Exam 5 Study Guide: Q Flashcards
what are important interventions with acute pancreatitis?
o NPO
to reduce GI activity & pancreatic enzyme production.
o IV Fluids
to prevent dehydration.
o NG Tube
to LIS for severe n/v.
o OPIOIDS
around the clock & PRN.
o FETAL POSITION
with legs drawn up for comfort.
What are important instructions following a laparoscopic cholecystectomy?
· Assist patient with early ambulation to promote absorption of CO2.
· Low-fat diet.
· Do no lift >10lbs for 1 wk
· Remove the dressing after 24 hours.
· Can shower after 48 hours but should not let the water pressure flow directly into the incision to avoid infection.
· Avoid drive while taking the pain medication.
What are normal and abnormal findings following ileostomy placement?
· Assess the stoma for color and contact the HCP if pale, bluish, or dark.
· The stool from an ascending colostomy can be expected to remain liquid because only a little, large bowel is available to reabsorb the liquid from the stool.
What are important points for a client following ileostomy placement?
· For patient support, the local chapter of the UOAA has resources for patients and their families, including specially trained visitors who provide support.
· A client with colostomy should avoid gassy food.
· The colostomy bag should be emptied when it is 1/3 to 1/2 full of stool or when there is gas in it.
What are risk factors and ways to reduce the risk of colon cancer?
· Colon cancer risk is reduced with higher intake of high fiber foods and brassica vegetables such as broccoli and cauliflower.
· CRC is rare before the age of 40, but increases rapidly with advancing age.
· Red meat increases the risk of colon cancer.
What are important diet and home environment points for patients with IBS?
· Eat a high-fiber diet (30-40 g/day), with 8-10 cups of liquid daily.
o Chicken with brown rice, broccoli, and apple juice have high fiber.
· Avoid alcohol, caffeine, and other gastric irritants.
· Home assessment includes adequacy and availability of bathroom facilities, opportunities for rest and relaxation, the patient’s knowledge of dietary therapy, and when to contact the provider.
What are important points with NG tubes?
· Check tube placement every 4-8 hours
· Monitor and document drainage
· Provide oral care every 4-8 hours
What is an ERCP & potential complications?
Endoscopic retrograde cholangiopancreatography
Complications:
· Systemic inflammatory response (SIRS)
· Perforation
· Hemorrhage
what must be assessed following an EGD?
GAG REFLEX
o must be assessed before giving PO fluids or food - usually one hour post procedure
How is HBV transmitted and what is the clinical course?
o TRANSMITTED THROUGH BLOOD AND BODY FLUIDS
- Accidental needle sticks or injuries from sharp instruments
- Primarily in health care workers and unprotected sex.
· Usual clinical course is 25-180 DAYS (about 6 months) after exposure
what is diverticulitis and common treatments?
o small pouch like protrusions in the colon
anticipate antibiotics and analgesia (very painful)
what is a common symptom with appendicitis?
severe RLQ pain at McBurney’s point
what are common complications with appendicitis?
o major complication = rupture/perforation
manifest as increased pain with cough or movement and pain relieved by bending the right hip or knees
what are some S/S of liver cirrhosis?
Peripheral edema secondary to hypoalbuminemia d/t decreased protein synthesis by liver.
· Jaundice (yellowish skin and sclera) and clay-colored stool r/t high bilirubin levels caused by inability of the liver to produce bile or because bile flow is blocked.
· S/S Hepatic encephalopathy d/t elevated AMMONIA: anxiety, behavioral or personality changes, lethargy, stupor, asterixis (flapping of hands or arms)
What are education points and complications of liver cirrhosis?
o EDUCATION:
stop drinking alcohol, follow up on labs, report unusual bleeding, avoid OTC drugs, especially NSAIDS, vitamins, and minerals.
o COMPLICATIONS:
portal HTN and ascites- third spacing of fluid could lead require paracentesis.
what is paracentesis?
· Rapid removal of ascetic fluid causes decreased abdominal pressure- can contribute to hypovolemia manifested by a decrease in urine output to below 30 ml/hr.
What are interventions for patients with hep C and cirrhosis?
o Assess the client’s level of consciousness throughout the day.
Changes may indicate high ammonia levels.
o Perform head-to-toe assessment and document findings.
Monitor for changes in abdominal girth
Report sudden abdominal pain- could be perforated ulcer
o Safety precautions in place- risk for falls.
Bed lowered, call in reach, & assistive devices in reach to prevent the client from trying to get up.
What are important labs and medication for patients with Hep C and Cirrhosis?
· Review all labs including COAGS & AMMONIAlevels.
o **LACTULOSE is given for high ammonia levels (it binds to the ammonia and expelled through the stool)
What are important points with Ulcerative colitis, chrons, and chronic cholecystitis?
o ULCERATIVECOLITIS
will have bloody stools with mucus and pus.
o CROHN’S
will have fatty, loose, and steatorrhea stools.
o CHRONIC CHOLECYSTITIS
will have clay-colored stools.
o CHRON’s DISEASE & ULCERATIVE COLITIS
are both inflammatory conditions.
o ULCERATIVE COLITIS
starts in the rectum where CROHN’s is more widespread.
what are S/S of ulcerative colitis?
· WBC will be elevated
· DURING EXACERBATIONS:
severe diarrhea & risk for dehydration, hypokalemia, and hypotension.
· Ulcerative Colitis will have BLOODY STOOLS WITH MUCUS AND PUS
what are important points with Chron’s disease?
o STRESS EXACERBATING and meditation can reduce stress
o LIMIT FIBER
COMPLICATIONS:
o peritonitis
o fistulas
o small bowel obstruction can be life-threatening
Crohn’s will have:
o FATTY, LOOSE, & STEATORRHEA STOOLS
What are important points of peptic ulcer disease?
CAUSE:
H. Pylori infection.
AVOID:
o eating before bedtime, spicy food, alcohol, and caffeine.
o avoid NSAIDs -increased risk of bleeding. Tylenol is ok.
o sudden increase in epigastric pain spreading across the abdomen could be GI perforation
What is the cause, intervention, outcome, and complication with GERD?
o CAUSE:
Bloating/abdominal distention when eating a large meal, during flatulence, and eructation increase intra-abdominal pressure & lower esophageal sphincter (LES) pressure decreases allowing gastric juice to enter esophagus.
o INTERVENTIONS:
weight loss, small/frequent meals, and not lying down within 3 hours of eating.
o OUTCOMES:
freedom from pain, knowledge of lifestyle changes to manage GERD
o COMPLICATION - RESPIRATORY SYMPTOMS:
aspiration of acid reflux into the tracheobronchial tree, larynx, pharynx, nose, and mouth (especially when supine).
medical emergency necessitating immediate action
ASPIRATION
what should patients with gastroenteritis avoid and what is it caused by?
o AVOID CAFFEINE AND DAIRY PRODUCTS
· Salmonella gastroenteritis may be caused by ingesting undercooked eggs, raw or undercooked poultry, seafood, pork, or unpasteurized milk- not beef.
What are important points with a GI obstruction?
· Passing flatus and belching indicate the return of peristaltic activity.
Increased pain may be experiencing perforation which is a medical emergency
what is a symptom of a lower GI bleed?
bright, red, bloody stools
how can you assess for scoliosis?
· Client would bend forward at the hips
- Standing behind the patient, the nurse looks for a lateral curve in the spine.
What is osteoporosis, and what are prevention and risk factors?
Loss of bone density where bone resorption increases and bone formation decreases, common in older women- not a result of a congenital disorder.
- Osteoporosis can cause fractures and contribute to falls.
o PREVENTION:
healthy lifestyle, avoidance of smoking & excessive alcohol intake (more than three drinks per day), weight bearing exercise
o RISK FACTORS:
gender (female), postmenopausal, age, sedentary lifestyle and use of corticosteroids, thyroid hormones, and absorption issues.
What are important statistics with osteoporosis?
o 50% of all postmenopausal women will sustain an osteoporotic fracture.
o Of these women, 25% will exhibit clinical signs of vertebral deformity and 15% will develop a hip fracture along with 20% of men
What are S/S and lab findings with osteomyelitis?
o The WBC count and ESR are commonly elevated.
o S/S: pain not relieved by rest, swelling, tenderness, warmth at the site, fever, nausea, chills, and general feeling malaise.
what should you assess and expect to find with fractures?
o ASSESS CAP REFILL AND SENSATION
(Slow capillary refill and increasing pain to left leg. The client may be developing compartment syndrome, and this should be reported to the HCP immediately).
o EXPECTED FINDINGS:
Edema, bruising, weakness of the extremity
