Exam 1 Flashcards
What is a community defined as?
A group of people with at least one characteristic in common
What is the principle challenge for a nurse performing a community health assessment?
Gaining entrance and acceptance into the community
What are the five components of the community “core”?
History, demographics, ethnicity, values and beliefs
What should be assessed first in a community health assessment, the core or the subsystems?
The core
Define “disability”
An inability to perform ADLs, or the need of an assistive device or person in order to perform an ADL.
What percent of people are disabled?
12.1%
A developmental disability is found between what ages?
0-22
What is an example of a developmental disability?
Spina bifida
At what age may an acquired disability occur?
Can occur at any age
What is an example of an acquired disability?
A traumatic brain injury
What is an age-associated disability?
A disability that occurs as part of the aging process
What is an example of an age-associated disability?
Hearing loss
What are three characteristics of a chronic illness?
Irreversible, has no cure, and requires care for at least 3 months
What are the three broad possible causes of chronic illness?
Genetics, injuries, or behavior
What are the nine phases of the Trajectory Model of Illness, in order?
Pretrajectory, trajectory, stable, unstable, acute, crisis, comeback, downward, dying.
What occurs with the pt in the pretrajectory phase?
The pt does not yet have an illness or diagnosis, but they have many risk factors (an example would be a pre-diabetic)
What will the pt’s family experience during the pretrajectory phase?
They may be frustrated or concerned for their loved one
What are the nursing interventions for the pretrajectory phase?
Testing, counseling and education
In what phase is the illness diagnosed?
Trajectory phase
What emotion will the family experience in the trajectory phase?
Anger
What are the two interventions for the trajectory phase?
Education and emotional support
What characterizes the stable phase?
The signs and symptoms of the illness are under control
What emotion does the family experience during the stable phase?
Relief
What are the two interventions for the stable phase?
Positive behaviors and health promotion education
What emotion will the family experience during the unstable phase?
Uncertainty
What are the interventions for the unstable phase?
Guidance, support, and education
What occurs during the unstable phase?
The illness exacerbates, and the pt experiences a setback
What is the difference between the unstable and the acute phase?
They are similar, but acute phase is worse. Acute phase also usually requires hospitalization and unstable phase can be managed at home.
What emotion does the family experience during the acute phase?
Fear
What are the interventions during the acute phase?
Direct care and support
What occurs during the crisis phase?
There is a critical, lifethreatening event, and ADLs are suspended
What are the interventions during the crisis phase?
Provide direct care, collaboration with healthcare team, and stabilize
What occurs during the comeback phase?
There is a gradual recovery from crisis with new or worsened disability
What emotions will the family experience during the comeback phase?
Relief and hopefulness
What are the interventions during the comeback phase?
Coordination of care and adaptation.
What occurs during the downward phase?
There is a rapid decline in functioning
What will the family feel during the downward phase?
They will be grieving
What are interventions for the downward phase?
Home care, a new treatment plan, and end of life planning
During the dying phase, death is imminent. What time frame does this mean?
Days to weeks away
What will the family feel during the dying phase?
Grieving
What are the interventions during the dying phase?
Direct care, comfort, and support
What is GI intubation defined as?
Insertion of a tube into the stomach or intestine through the mouth, nose, or abdominal wall
What three materials can GI tubes be made of?
Rubber, polyurethane, or silicone
What is decompression during GI intubation used for?
To remove gas and fluid build-up
What does aspiration during GI intubation refer to?
Removal of substances via suctioning (could be to obtain a sample)
What does lavage during GI intubation refer to?
Washing/cleansing the stomach to remove toxins
What is another name for lavage?
Stomach-pumping
What size must feeding tubes be?
12 French or smaller
What is the relationship between the size of tube and the speed of the feeding?
A larger tube=quicker feeding
Orogastric tubes are commonly used in what two specialties for what purpose?
In the ICU and ER in order to quickly decompress the stomach
Is a Levin tube a type of nasogastric or orogastric tube?
Nasogastric tube
How many lumens does a Levin tube have and what is its main purpose?
Single lumen; main purpose is decompression
What type of tube is a Gastric/Salem sump?
A nasogastric tube
What is a gastric/salem sump used for?
Decompression or feeding
What type of tube is a Dobhoff tube?
Nasogastric tube
Where do enteric tubes sit?
In the intestine
What are the two main types of enteric tubes?
Nasoduodenal and nasojejunal
For how long should enteric tubes be used?
Not for longer than 4-6 weeks
Since enteric tubes can only be used for 4-6 weeks, what are better options for longer-term feeding?
Gastrostomy and jejunostomy
What is a gastrostomy?
When the stomach wall is brought to the surface and a permanent stoma is created
What is a jejunostomy?
When part of the jejunum is brought to the surface and a stoma is created
What is parenteral nutrition?
When nutrients are given IV
When is parenteral nutrition indicated?
When a pt has a non-functioning GI tract
What is a major consideration when selecting peripheral or central lines for parenteral feedings?
Peripheral are for shorter term use (5-7 days), while central lines are for longer-term use
What is one downside of using a central line for parenteral feedings?
Higher risk of infection than with a peripheral line
Rebound hypoglycemia is a complication of what, and why?
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
What needs to be used to administer parenteral nutrition?
An infusion pump
Why should blood glucose levels be monitored during parenteral nutrition?
Because parenteral nutrition may cause hyperglycemia
Besides hyperglycemia, what other major problem are pts receiving parenteral nutrition at risk for? How is this monitored for?
Fluid imbalance. Should do strict I&O, monitor weight, look for s/sx of dehydration or fluid overload
The nurse should let the pt know that gagging may occur during NG tube insertion until what?
Until the tube has passed the throat
On what side of the pt should you stand to measure NG tube length?
On the pt’s right side
How is the tubing measured for an NG tube?
From the tip of the nose, to the tip of the earlobe, to the tip of the xyphoid process
How should a pt be seated for NG tube insertion?
Upright
Why might lidocaine be given during NG tube insertion?
To numb the nares and suppress the gag reflex
How should the pt’s head be positioned when inserting an NG tube?
Should be tilted up slightly at first, then, when resistance is encountered during insertion, tilt down slightly
What should you instruct the pt to do as you insert an NG tube?
Swallow
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?
That the tube has gone down the trachea. In this case, remove the tube and recover the pt
How should NG tube placement be confirmed?
With an x-ray
How often should NG tube placement be checked?
Every 4 to 8 hours
What colors can gastric aspirate be?
Green, cloudy, brown or tan
What colors can intestinal aspirate be?
Clear, yellow or bile colored
What colors can respiratory aspirate be?
Clear or cloudy
What is the pH of gastric aspirate?
1-4
What is the pH of intestinal aspirate?
6 or more
What is the pH of respiratory aspirate?
7 or more
What is one advantage and one disadvantage of using an xray to confirm NG tube placement?
Advantage= most effective method. Disadvantage=expensive
What are the advantages and disadvantages of measuring the length of exposed tubing to confirm NG tube placement?
It is easy and cheap, but does not r/o the possibility that the tube has migrated to the resp. system
Why doesn’t the color of aspirate from an NG tube r/o migration to the resp system?
Because both intestinal and resp secretions can be clear
Which method of measuring an NG tube is not good for patients on continuous feedings?
Looking at the color of the aspirate
pH of aspirate is a good way to distinguish between what two placements for NG tubes?
Gastric and intestinal
A pt with an NG tube is vomiting, has chest pain, and has an increased need for suctioning. The nurse suspects what?
NG tube migration into the resp. system
Why should NG tubes be flushed?
So that they remain patent
How often should the tape be changed on an NG tube?
Daily and PRN
How should the mucosa be moistened in someone with an NG tube?
With steam or vapor
Should bowel sounds be assessed in a pt with an NG tube?
Yes
What position should the pt be in for NG tube removal?
Semi-Fowler’s
During a clamp test on their NG tube, a pt develops N/V and abdominal distention. What does this mean?
This indicates that they have failed the clamp test
During a clamp test, how long is the NG tube clamped for?
4-6 hours
What should the NG tube be flushed with before removal, and how much?
Should be flushed with 30mL air
How should the pt breath when removing their NG tube?
Should hold their breath
The nurse should pull gently and slowly for the removal of how much of the NG tube? What should they do after this?
The first 6-8 inches; after this, pull out rapidly
What should the nurse not do if resistance is felt during NG tube removal?
Do not pull hard
Which has a lower risk of aspiration, enteric or nasogastric tubes?
Enteric tubes
What is an advantage of continuous feedings over bolus feedings?
Lower risk of aspiration
High osmolality enteric feedings can lead to what?
Dumping syndrome
A pt receiving enteric feedings develops tachycardia, hypotension and dehydration. The nurse suspects what?
Dumping syndrome
By what two methods can a bolus feeding be given?
Gravity or drip
Bolus feedings by gravity take how long to complete? How about bolus feedings by drip?
Bolus takes ~15 mins, drip ~30 mins
A pt with a functional GI system and low aspiration risk should be fed how?
NG tube, PEG tube, or gastrostomy.
A pt with a functional GI system and high aspiration risk should be fed how?
Nasoenteric or jejunostomy tube.
Open systems during enteral feedings are more prone to what?
Bacterial infections
During an enteric feeding a pt develops N/V and gas. What does the nurse suspect may be happening?
The feeding may be too fast, or the formula too cold or have too much fiber
What temp should the formula be for enteric feedings?
Room temp
During enteral feedings, can you mix meds and feedings?
No
The HOB should be at what angle during enteral feedings, and should remain like this for how long after?
At 30-45 degrees, and should remain there for one hour after
Aspirating how much residual during enteral feedings warrants further assessment?
More than 200mL twice in a row
What is the smallest size syringe that can be used for a gravity tube feeding?
30mL
What is GERD defined as?
The backward movement of stomach contents into the esophagus, caused by a weak sphincter
What kinds of food may exacerbate GERD?
Milk, chocolate, caffeine
What does “pyrosis” mean? What is it a symptom of?
It is heartburn and is a symptom of GERD
What is dyspepsia and what is it a symptom of?
Indigestion, a symptom of GERD
What is odynophagia? What is it a symptom of?
Painful swallowing. Symptom of GERD
What type of meals should people with GERD eat?
Small, frequent meals
Pts with GERD should avoid laying down for how long after a meal?
For one hour after
In what position should people with GERD sleep?
In a low Fowler’s position
If nonsurgical interventions for GERD don’t work, what surgery may need to be performed?
Nissen fundoplication
How does Nissen fundoplication work?
The fundus (top of the stomach) is wrapped around the lower esophageal spinchter, thus tightening it
For how long after Nissen fundoplication might someone have dysphagia? What could it mean if dysphagia persists beyond this point?
Could be for 6 weeks; if it persists, this could mean that the fundus is wrapped too tightly around the esophagus
Some pts with Nissen fundoplication may lose the ability to do what?
Burp
Prolonged, untreated GERD may lead to what?
Barrett’s esophagus – this is when the cells of the esophagus begin to resemble the cells of the intestine
Barrett’s esophagus is a risk factor for what?
Esophageal cancer
What is a hiatal hernia?
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
What are the concerns with hiatal hernias?
They may become obstructed or strangulated
Which type of hiatal hernia is more common, sliding or rolling?
Sliding
What is the difference between a rolling and a sliding hiatal hernia?
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
What is the main difference in the symptoms between a sliding and a rolling hernia?
Sliding hernia has GERD-like symptoms, while rolling hernias have respiratory symptoms
Which type of hernia has a higher risk of strangulation?
Rolling
Interventions for hiatal hernias are the same as interventions for what other problem?
GERD
What is chronic gastritis?
Inflammation of the lining of the stomach
Nonerosive gastritis is mainly caused by what?
H. pylori
What is erosive gastritis mainly caused by?
Long-term NSAID use
Explain how gastritis may cause pernicious anemia.
Gastritis destroys parietal cells, and thus B12 cannot be absorbed by the body. Without B12, RBCs cannot be produced and anemia results
A pt presents with anorexia, heartburn, a sour taste, and bloody vomit or stool. The nurse suspects what?
Chronic gastritis
Why might a pt with chronic gastritis have an NG tube?
So that their gut can rest
How is chronic gastritis d/t H. pylori treated?
With antibiotics
How is chronic gastritis d/t NSAID use treated?
By educating the pt, and providing an alternate, non-NSAID analgesic
What are peptic ulcers?
Painful sores in the GI tract that erode past the mucosa by at least 1/2 cm
In what four locations may a peptic ulcer appear?
Duodenum, gastric, pyloris (opening b/t stomach and duodenum), and esophagus
In what location are peptic ulcers most common?
In the duodenum
What age group is at the greatest risk for peptic ulcers?
Age 65+
Why is NSAID use a risk factor for peptic ulcers?
NSAID use decreases the secretion of the mucus in the stomach that acts as a barrier against stomach acid
What is the main underlying cause of peptic ulcers?
H. pylori and the secretion of HCl by the stomach
Stress, COPD, and chronic renal disease increase the secretion of what?
HCl (stomach acid)
What type of pain do peptic ulcers cause and where?
A dull, gnawing pain in the mid-epigastric region
What is the preferred method of diagnosis for peptic ulcers?
Endoscopy
When does pain tend to occur with gastric vs duodenal ulcers?
Pain is worse right after a meal with gastric ulcers; may occur up to three hours after a meal with duodenal ulcers
Which type of ulcer pain is relieved with food and which is made worse with food?
Gastric ulcer pain is worse with food; duodenal pain is relieved with food
Which type of ulcer tends to cause weight gain and which type tends to cause weight loss?
Gastric tends to cause weight loss and duodenal tends to cause weight gain
What does perforation with a gastric ulcer mean?
That the ulcer has eroded all the way thru the gastric serosa
A pt presents with sudden, severe abdominal or right shoulder pain; vomiting; and abdominal tenderness. The nurse suspects what?
Perforation of a gastric ulcer
What is gastric outlet obstruction?
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
A pt presents with N/V, constipation, and fullness. The nurse suspects what?
Gastric outlet obstruction
What does a vagatomy for peptic ulcer disease involve?
Cutting the vagus nerve, which decreases stomach acid secretion
What is the pyloris?
Opening between the stomach and small intestine
What does a pylorosplasty for peptic ulcer disease involve?
Widening the pyloris so that the stomach can empty faster
What does an antrectomy for peptic ulcer disease involve?
Removing the pyloris, since the pyloris contains the cells that secrete stomach acid
What is chronic constipation defined as?
Less than 3 BMs per week. Symptoms must be present for at least 12 weeks of the preceding 12 months
What is chronic diarrhea defined as?
Greater than 3 BMs per day with increased volume (over 200 grams per day)
How long does chronic diarrhea persist for?
2-3 weeks and returns sporadically over time
Why might cardiac dysrhythmias result from diarrhea?
Because of potassium loss
What acid-base imbalance may occur as a result of diarrhea and why?
Metabolic acidosis, d/t the loss of bicarb
What ages are at the greatest risk for inflammatory bowel disease?
Ages 15-30
Which form of IBD presents as remissions and exacerbations?
Ulcerative colitis
Which form of IBD causes more severe diarrhea and bleeding?
Ulcerative colitis
Ulcerative colitis causes pain where?
Lower left quadrant
Crohn’s disease causes pain where?
Lower right quadrant
Which form of IBD involves more fistulas?
Crohn’s
Surgery may be curative for which form of IBD?
Ulcerative colitis
What kind of diet should be given to a pt with IBD?
A low-residue diet
What does it mean to say that IBS is a functional disorder?
That there is no structural problem that can be seen in the GI tract, yet symptoms still exist
Why should pts with IBS not drink while eating meals?
Because it may cause abdominal distention
What is the difference between mechanical and functional intestinal obstruction?
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
Obstructions most commonly occur in what part of the intestine?
The small intestine
What are the most common causes of small bowel obstructions?
Neoplasms and hernias
Small bowel obstructions cause what kind of pain?
Colicky, wave-like pain
Large bowel obstructions cause what kind of pain?
Crampy lower abdominal pain
In what type of bowel obstruction may you see weirdly shaped stool?
In a large bowel obstruction
Will you see stool being passed in a small bowel obstruction?
No, but you may see blood or mucus being passed
When after GI surgery can PO intake be resumed?
When bowel sounds return
How often should a pt eat when first resuming PO intake after GI surgery? What should they have in between meals?
Should eat 6 small meals a day and have 120 mL fluid between meals
Dysphagia is more common in pts who have surgery where?
On the lower esophagus
What are signs of gastric retention after GI surgery?
N/V and abdominal distention
Bile reflux may occur when what is removed?
Pyloris
What is the major sign of bile reflux?
Pt will vomit biliary material
What is dumping syndrome?
When the contents of your stomach move too quickly into your small bowel
What is an intestinal diversion?
A way of allowing stool to leave the body that is not thru the normal route (done when there is disease or injury)
What is the substance that comes out of an ostomy called?
Effluent
What color should a stoma be?
Bright pink or red
What might a purple stoma indicate?
Obstruction
What might a pale stoma indicate?
Anemia
How far from the skin should a stoma protrude?
1/2 inch to 1 inch
How often should an ostomy bag be emptied?
When it is ½ to ¾ full, or 3-4 times per day if it does not fill
How often should an ostomy bag be changed?
Every 5 days
What kind of diet should a pt with a new stoma be on and for how long?
Low residue, for the first 6-8 weeks
Irrigation is usually done for what type of stoma?
Colostomies
What is the primary risk factor for esophageal cancer?
Barrett’s esophagus
A pt presents with dysphagia, painful swallowing, and hiccups. The nurse suspects what?
Esophageal cancer
What position should a pt be in for esophageal cancer?
Low Fowler’s
Excess stomach acid increases the risk of what type of cancer?
Gastric cancer
Gastric cancer may be confused with what other problem?
Peptic ulcer disease
What are the symptoms of duodenal tumors?
Intermittent pain and occult bleeding if severe. Usually benign
What is the most common sign of colorectal cancer?
A change in bowel habits
When does effluent occur after a colostomy is created?
When peristalsis occurs
When does effluent occur after an ileostomy is formed?
Within 24 to 48 hours
