ```

Answer 17

``` I = incentive spirometry C = cough and deep breathing O = oral care U = understanding G = getting out of bed H = head of bed elevated ```

Answer 18

Inhalation of foreign material into the lungs Risk Factors- seizure activity, brain injury, decreased LOC, flat body positioning, enteral tube feedings, swallowing disorders (dysphagia) prevention: HOB 30-45 degrees Use sedatives sparingly Enteral tubes - confirm tip location, check for residuals, avoid bolus feedings Swallow evaluation before initiating PO feedings in patients intubated >2 days Maintain endotracheal cuff pressure and suction before deflating Tests: Bedside Swallow Screen

Answer 19

inflammation of lung parenchyma from bacteria, fungi and viruses: Community acquired (vaccine only good for this) Health care associated Hospital acquired (resistant to some antibiotics) Ventilator associated

Answer 20

``` PREVENTION IS KEY Elderly, Chronic health or coexisting condition Not vaccinated, Immunocompromised, Immobility, CVA, decreased LOC Tobacco, alcohol use, Upper airway infections NPO status, placement of NG/OG, endotracheal, or tracheostomy tube, Mechanical ventilation CAUSED A LOT BY ASPIRATION ```

Answer 21

antibiotics (bacterial pneumonia) supportive (viral pneumonia): rest, hydration, antipyretics, antitussive, antihistamines, decongestants Airway – oxygen, chest physiotherapy, TCDB (turn, cough, deep breath) Fluid – at least 2L/day Nutrition – small, frequent meals

Answer 22

Flushed cheeks, anxiety Myalgia, headache, chills Pleuritic pain Accessory muscle use- Chest muscle weakness (from coughing) Cough, sputum (purulent, blood-tinged or rust-colored)

Answer 23

CXR: Most common dx test (may not show changes until 2 or more days after sx are present) Sputum: gram stain & culture: obtain sputum culture prior to antibiotic therapy Blood culture: bacteremia occurs frequently CBC: WBC > 11,000 w/bacterial Oximetry; ABGs Fiberoptic bronchoscopy: Obtain sputum specimen or remove secretions, use this when pneumonia is bad

Answer 24

``` cough fever chills tachycardia tachypnea dyspnea pleural pain malaise respiratory distress decresed blood sounds ```

Answer 25

obstruction of broncioles decreased gas exchange increased exudate

Answer 26

Constant frequent contact with people Congregate settings (ex. Jails, shelters) Medically underserved Poor nutrition Immune dysfunction or sick with other diseases HIV+ Immigrants Age: Babies or children under 15 or elderly People living in or traveling to Mexico, Philippines, Latin American, Cuba, or Southeast Asia, plus more Being infected with TB bacteria within the last 2 years Illegal drug use

Answer 27

``` Low-grade fever (late-afternoon) Cough: nonproductive to sputum filled Night sweats Fatigue Weight loss Pleuritic chest pain Hemoptysis (advanced state)- coughing up blood ```

Answer 28

TB Skin Test (Mantoux test): Intradermal Prified protein Derivative (PPD) only shows if person was ever exposed, not that they are necessarily infected. If skin test is + then one must get a chest xray. measures delayed cell-mediated (Type IV) hypersensitivity reaction (develops within 3-10 weeks after infection) Once a person becomes positive, they usually remain so for life. If pt received the BCG vaccine, TB skin test is not contraindicated, but may need further evaluation (CXR) to diagnose TB POSITIVE SKIN TEST RESULT: Measure diameter of the induration (not erythema- bump/hard center). >10 mm induration > 5 mm if high-risk (HIV) Exposed but not infected Infected but no active disease Active TB disease NEGATIVE SKIN TEST RESULT 0-10 mm induration “Never exposed” Calcified Lesions on CXR: Chest X-ray to look for any lesions on the lungs (usually in upper lobes) QuantiFERON- TB Gold: Whole-blood test If TB +: Enzyme-linked immunosorbent assay (ELISA) detects release of interferon-gamma by WBCs Results available in 24 hours Results not affected by prior BCG vaccination THIS IS EXPENSIVE, USE ONLY IS REALLY NEEDED Sputum Studies •Sputum smear- Acid-fast Bacilli (AFB) •Sputum culture- TB Biopsy findings: lesions on upper lobes

Answer 29

assessment: complete history: Past and present medical history is assessed as well as both of the parents’ histories. physical examination: A TB patient loses weight dramatically and may show the loss in physical appearance. tuberculin skin test chest x-ray Drug susceptibility testing If symptoms are present then further assessment will be done on respiratory function: breathing sounds, fremitus (vibrations), and egophony (increased resonance to voice sounds when auscultating) Interventions: Promote airway clearance: postural drainage: sit up right and increase fluid intake Promote adherence to treatment regimen: must stick to exact regimen in order to be most effective and prevent transmission Promoting activity and adequate nutrition Prevent transmission of TB infection: instruct the patient about important hygiene measures, including mouth care, covering the mouth and nose when coughing and sneezing, proper disposal of tissues, and hand hygiene. Also educate that it can spread to nonpulmonary sites on the infected as well as be transmitted to others. Diagnosis: Risk for infection related to inadequate primary defenses and lowered resistance. Ineffective airway clearance related to thick, viscous, or bloody secretions. Risk for impaired gas exchange related to decrease in effective lung surface. Activity intolerance related to imbalance between oxygen supply and demand. Imbalanced nutrition: less than body requirements related to inability to ingest adequate nutrients.

Answer 30

People with disease: treated with 4 medications for 2 months and then 2 medications for 4-7 months Other people exposed or recent positive skin test: use a med just a few months Treated with Anti-TB agent for 6-12 months (total time) - Isoniazid (INH) - dose, SE (peripheral neuritis, hepatic enzyme elevation, hepatitis), interactions (pg. 603), teaching, use for 6-9 months unless for prevention Effects Liver - Rifampin- SE (hepatitis, orange-red coloration of body secretions) Effects Liver - Rifabutin - Rifapentine - Pyrazinamide (PZA)- hyperuricemia (monitor uric acid) Effects Liver - Ethambutol - Combination drugs

Answer 31

``` Dyspnea Chest pain Tachycardia Hemoptysis Tachypnea hypoxia ```

Answer 32

assessment: Death commonly comes 1 hr after symptoms start so early detection is key clinical assessment: focus on the clinical probability of risk, clinical history, symptoms, signs, and testing Health history: Family history: Medication record: Physical exam: Extremities are evaluated for warmth, redness, and inflammation. Diagnostic Findings: can show abnormal lung function CXR: ECG: ABG: V/Q scan: most important, evaluates the different regions of the lung and allows comparisons of the percentage of ventilation and perfusion in each area. Diagnosis: Ineffective peripheral tissue perfusion related to obstructed pulmonary artery. Risk for shock related to increased workload of the right ventricle. Acute pain related to pleuritic origin. ``` Goals: Increase perfusion Verbalize understanding of condition, therapy regimen, and medication side effects. Display hemodynamic stability. Report pain is relieved or controlled. Follow prescribed pharmacologic regimen. ``` Interventions: Prevent venous stasis: Encourage ambulation and active and passive leg exercises to prevent venous stasis. Monitor thrombolytic therapy:Monitoring thrombolytic and anticoagulant therapy through INR or PTT. Manage pain: Turn patient frequently and reposition to improve ventilation-perfusion ratio. Manage oxygen therapy: Assess for signs of hypoxemia and monitor the pulse oximetry values. Relieve anxiety: Encourage the patient to talk about any fears or concerns related to this frightening episode. evaluate: Increased perfusion. Verbalized understanding of condition, therapy regimen, and medication side effects. Displayed hemodynamic stability. Reported pain is relieved or controlled. Followed prescribed pharmacologic regimen.

Answer 33

Anticoagulation therapy: Heparin, and warfarin sodium has been traditionally been the primary method for managing acute DVT and PE. Thrombolytic therapy: Urokinase, streptokinase, alteplase are used in treating PE, particularly in patients who are severely compromised. Surgical embolectomy: the removal of the actual clot and must be performed by a cardiovascular surgical team with the patient on cardiopulmonary bypass. Transvenous catheter embolectomy: a technique in which a vacuum-cupped catheter is introduced transvenously into the affected pulmonary artery. Interrupting the vena cava: prevents dislodged thrombi from being swept into the lungs while allowing adequate blood flow.

Answer 34

``` Smoking Environmental exposure: aire pollution, second hand smoke, chemicals, allergens Recurrent URI Age Genetic predisposition Air-way hyper-responsiveness No gender predisposition ```

Answer 35

``` Dyspnea, persistent and progressive Chronic cough Sputum productions Increase A to P diameter (AKA:Barrel Chest) Intercostal retractions Wheezing, rhonchi Body position; tripod Weight loss Fatigue Use of accessory muscles to breath Clubbing Pursed-lip breathing ```

Answer 36

Assessment: Health history: obtain a thorough health history from patients with known or potential COPD. Assess patient’s exposure to risk factors. Assess the patient’s past and present medical history. Assess the signs and symptoms of COPD and their severity. Assess the patient’s knowledge of the disease. Assess the patient’s vital signs. Assess breath sounds and pattern. ``` Diagnosis: Blood Tests -ABG -CBC- will affect how it correlates with PaO2 Sputum studies Chest x-ray (CXR) Pulse Oximetry- fingers, toes, ear lobe, or forehead Pulmonary function test/Spirometry Bronchoscopy ``` Planning/goals Improvement in gas exchange. Achievement of airway clearance. Improvement in breathing pattern. Independence in self-care activities. Improvement in activity intolerance. Ventilation/oxygenation adequate to meet self-care needs. Nutritional intake meeting caloric needs. Infection treated/prevented. Disease process/prognosis and therapeutic regimen understood. Plan in place to meet needs after discharge. Interventions: High Fowler’s position and Tripod position Monitor vital signs, pulse ox, and sputum Encourage diaphragmatic & pursed lip breathing Encourage “Huff” coughing Respiratory treatments Bronchodilators LOW concentration of O2 (1-2 L/min) as ordered Chest physiotherapy Suction if necessary Monitor weight Promote nutrition Small, frequent meals (High cal., high protein) Activity as tolerated Medications as prescribed Prevent infection: flu & pneumonia vaccines Smoking cessation Self-care strategies Evaluation Identifies the hazards of cigarette smoking Identifies resources for smoking cessation Enrolls in smoking cessation program Minimizes or eliminates exposures Verbalizes the need for fluids Is free of infection Practices breathing techniques Performs activities with less shortness of breath

Answer 37

Smoking cessation Education/Self-Management Pharmacologic Therapy: alpha1-antitrypsin augmentation therapy, antibiotic agents, mucolytic agents, antitussive agents, vasodilators, and narcotics Bronchodilators: relieve bronchospasm by altering the smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation Corticosteroids: A short trial course of oral corticosteroids may be prescribed for patients to determine whether pulmonary function improves and symptoms decrease Pulmonary rehab Oxygen surgery

Answer 38

``` Cough Wheezing (initially on expiration, severe=inspiration too Dyspnea Chest tightness Tachypnea Tachycardia Use of accessory muscles Restlessness Decreased O2 sat Cyanosis Hyperresonance Diaphoresis (if severe) Widened pulse pressure (if severe) ```

Answer 39

``` Assessment: fam history hisotry Assess respiratory status: Assess the patient’s respiratory status by monitoring the severity of symptoms, breath sounds, peak ﬂow, pulse oximetry, and vital signs. assess medications ``` ``` Diagnostic Tests: Spirometry: Forced vital capacity (FVC) Forced expiratory volume in 1 second (FEV 1) FEV1/FVC ratio (FEV1/FVC): % <70% Blood tests: IgE immunoglobulin: because asthma is an allergic reaction Arterial Blood Gas (ABG) Chest x-ray (CXR) Pulse oximetry: Peak Flow: measure the highest airflow during a forced expiration, helps measure asthma severity and, when added to symptom monitoring, indicates the current degree of asthma control Measure same time everyday Repeat 3 times Record highest reading Zones for assessment ``` Diagnosis: Nursing Diagnoses: Ineffective airway clearance related to increased production of mucus and bronchospasm. Impaired gas exchange related to altered delivery of inspired O2. Anxiety related to perceived threat of death. Interventions: Pharmacologic therapy: Administer medications as prescribed and monitor patient’s responses to medications. Fluid therapy: Administer fluids if the patient is dehydrated. Planning/Goals: Maintenance of airway patency. Expectoration of secretions. Demonstration of absence/reduction of congestion with breath sounds clear, respirations noiseless, improved oxygen exchange. Verbalization of understanding of causes and therapeutic management regimen. Demonstration of behaviors to improve or maintain clear airway. Identification of potential complications and how to initiate appropriate preventive or corrective actions. Evaluation: Maintenance of airway patency. Expectoration or clearance of secretions. Absence /reduction of congestion with breath sound clear, noiseless respirations, and improved oxygen exchange. Verbalized understanding of causes and therapeutic management regimen. Demonstrated behaviors to improve or maintain clear airway. Identified potential complications and how to initiate appropriate preventive or corrective actions.

Answer 40

``` High Fowler’s position Vital signs & Pulse ox Peak flow O2 as ordered Patient education: ID triggers and measures to prevent exposure Lifelong management Medication administration Use of peak flow meter Asthma Action Plan: Help pt to develop their asthma action plan so they can prevent attacks and have a better quality of life ``` ``` A- adrenergics S- steroids T- theophylline H- Hydration (IV) M- mask O2 A- anticholingergics ```

Answer 41

``` hypersensitivty URI exercise air pollutants GERD ```

Answer 42

-Pain: duration, pattern, frequency, location, referred -Previous GI disorders, abdominal surgeries -GI symptoms: Change in appetite, weight (gain or loss) -Medications -Social history -Travel history -Nutritional history Special diet needs Food alleergies, intolerances Change in eating habits socioeconomic status Culture/ethnicity

Answer 43

-Inspection: Mouth, tongue, buccal mucosa, teeth and gums, abdominal skin -Auscultation: Always precedes percussion and palpation -Percussion: Percussion of entire abdomen -Palpation: Assess area of tenderness last. Murphy's sign and rebound tenderness -Rectal examination Last part, most uncomfortable

Answer 44

``` -Serum labs: CBC and metabolic profile Liver enzymes (AST & ALT) and cholesterol and triglycerides, PT/PTT Bilirubin; amylase and lipase Ammonia -Stool tests: FOBT, steatorrhea, ova parasites, C. Diff -Abdominal ultrasonography -Imaging Studies: Upper and lower GI tract studies CT, MRI, PET, motility studies ```

Answer 45

Purpose: - Identify structural abnormalities of rectum, colon - Barium enema enhances radiographic visualization Before Test: - Clear liquid diet 24 hours - NPO 8 hours - Bowel cleansing with laxatives, enemas, suppositories evening before After the test: - Increase fluids to wash out enema. - Stool may be chalky white for 24 to 72 hours when it comes out.

Answer 46

``` Before test: -Low-residual diet for 48 hrs. -No food for 8 hrs. No fluids for 4 hrs. -Withhold analgesics & anticholinergics for 24 hr. -Patient drinks 16 oz. of barium During: -Films taken every 20min. until medium reaches terminal ileum -Rotate examination table After test: -Increase fluids -Mild laxative or stool softener -Stools may be chalky white for 24 to 72 hr. ```

Answer 47

Purpose: visualize esophagus, stomach, & duodenum Before test: -Avoid anticoagulants, ASA, NSAIDs for several days -NPO 8 hr. Position left lateral. -Conscious sedation: spray anesthetic, midazolam IV, atropine, glucagon After test: -Assess VS, O2 sat, LOC, & pain every 30 min. -NPO until gag reflex returns. -Throat discomfort possible for several days. -Must be transported home by another person. Complications: perforation (pain, bleeding), dysphagia, rapidly elevated temperature

Answer 48

Purpose: Visualize entire colon to ileocecal valve. Identify tumors, polyps, inflammatory bowel disease -Before test: Bowel prep varies by physician/clinic Liquid diet for 12-24 hr before; NPO for 6 to 8 hr -During test: Same as for EGD -After test: Same as for EGD If polypectomy or tissue biopsy, visible blood in stool is possible Teach: flatus Complications: perforation Report: abd. pain, chills, fever, rectal bleeding, mucopurulent discharge

Answer 49

Patho: upper stomach and gastroesophageal junction pushes through diaphragm and moves into thorax. Causes: Increased abdominal cavity pressure (coughing, straining, lifting, pregnancy, obesity) Manifestations: -50% asymptomatic -Heartburn, pyrosis, regurgitation, dysphagia Complications: -hemorrhage, obstruction, strangulation ``` Assessment: -Differentiate chest pain (angina) from CP caused by reflux -Auscultate lungs (asthma) Diagnosis: -Barium swallow with fluaroscopy -EGD -Esophageal manometry -pH test -Gastric emptying study ``` Management: -Frequent, small meals Avoid eating late in evening -Avoid acidic and fatty foods. Avoid caffeine, alcohol, ketchup and mustard, vinegar -Elevate head after eating. Do not recline for at least 1 hr pc -Elevate HOB -Lose weight -Quit smoking -Avoid wearing a tight belt, clothing. Avoid straining -Take meds that reduce acid in stomach

Answer 50

Contents flow back into esophagus Causes: - Incompetent Les or relaxation of LES - Increased gastric volume (after meals) - Positioning (bending over, lying down) - Increased gastric pressure (pregnancy, obesity) - Hiatal hernia Risk Factor: Obesity ``` Medications: -PPI (omeprazole) most effective! take 30 minutes before eating twice daily dosing -gaviscon (antacid) -carafate -H2 receptor antagonists (cimetidine) -baclofen ``` endoluminal therapies -Transoral incisionless fundoplication (TIF) Surgery: fundoplication ``` Manifestations: -Dyspepsia: “heartburn” (usually after meals, when bending over or reclining) Regurgitation of sour substance into mouth -Hypersalivation (water brash) -Eructation (belching) -Flatulence (gas) -Bloating -Odynophagia (painful swallowing) -Pain after eating -Dysphagia -N & V ``` other manifestations: - Chest pain - Wheezing - Coughing - Dyspnea

Answer 51

- Lose weight - Diet: small, more frequent. Avoid carbonated drinks, alcohol, caffiene, tobacco, high-fiber and low fat diet recommended. - After you eat don't lay down - Avoid tight clothing - Regular sleeping patterns, don't stay up late - Avoid eating right before bed

Answer 52

Fundus is wrapped around distal esophagus: Nissen fundoplication for GERD or hiatal hernia repair. Post-op management: - Respiratory care - NG managment - Nutrional care Post-op Teaching: -Activity restrictions: no driving for 1 week, do not drive if taking opioids, walk every day, no heavy lifting. - Complications: - Temp greater than 101. 100 for elderly - N/V, uncontrollable bloating, pain - Temporary dysphagia - gas bloat syndrome - atelectasis, pneumonia - Obstructed NG tube

Answer 53

- Acidic stomach contents damage esophagus - Leads to Esophagitis and ulcers develop. Healing occurs, but may substitute Barrett's epithelium for normal squamous cell epithelium - Barrett's esophagus (Premalignant)-> esophageal scarring and strictures -> esophageal cancer -> hemorrhage, aspiration penumonia, asthma laryngitis, dental decay, cardiac disease - Asthma

Answer 54

Lining of the esophageal mucosa is altered - Manifestations and Assessment: - Complains of s/s of GERD - Frequent heartburn Management - EGD performed - Monitoring

Answer 55

- Inflammation of gastric mucosa - Impaired mucosal barrier allows HCl to come into contact with gastric mucosa - Epigastric pain, anorexia, hiccups, n/v

Answer 56

Risk Factors: - 40-60 years old - H. pylori infection - familial tendancy (type O blood) - chronic use of NSAIDs, alcohol, smoking Manifestations: - May be asymptomatic - dull, gnawing pain, burning in midepigastrium or back - Pain often relieved by eating - heartburn, V/C/D, bleeding Treatment: - combination of antibiotics to eradicate H. pylori - H2 receptor antagonists - PPIs - Surgery ``` Assessment: -Pain -72 hour diet recall -VS -Meds? NSAIDS? Gi: melena, occult? Lifestyle? Habits? ``` Nursing Dx: -Acute pain -Anxiety Imbalance Nutrition Interventions: - Relieve pain - Lifestyle management: reduce anxiety, adeq. rest, smoking cessation - Maintain optimal nutrition - Manage complications - Home Care Evaluation

Answer 57

Hemorrhage | Perforation