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Exam 3 Flashcards

1
Q
  1. Cholelithiasis: Cause, patho, signs and symptoms (four F’s of gallbladder disease)
A

Gall stones - common causes:
-DM, hemolytic blood disorders, Crohn’s, Statin drugs, fatty meals

Patho: inflammation of the gallbladder; gall stones sometimes get stuck in bile duct & it must be removed

Four F’s: Female, Forty, Fat, Fertile

S/S:

  • upper abdominal pain
  • pain radiates to right shoulder
  • pain triggered by high fat
  • anorexia, nausea, vomiting
  • dyspepsia (indigestion)
  • eructation, flatulence, abd fullness, rebound tenderness
  • clay color school
  • dark urine
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2
Q
  1. Describe the non-surgical management of gallbladder disease.
A
  • NPO w/ IV & NG suction
  • Foods to allowed
  • Foods to avoid
  • Anticholinergic - Bentyl: decreases ductal tone & bilary spasm
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3
Q
  1. What are the foods allowed & avoid for treatment of cholecystitis.
A

Allowed: skim milk, cooked fruit, rice, tapioca, lean meat, mashed potatoes, non-gas forming veges, bread, coffee, iced tea

Avoid: eggs, cream, pork, fried foods, cheese, rich dressing, gas-forming veges, alcohol

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4
Q
  1. Explain the ESWL
A

Extracorporeal Shock Wave Lithotripsy:

externally applied acoustic pulse (shock waves) to break up gall stones, guided by ultrasound

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5
Q
  1. Compare the postoperative care required for the laparoscopic cholecystectomy vs traditional cholecystectomy.
A

Lap:

  • free air pain
  • early ambulation
  • 1-3 weeks resume normal activity

Traditional:

  • meds for pain relief (it’s worse)
  • TCDB
  • incision & surgical drains (T-tube & JP drains)
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6
Q
  1. What is a T-tube?
A

Allows bile to drain from the body into a pouch

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7
Q
  1. How do you care for a T-tube? What home care instructions are needed for a patient discharged with a T-tube?
A

Care:
-can remain in place for 6 weeks
-report absence of draining, especially w/ N&V
-report drainage of more than 100-150/day avg. up to 500
-watch drainage color (green/yellow=normal, red=blood)
-clamp tube 1-2 hours before & after meals (total 4 hours)
-clear liquids to solid food slowly
Home Care:
-as above
-no heavy lifting

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8
Q

A1. Review and know the content learned from skills lab or NS 205 on tracheostomy care & assessment.

A

See book. Look up!

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9
Q

A2. Why (rationale) does the patient with an artificial airway have to humidify and warm the air?

A

?? because they dry out worse and the skin around dry out worse?

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10
Q

A3. What are the signs & symptoms for head and neck cancer?

A
  • a lump or a sore that does not heal
  • a sore throat that does not go away
  • difficulty in swallowing
  • a change or hoarseness in the voice
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11
Q

A4. What are the risk factors for developing head & neck cancer?

A

alcohol and tobacco use

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12
Q

A5. Laryngeal cancer can be devastating because why?

A
  • makes it harder to breath
  • more difficult to swallow
  • can’t speak normally
  • appearance effected
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13
Q

A6. What is an Indirect and Direct Laryngoscopy? Is there a pre-op or post-op?

A

Indirect uses a mirror and reflects light into throat to view the larynx. No pre- or post-op needed.

Direct is using a scope and a direct view. May need pre- and post-op. Will have no gag reflex for a bit after waking, will be sightly sedated for procedure.

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14
Q

A7. What are the side effects or do’s and don’ts for a pt who is receiving radiation therapy for larynx cancer.

A
  • Risk for aspiration related to edema, anatomic changes
  • Imbalance nutrition related to inflammation, dysphagia, etc.
    • hoarseness will become worse but will improve
    • sore throat and difficulty swallowing
    • gargling with saline or sucking ice
    • mouthwashes and throat spray
    • pain medication
    • avoid lotion on skin, cover areas in sun
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15
Q

A8. What is the basic nursing care for a patient with Laryngeal Cancer?

A
  • Patient care, airway: suction, sit up, could become occluded
  • Medications: may have to crush, easier to swallow
  • Pain: meds, alternatives (humid O2, lozenges, chloraseptic, salt water)
  • Oral care: very important, rinse and gargle
  • Emotional care: they have CA, duh
  • Speech therapy, social worker, support groups
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16
Q

A9. Laryngectomy: What is it?

A

removal of all or part of the larynx (vocal cords)

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17
Q

A10. Difference between partial and total laryngectomy.

A

Partial: one or part of one

Total: all

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18
Q

A11. Nursing Care preoperative

A
  • communication may be a problem, develop way
  • anxious, need support
  • what to expect
  • discuss pain treatment and expectations
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19
Q

A12. Post-operative care laryngectomy

A
  • respiratory status
  • VS
  • extra & smaller trach available
  • suction & O2 ready
  • monitor wound area, do not touch till doc says so
  • fed thru NG tube
  • 11 cranial nerve cut sometimes, causes shoulder drop
  • circulation of wound, want pink
20
Q

A13. Client Education for pt after laryngectomy surgery

A
  • trach and stoma care
  • smoking cessation
  • stress reduction techniques
  • resources
  • TCDB, saline for secretion clearance
  • educate on suctioning
  • cleaning of tube and other stuff
21
Q

A14. What is a cordectomy or hemilaryngectomy?

A

hemilaryngectomy: remove the anterior soft parts of the larynx in continuity with the underlying thyroid cartilage
cordectomy: remove a vocal cord

  • Nursing actions: more risk for aspiration
  • Care after D/C:
  • Client education:
22
Q

A15. What are the complications that are possible after laryngectomy surgery:

  • Airway Obstruction: What do you do?
  • Aspiration:
    • what happens if they aspirate?
    • what are you going to do?
    • how do you check for aspiration?
A

Airway obstruction: sit up, humid O2, suction, cough

Aspiration: pt can get pneumonia; if they do, notify doc, suction and get CXR; no pneumonia, swallow test w/ speech therapist; possible change to thicker liquids.

23
Q

B1. What are the two primary risk factors for esophageal cancer in Western Society?

A

tobacco and alcohol use

24
Q

B2. How can GERD play a role in esophageal cancer?

A

GERD causes Barrett’s esophagus which can lead to cancer

25
B3. Describe the nonsurgical management of esophageal cancer.
Nutrition: dietician, weight, positioning, diet (high cal, soft food, thick liquid, shakes), eventually have to have tube feeding. W/ tube feed, residual must be checked q4h; residual should be less than 30, call if over 100; if you w/draw 200, only put back 60; certain positions cause more residual.
26
B4. Explain the preoperative and postoperative care of the patient undergoing surgery for esophageal surgery.
Pre: stop smoking, diet (NPO), educate on after surgery Post: position (fowlers to semi), tubes (peg, NG, drains), diet (NPO to clear to soft etc.), TCDB, blood clot prevention, pneumonia possible (from aspiration or atelectisis)
27
B5. Be able to note the differences between esphagectomy and esophagogastrostomy post-op care and procedure itself.
esophagectomy: removal of esophagus esophagogastrostomy: removal of esophagus and part of stomach must eat very small amounts of food at a time. esophagus can be replaced with a piece of colon if stomach not removed. stomach can be stretched up to replace esophagus with an esophagogastrostomy.
28
B6. Explain Dumping Syndrome: What causes it? What are the signs? What do you do for it?
Often seen after gastric bypass surgery. a condition where ingested foods bypass the stomach too rapidly and enter the small intestine largely undigested S/S: early dumping include nausea, vomiting, bloating, cramping, diarrhea, dizziness, and fatigue. "Late" dumping happens one to three hours after eating. Symptoms of late dumping include weakness, sweating, and dizziness Treatment: avoid certain foods; meds; several small meals a day
29
B7. What discharge teaching would you give to your patient post esophageal surgery?
- incentive spirometer and ambulation - protection from infections - incision care, s/s of infection - meals & diet: 6-8 small meals a day, high calorie & protein - weight: contact doc for loss of 5 or more pounds a week - dysphagia (difficulty swallowing) - support groups
30
B8. Be able to determine the proper nursing diagnosis, goals, and interventions for a patient with esophageal cancer and postoperative care of a patient following an esophageal surgery.
Imbalanced Nutrition: less than body requirements related to impaired swallowing.
31
C1. List the primary risk factors for gastric carcinoma. What are the cultural considerations associated with the disease?
2 main causes: H-Pylori & Barretts Esophagus Others: Pt w/ pernicious anemia (older women), gastric polyps (similar to colon), chronic atrophic gastritis; Ingestion of pickled foods, salted fish (ocean), salted meat (cow, pig, chicken), nitrates (lunchmeats, packaged; MSG is a nitrate); smoking; alcohol; genetics ??Cultural consideration: foods they eat??
32
C2. What roles do vitamin B12, D, and Calcium play in digestion?
B12: people w/ pernicious anemia cannot absorb B12; it helps prevent anemia D: promotes calcium absorption to help increase bone mass Calcium: Helps build strong bones and teeth
33
C3. What is bariatric surgery? What does a pt have to go thru in order to have the surgery?
It decreases the size of the stomach. Must have a long history of obesity, other medical conditions r/t obesity, BMI greater than 40, psych eval, documentation of other diets tried, counseling
34
C4. Postoperative care for the patient after bariatric surgery.
- monitor bowel sounds - up as quick as possible - 1st meal should only be 30ml - no fluids with meals ever - risk of infection - other common postop problems - abdominal binder
35
C5. What is dumping syndrome? What type of diet should the pt be on? what happen if they do not follow the proper diet?
- Sudden vomiting due to abdominal fullness. - Occurs 15-30 min after eating - S/S: weakness, dizziness, vertigo, diaphoresis, epigastric fullness, tachycardia, abd cramping, self-limiting - Diet: No fluids with meals, 6-8 small meals per day, no high carbs, 2 servings of proteins a day, take supplements, avoid empty calories
36
C6. What are the complications to be monitored for the postoperative period?
- dumping syndrome - infections - other common complications (DVT, pneumonia)
37
C7. What patient teaching is needed in preparation for discharge to home?
diet restrictions, signs of infection, meds and supplements
38
D1. What are common causes of lung abscess versus pulmonary empyema?
Lung abscess: Infections; pulmonary infarction; malignancy; necrosis secondary to silicosis and coal miners pneumoconiosis (black lung); History of pneumonia, aspiration, or obstruction; aspiration after swallowing post alcoholic blackouts, seizures, neurological deficits (stroke, MS, etc..); TB or fungal infections can have multiple abscesses. Pulmonary Empyema: infections, lung abscess, infected pleural effusion
39
D2. What are the different side effects for lung abscess versus pulmonary empyema?
Lung Abscess: pleuritic chest pain w/ decreased lung sounds; temp; pale, fatigue, night sweats, foul odor sputum; dullness on chest percussion; crackles over site of lesion or pleural friction rub Pulmonary Empyema: pleuritic chest pain and friction rub/decrease lung sounds; dyspnea; UNEQUAL CHEST EXPANSION; pleural effusion; foul smelling sputum; compression of lung tissue near effusion; anorexia, night sweats
40
D3. What are the most common organisms for lung abscess?
bacteria, fungi, parasites????????
41
D4. What causes pleuritic chest pain? What do you assess for?
An inflammation of the pleural space or fluid in the pleural space Pleural friction rub, diminished lung sounds, percussion
42
D5. What type of breath sounds are often heard over area of lung abscess? Why would you expect this to be the case?
Crackles over site of lesion or pleural friction rub. Dullness on chest percussion. The inflammation causes roughness, there is pus
43
D6. Explain in detail the postoperative teaching for a patient after thoracic surgery.
a. position- up at 45-90 degree b. cough & deep breathing/incentive- helps to prevent pneumonia and keeps "stuff" loose. c. abdominal breathing-?? d. pain- meds, positioning e. ROM- range of motion...draw pics f. nutrition- g. bleeding & subQ emphysema-
44
D7. What fills the space after lobectomy and pneumonectomy? Will you hear lung sounds or not?
After a lobectomy the remainder of the lung will fill the space and eventually you will hear lung sounds. After a pneumonectomy, there will be a "stump" and it fills with fluid, no lung sounds will be heard.
45
D8. Explain the care of a chest tube.
a. Complications:

Med Surg 2 (1 decks)

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