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Practice of Nursing IV > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

What is a community defined as?

A

A group of people with at least one characteristic in common

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2
Q

What is the principle challenge for a nurse performing a community health assessment?

A

Gaining entrance and acceptance into the community

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3
Q

What are the five components of the community “core”?

A

History, demographics, ethnicity, values and beliefs

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4
Q

What should be assessed first in a community health assessment, the core or the subsystems?

A

The core

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5
Q

Define “disability”

A

An inability to perform ADLs, or the need of an assistive device or person in order to perform an ADL.

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6
Q

What percent of people are disabled?

A

12.1%

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7
Q

A developmental disability is found between what ages?

A

0-22

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8
Q

What is an example of a developmental disability?

A

Spina bifida

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9
Q

At what age may an acquired disability occur?

A

Can occur at any age

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10
Q

What is an example of an acquired disability?

A

A traumatic brain injury

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11
Q

What is an age-associated disability?

A

A disability that occurs as part of the aging process

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12
Q

What is an example of an age-associated disability?

A

Hearing loss

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13
Q

What are three characteristics of a chronic illness?

A

Irreversible, has no cure, and requires care for at least 3 months

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14
Q

What are the three broad possible causes of chronic illness?

A

Genetics, injuries, or behavior

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15
Q

What are the nine phases of the Trajectory Model of Illness, in order?

A

Pretrajectory, trajectory, stable, unstable, acute, crisis, comeback, downward, dying.

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16
Q

What occurs with the pt in the pretrajectory phase?

A

The pt does not yet have an illness or diagnosis, but they have many risk factors (an example would be a pre-diabetic)

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17
Q

What will the pt’s family experience during the pretrajectory phase?

A

They may be frustrated or concerned for their loved one

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18
Q

What are the nursing interventions for the pretrajectory phase?

A

Testing, counseling and education

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19
Q

In what phase is the illness diagnosed?

A

Trajectory phase

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20
Q

What emotion will the family experience in the trajectory phase?

A

Anger

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21
Q

What are the two interventions for the trajectory phase?

A

Education and emotional support

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22
Q

What characterizes the stable phase?

A

The signs and symptoms of the illness are under control

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23
Q

What emotion does the family experience during the stable phase?

A

Relief

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24
Q

What are the two interventions for the stable phase?

A

Positive behaviors and health promotion education

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25
Q

What emotion will the family experience during the unstable phase?

A

Uncertainty

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26
Q

What are the interventions for the unstable phase?

A

Guidance, support, and education

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27
Q

What occurs during the unstable phase?

A

The illness exacerbates, and the pt experiences a setback

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28
Q

What is the difference between the unstable and the acute phase?

A

They are similar, but acute phase is worse. Acute phase also usually requires hospitalization and unstable phase can be managed at home.

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29
Q

What emotion does the family experience during the acute phase?

A

Fear

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30
Q

What are the interventions during the acute phase?

A

Direct care and support

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31
Q

What occurs during the crisis phase?

A

There is a critical, lifethreatening event, and ADLs are suspended

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32
Q

What are the interventions during the crisis phase?

A

Provide direct care, collaboration with healthcare team, and stabilize

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33
Q

What occurs during the comeback phase?

A

There is a gradual recovery from crisis with new or worsened disability

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34
Q

What emotions will the family experience during the comeback phase?

A

Relief and hopefulness

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35
Q

What are the interventions during the comeback phase?

A

Coordination of care and adaptation.

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36
Q

What occurs during the downward phase?

A

There is a rapid decline in functioning

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37
Q

What will the family feel during the downward phase?

A

They will be grieving

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38
Q

What are interventions for the downward phase?

A

Home care, a new treatment plan, and end of life planning

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39
Q

During the dying phase, death is imminent. What time frame does this mean?

A

Days to weeks away

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40
Q

What will the family feel during the dying phase?

A

Grieving

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41
Q

What are the interventions during the dying phase?

A

Direct care, comfort, and support

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42
Q

What is GI intubation defined as?

A

Insertion of a tube into the stomach or intestine through the mouth, nose, or abdominal wall

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43
Q

What three materials can GI tubes be made of?

A

Rubber, polyurethane, or silicone

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44
Q

What is decompression during GI intubation used for?

A

To remove gas and fluid build-up

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45
Q

What does aspiration during GI intubation refer to?

A

Removal of substances via suctioning (could be to obtain a sample)

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46
Q

What does lavage during GI intubation refer to?

A

Washing/cleansing the stomach to remove toxins

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47
Q

What is another name for lavage?

A

Stomach-pumping

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48
Q

What size must feeding tubes be?

A

12 French or smaller

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49
Q

What is the relationship between the size of tube and the speed of the feeding?

A

A larger tube=quicker feeding

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50
Q

Orogastric tubes are commonly used in what two specialties for what purpose?

A

In the ICU and ER in order to quickly decompress the stomach

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51
Q

Is a Levin tube a type of nasogastric or orogastric tube?

A

Nasogastric tube

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52
Q

How many lumens does a Levin tube have and what is its main purpose?

A

Single lumen; main purpose is decompression

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53
Q

What type of tube is a Gastric/Salem sump?

A

A nasogastric tube

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54
Q

What is a gastric/salem sump used for?

A

Decompression or feeding

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55
Q

What type of tube is a Dobhoff tube?

A

Nasogastric tube

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56
Q

Where do enteric tubes sit?

A

In the intestine

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57
Q

What are the two main types of enteric tubes?

A

Nasoduodenal and nasojejunal

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58
Q

For how long should enteric tubes be used?

A

Not for longer than 4-6 weeks

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59
Q

Since enteric tubes can only be used for 4-6 weeks, what are better options for longer-term feeding?

A

Gastrostomy and jejunostomy

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60
Q

What is a gastrostomy?

A

When the stomach wall is brought to the surface and a permanent stoma is created

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61
Q

What is a jejunostomy?

A

When part of the jejunum is brought to the surface and a stoma is created

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62
Q

What is parenteral nutrition?

A

When nutrients are given IV

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63
Q

When is parenteral nutrition indicated?

A

When a pt has a non-functioning GI tract

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64
Q

What is a major consideration when selecting peripheral or central lines for parenteral feedings?

A

Peripheral are for shorter term use (5-7 days), while central lines are for longer-term use

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65
Q

What is one downside of using a central line for parenteral feedings?

A

Higher risk of infection than with a peripheral line

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66
Q

Rebound hypoglycemia is a complication of what, and why?

A

Of central line parenteral feedings, b/c the pt produces a lot of insulin while being fed. If d/c’d too fast, this can cause rebound hypoglycemia since the body is still producing a lot of insulin

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67
Q

What needs to be used to administer parenteral nutrition?

A

An infusion pump

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68
Q

Why should blood glucose levels be monitored during parenteral nutrition?

A

Because parenteral nutrition may cause hyperglycemia

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69
Q

Besides hyperglycemia, what other major problem are pts receiving parenteral nutrition at risk for? How is this monitored for?

A

Fluid imbalance. Should do strict I&O, monitor weight, look for s/sx of dehydration or fluid overload

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70
Q

The nurse should let the pt know that gagging may occur during NG tube insertion until what?

A

Until the tube has passed the throat

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71
Q

On what side of the pt should you stand to measure NG tube length?

A

On the pt’s right side

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72
Q

How is the tubing measured for an NG tube?

A

From the tip of the nose, to the tip of the earlobe, to the tip of the xyphoid process

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73
Q

How should a pt be seated for NG tube insertion?

A

Upright

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74
Q

Why might lidocaine be given during NG tube insertion?

A

To numb the nares and suppress the gag reflex

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75
Q

How should the pt’s head be positioned when inserting an NG tube?

A

Should be tilted up slightly at first, then, when resistance is encountered during insertion, tilt down slightly

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76
Q

What should you instruct the pt to do as you insert an NG tube?

A

Swallow

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77
Q

During insertion of an NG tube you notice the pt has lost the ability to speak, and has become cyanotic. What does this indicate? What should you do?

A

That the tube has gone down the trachea. In this case, remove the tube and recover the pt

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78
Q

How should NG tube placement be confirmed?

A

With an x-ray

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79
Q

How often should NG tube placement be checked?

A

Every 4 to 8 hours

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80
Q

What colors can gastric aspirate be?

A

Green, cloudy, brown or tan

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81
Q

What colors can intestinal aspirate be?

A

Clear, yellow or bile colored

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82
Q

What colors can respiratory aspirate be?

A

Clear or cloudy

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83
Q

What is the pH of gastric aspirate?

A

1-4

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84
Q

What is the pH of intestinal aspirate?

A

6 or more

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85
Q

What is the pH of respiratory aspirate?

A

7 or more

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86
Q

What is one advantage and one disadvantage of using an xray to confirm NG tube placement?

A

Advantage= most effective method. Disadvantage=expensive

87
Q

What are the advantages and disadvantages of measuring the length of exposed tubing to confirm NG tube placement?

A

It is easy and cheap, but does not r/o the possibility that the tube has migrated to the resp. system

88
Q

Why doesn’t the color of aspirate from an NG tube r/o migration to the resp system?

A

Because both intestinal and resp secretions can be clear

89
Q

Which method of measuring an NG tube is not good for patients on continuous feedings?

A

Looking at the color of the aspirate

90
Q

pH of aspirate is a good way to distinguish between what two placements for NG tubes?

A

Gastric and intestinal

91
Q

A pt with an NG tube is vomiting, has chest pain, and has an increased need for suctioning. The nurse suspects what?

A

NG tube migration into the resp. system

92
Q

Why should NG tubes be flushed?

A

So that they remain patent

93
Q

How often should the tape be changed on an NG tube?

A

Daily and PRN

94
Q

How should the mucosa be moistened in someone with an NG tube?

A

With steam or vapor

95
Q

Should bowel sounds be assessed in a pt with an NG tube?

A

Yes

96
Q

What position should the pt be in for NG tube removal?

A

Semi-Fowler’s

97
Q

During a clamp test on their NG tube, a pt develops N/V and abdominal distention. What does this mean?

A

This indicates that they have failed the clamp test

98
Q

During a clamp test, how long is the NG tube clamped for?

A

4-6 hours

99
Q

What should the NG tube be flushed with before removal, and how much?

A

Should be flushed with 30mL air

100
Q

How should the pt breath when removing their NG tube?

A

Should hold their breath

101
Q

The nurse should pull gently and slowly for the removal of how much of the NG tube? What should they do after this?

A

The first 6-8 inches; after this, pull out rapidly

102
Q

What should the nurse not do if resistance is felt during NG tube removal?

A

Do not pull hard

103
Q

Which has a lower risk of aspiration, enteric or nasogastric tubes?

A

Enteric tubes

104
Q

What is an advantage of continuous feedings over bolus feedings?

A

Lower risk of aspiration

105
Q

High osmolality enteric feedings can lead to what?

A

Dumping syndrome

106
Q

A pt receiving enteric feedings develops tachycardia, hypotension and dehydration. The nurse suspects what?

A

Dumping syndrome

107
Q

By what two methods can a bolus feeding be given?

A

Gravity or drip

108
Q

Bolus feedings by gravity take how long to complete? How about bolus feedings by drip?

A

Bolus takes ~15 mins, drip ~30 mins

109
Q

A pt with a functional GI system and low aspiration risk should be fed how?

A

NG tube, PEG tube, or gastrostomy.

110
Q

A pt with a functional GI system and high aspiration risk should be fed how?

A

Nasoenteric or jejunostomy tube.

111
Q

Open systems during enteral feedings are more prone to what?

A

Bacterial infections

112
Q

During an enteric feeding a pt develops N/V and gas. What does the nurse suspect may be happening?

A

The feeding may be too fast, or the formula too cold or have too much fiber

113
Q

What temp should the formula be for enteric feedings?

A

Room temp

114
Q

During enteral feedings, can you mix meds and feedings?

A

No

115
Q

The HOB should be at what angle during enteral feedings, and should remain like this for how long after?

A

At 30-45 degrees, and should remain there for one hour after

116
Q

Aspirating how much residual during enteral feedings warrants further assessment?

A

More than 200mL twice in a row

117
Q

What is the smallest size syringe that can be used for a gravity tube feeding?

A

30mL

118
Q

What is GERD defined as?

A

The backward movement of stomach contents into the esophagus, caused by a weak sphincter

119
Q

What kinds of food may exacerbate GERD?

A

Milk, chocolate, caffeine

120
Q

What does “pyrosis” mean? What is it a symptom of?

A

It is heartburn and is a symptom of GERD

121
Q

What is dyspepsia and what is it a symptom of?

A

Indigestion, a symptom of GERD

122
Q

What is odynophagia? What is it a symptom of?

A

Painful swallowing. Symptom of GERD

123
Q

What type of meals should people with GERD eat?

A

Small, frequent meals

124
Q

Pts with GERD should avoid laying down for how long after a meal?

A

For one hour after

125
Q

In what position should people with GERD sleep?

A

In a low Fowler’s position

126
Q

If nonsurgical interventions for GERD don’t work, what surgery may need to be performed?

A

Nissen fundoplication

127
Q

How does Nissen fundoplication work?

A

The fundus (top of the stomach) is wrapped around the lower esophageal spinchter, thus tightening it

128
Q

For how long after Nissen fundoplication might someone have dysphagia? What could it mean if dysphagia persists beyond this point?

A

Could be for 6 weeks; if it persists, this could mean that the fundus is wrapped too tightly around the esophagus

129
Q

Some pts with Nissen fundoplication may lose the ability to do what?

A

Burp

130
Q

Prolonged, untreated GERD may lead to what?

A

Barrett’s esophagus – this is when the cells of the esophagus begin to resemble the cells of the intestine

131
Q

Barrett’s esophagus is a risk factor for what?

A

Esophageal cancer

132
Q

What is a hiatal hernia?

A

When the hiata (the opening in the diaphragm that the esophagus passes thru) becomes enlarged, and the stomach moves up thru it and into the lower portion of the thorax

133
Q

What are the concerns with hiatal hernias?

A

They may become obstructed or strangulated

134
Q

Which type of hiatal hernia is more common, sliding or rolling?

A

Sliding

135
Q

What is the difference between a rolling and a sliding hiatal hernia?

A

Sliding hernia occurs when the upper part of the stomach slides in and out of the thorax; rolling hernia occurs when the part of the stomach pushes thru the diaphragm and sits beside the esophagus

136
Q

What is the main difference in the symptoms between a sliding and a rolling hernia?

A

Sliding hernia has GERD-like symptoms, while rolling hernias have respiratory symptoms

137
Q

Which type of hernia has a higher risk of strangulation?

A

Rolling

138
Q

Interventions for hiatal hernias are the same as interventions for what other problem?

A

GERD

139
Q

What is chronic gastritis?

A

Inflammation of the lining of the stomach

140
Q

Nonerosive gastritis is mainly caused by what?

A

H. pylori

141
Q

What is erosive gastritis mainly caused by?

A

Long-term NSAID use

142
Q

Explain how gastritis may cause pernicious anemia.

A

Gastritis destroys parietal cells, and thus B12 cannot be absorbed by the body. Without B12, RBCs cannot be produced and anemia results

143
Q

A pt presents with anorexia, heartburn, a sour taste, and bloody vomit or stool. The nurse suspects what?

A

Chronic gastritis

144
Q

Why might a pt with chronic gastritis have an NG tube?

A

So that their gut can rest

145
Q

How is chronic gastritis d/t H. pylori treated?

A

With antibiotics

146
Q

How is chronic gastritis d/t NSAID use treated?

A

By educating the pt, and providing an alternate, non-NSAID analgesic

147
Q

What are peptic ulcers?

A

Painful sores in the GI tract that erode past the mucosa by at least 1/2 cm

148
Q

In what four locations may a peptic ulcer appear?

A

Duodenum, gastric, pyloris (opening b/t stomach and duodenum), and esophagus

149
Q

In what location are peptic ulcers most common?

A

In the duodenum

150
Q

What age group is at the greatest risk for peptic ulcers?

A

Age 65+

151
Q

Why is NSAID use a risk factor for peptic ulcers?

A

NSAID use decreases the secretion of the mucus in the stomach that acts as a barrier against stomach acid

152
Q

What is the main underlying cause of peptic ulcers?

A

H. pylori and the secretion of HCl by the stomach

153
Q

Stress, COPD, and chronic renal disease increase the secretion of what?

A

HCl (stomach acid)

154
Q

What type of pain do peptic ulcers cause and where?

A

A dull, gnawing pain in the mid-epigastric region

155
Q

What is the preferred method of diagnosis for peptic ulcers?

A

Endoscopy

156
Q

When does pain tend to occur with gastric vs duodenal ulcers?

A

Pain is worse right after a meal with gastric ulcers; may occur up to three hours after a meal with duodenal ulcers

157
Q

Which type of ulcer pain is relieved with food and which is made worse with food?

A

Gastric ulcer pain is worse with food; duodenal pain is relieved with food

158
Q

Which type of ulcer tends to cause weight gain and which type tends to cause weight loss?

A

Gastric tends to cause weight loss and duodenal tends to cause weight gain

159
Q

What does perforation with a gastric ulcer mean?

A

That the ulcer has eroded all the way thru the gastric serosa

160
Q

A pt presents with sudden, severe abdominal or right shoulder pain; vomiting; and abdominal tenderness. The nurse suspects what?

A

Perforation of a gastric ulcer

161
Q

What is gastric outlet obstruction?

A

This is a complication of peptic ulcer disease that occurs when the area near the pyloric sphincter becomes scarred and stenosed as a result of healed peptic ulcers in that area

162
Q

A pt presents with N/V, constipation, and fullness. The nurse suspects what?

A

Gastric outlet obstruction

163
Q

What does a vagatomy for peptic ulcer disease involve?

A

Cutting the vagus nerve, which decreases stomach acid secretion

164
Q

What is the pyloris?

A

Opening between the stomach and small intestine

165
Q

What does a pylorosplasty for peptic ulcer disease involve?

A

Widening the pyloris so that the stomach can empty faster

166
Q

What does an antrectomy for peptic ulcer disease involve?

A

Removing the pyloris, since the pyloris contains the cells that secrete stomach acid

167
Q

What is chronic constipation defined as?

A

Less than 3 BMs per week. Symptoms must be present for at least 12 weeks of the preceding 12 months

168
Q

What is chronic diarrhea defined as?

A

Greater than 3 BMs per day with increased volume (over 200 grams per day)

169
Q

How long does chronic diarrhea persist for?

A

2-3 weeks and returns sporadically over time

170
Q

Why might cardiac dysrhythmias result from diarrhea?

A

Because of potassium loss

171
Q

What acid-base imbalance may occur as a result of diarrhea and why?

A

Metabolic acidosis, d/t the loss of bicarb

172
Q

What ages are at the greatest risk for inflammatory bowel disease?

A

Ages 15-30

173
Q

Which form of IBD presents as remissions and exacerbations?

A

Ulcerative colitis

174
Q

Which form of IBD causes more severe diarrhea and bleeding?

A

Ulcerative colitis

175
Q

Ulcerative colitis causes pain where?

A

Lower left quadrant

176
Q

Crohn’s disease causes pain where?

A

Lower right quadrant

177
Q

Which form of IBD involves more fistulas?

A

Crohn’s

178
Q

Surgery may be curative for which form of IBD?

A

Ulcerative colitis

179
Q

What kind of diet should be given to a pt with IBD?

A

A low-residue diet

180
Q

What does it mean to say that IBS is a functional disorder?

A

That there is no structural problem that can be seen in the GI tract, yet symptoms still exist

181
Q

Why should pts with IBS not drink while eating meals?

A

Because it may cause abdominal distention

182
Q

What is the difference between mechanical and functional intestinal obstruction?

A

A mechanical blockage is when pressure on the intestine stops the flow, and functional blockage is when the contents cannot be propelled along the bowel because peristalsis has stopped for some reason

183
Q

Obstructions most commonly occur in what part of the intestine?

A

The small intestine

184
Q

What are the most common causes of small bowel obstructions?

A

Neoplasms and hernias

185
Q

Small bowel obstructions cause what kind of pain?

A

Colicky, wave-like pain

186
Q

Large bowel obstructions cause what kind of pain?

A

Crampy lower abdominal pain

187
Q

In what type of bowel obstruction may you see weirdly shaped stool?

A

In a large bowel obstruction

188
Q

Will you see stool being passed in a small bowel obstruction?

A

No, but you may see blood or mucus being passed

189
Q

When after GI surgery can PO intake be resumed?

A

When bowel sounds return

190
Q

How often should a pt eat when first resuming PO intake after GI surgery? What should they have in between meals?

A

Should eat 6 small meals a day and have 120 mL fluid between meals

191
Q

Dysphagia is more common in pts who have surgery where?

A

On the lower esophagus

192
Q

What are signs of gastric retention after GI surgery?

A

N/V and abdominal distention

193
Q

Bile reflux may occur when what is removed?

A

Pyloris

194
Q

What is the major sign of bile reflux?

A

Pt will vomit biliary material

195
Q

What is dumping syndrome?

A

When the contents of your stomach move too quickly into your small bowel

196
Q

What is an intestinal diversion?

A

A way of allowing stool to leave the body that is not thru the normal route (done when there is disease or injury)

197
Q

What is the substance that comes out of an ostomy called?

A

Effluent

198
Q

What color should a stoma be?

A

Bright pink or red

199
Q

What might a purple stoma indicate?

A

Obstruction

200
Q

What might a pale stoma indicate?

A

Anemia

201
Q

How far from the skin should a stoma protrude?

A

1/2 inch to 1 inch

202
Q

How often should an ostomy bag be emptied?

A

When it is ½ to ¾ full, or 3-4 times per day if it does not fill

203
Q

How often should an ostomy bag be changed?

A

Every 5 days

204
Q

What kind of diet should a pt with a new stoma be on and for how long?

A

Low residue, for the first 6-8 weeks

205
Q

Irrigation is usually done for what type of stoma?

A

Colostomies

206
Q

What is the primary risk factor for esophageal cancer?

A

Barrett’s esophagus

207
Q

A pt presents with dysphagia, painful swallowing, and hiccups. The nurse suspects what?

A

Esophageal cancer

208
Q

What position should a pt be in for esophageal cancer?

A

Low Fowler’s

209
Q

Excess stomach acid increases the risk of what type of cancer?

A

Gastric cancer

210
Q

Gastric cancer may be confused with what other problem?

A

Peptic ulcer disease

211
Q

What are the symptoms of duodenal tumors?

A

Intermittent pain and occult bleeding if severe. Usually benign

212
Q

What is the most common sign of colorectal cancer?

A

A change in bowel habits

213
Q

When does effluent occur after a colostomy is created?

A

When peristalsis occurs

214
Q

When does effluent occur after an ileostomy is formed?

A

Within 24 to 48 hours

Practice of Nursing IV (3 decks)

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