Inflammation/Elimination Study NUR3 Flashcards
This condition is caused by H. Pylori bacteria and causes: midepigastric pain relieved by food if there is a duodenal ulcer or worsened by food if there is a gastric or stress ulcer, anorexia, and bloating
Peptic Ulcer Disease
This test is the most accurate for diagnosing PUD and the patient is required to remain NPO until gag reflex has returned
EGD
Treatment for this condition is: possible NG tube to rest GI and determine presence of blood in stomach; pain management with H2 blockers, Bismuth, PPIs, and antibiotics; triple therapy (PPi + 2 antibiotics) or quad therapy (PPI + 2 antibiotics + Bismuth)
Peptic Ulcer Disease
What are the diet recommendations for someone with PUD?
Bland diet; avoid irritating foods, alcohol, caffeine; eat 6 small meals a day
Patient teaching for Bismuth therapy
Do not take Aspirin with this medicine. It may cause black tongue and stools, but it is temporary and harmless.
True or false: It is okay to abruptly stop taking a PPI if you do not notice any changes
False
Patient with peptic ulcer disease reports having hematamesis, melana, and dizziness. Their heart rate is 135, BP is 110/60, Hgb/Hct is decreased. What do you suspect?
Hemorrhage
Patient presents with a rigid, board-like abdomen. What do you suspect?
Peritonitis
Patient presents with pain in the RLQ (Mcburney’s point), N/V, low grade fever, anorexia, and rebound tenderness of the abdomen. What do you suspect?
Appendicitis
What are the priority nursing interventions for appendicitis?
NPO; prophylactic antibiotics to prepare for surgery, IV fluids, Pain management
True or false: You can apply heat to the abdomen to relieve pain for someone with appendicitis
False. No heat can be applied and no enemas or laxatives can be administered due to risk of rupture.
What are the complications of appendicitis?
Peritonitis, Perforation, Gangrene, Sepsis
Patient presents with a rigid, board-like abdomen. What is your priority interventions?
Place in Fowler’s or semi-fowler’s position to promote drainage of peritoneal fluid. Monitor respiratory status and administer O2. Keep NPO. Administer hypertonic IV fluids and broad-spectrum antibiotics.
Patient had an appendectomy yesterday. They report abdominal and shoulder pain. Is this to be expected?
Yes. The abdomen in inflated during an appendectomy which can cause gas pains after the procedure. The gas pains can radiate to the shoulder from the abdomen.
Patient presents with a random onset of sever LUQ pain while lying down and resorts to fetal position to relieve pain. They state they have been feeling nauseous and their stool has also been looking white and floating in the toilet. You notice their eyes appear yellow and their stomach appears distended. Their glucose, ALT, bilirubin, and amylase are elevated. What do you suspect?
Chronic pancreatitis flare up
Patient with pancreatitis reports “bruising” around the umbilicus. What is this?
Cullen’s sign
Patient with pancreatitis reports “bruising” around their flank area. What is this?
Grey Turner’s Sign
What are the nursing interventions for someone with pancreatitis?
Pain management(opioids, NPO, and fetal position); NG tube to promote nutrition and rest GI; IV fluids; promote frequent rest periods; PPIs to decrease gastric acid
The cause of a patient’s pancreatitis is gallstones. What procedure(s) would you anticipate?
ERCP or lapcholey
What is the most accurate test to confirm pancreatitis?
Contrast-enhanced CT
For pancreatic enzyme replacement therapy (PERT), how and when should a patient take this medicine?
Take with every meal and snack. Do not chew or crush. Can be sprinkled on no-protein food
Client education for pancreatic enzyme replacement therapy (PERT) to monitor the effectiveness of the therapy
Record number and consistency of stools. There should be a decrease of fatty stools
Diet recommendations for someone with pancreatitis
Avoid alcohol, caffeine, and GI stimulants. Eat small frequent meals. High carb, high protein, low fat, bland diet.
Patient presents with ascites. What procedure do you anticipate?
Paracentesis to remove the extra fluid. It is done at bedside. Patient should empty bladder prior to the procedure and prior to being weighed before the procedure. Weigh patient before and after procedure.
Where would the pain be felt for someone with hepatitis if they were experiencing pain?
RUQ
What are the hepatitis virus types that can be spread via fecal-oral?
HAV and HEV
What are the hepatitis virus types that can be spread via blood/body fluids?
HBV, HCV, HDV
What hepatitis virus types do have a vaccine?
HAV, HBV
If a patient received the hepatitis B vaccine, what other hepatitis virus are they protected from and why?
Hepatitis D because to have hepatitis D, you also have to have Hepatitis B
What is the most common chronic form of hepatitis virus?
HCV
How long does a patient have to have hepatitis before being diagnosed with chronic hepatitis?
Longer than 6 months
What procedure is done to confirm the diagnosis and stage of progression for hepatitis virus?
Liver Biopsy
What is a patient most at risk for after a liver biopsy?
Hemorrhage/bleeding
True or False: ALL hepatitis virus diagnoses must be reported to the health department
True
How do you evaluate the effectiveness of antivirals for a patient with HBV?
Routine blood tests
A patient has been exposed to HAV. How long do they have to receive the immunoglobulin?
10-14 days
What is a priority intervention for someone diagnosed with hepatitis?
Symptomatic care and promote rest
Diet recommendations for someone with Hepatitis
High-carb, high-calorie, moderate fat and protein diet. Small frequent meals.
What should a patient with hepatitis avoid?
Poor hygiene, alcohol, OTC meds, and herbs
This condition is caused by permanent scarring of the liver that results in the liver shrinking and hardening causing it not to function properly
Cirrhosis
What vitamins does the liver absorb?
Fat soluble vitamins (A,D,E,K)
If a patient with cirrhosis is not absorbing vitamin K, what are they most at risk of?
Bleeding
Patient presents with jaundice, fatigue, RUQ pain, and pruritis. What do you suspect?
Cirrhosis
What can you expect to see for ALT, AST, PT/INR, and bilirubin lab values in a patient with cirrhosis?
ALT, AST, Bilirubin elevated. PT/INR decreased.
Patient with cirrhosis starts showing signs of AMS(confusion). What interventions will you do and anticipate?
Check ammonia levels for increase ( hepatic encephalopathy) and administer lactulose for treatment
What patient education should you include when giving someone lactulose?
It will cause diarrhea but that is the reason for giving it so that the extra ammonia will be excreted
How would you manage fluid volume in a patient with cirrhosis?
Diuretics and a low sodium diet
How would you manage pruritis in someone with cirrhosis?
Corticosterioid cream, avoid getting too warm, apply cool compresses
What should a patient with cirrhosis avoid
Alcohol, NSAIDS, OTC meds
Diet recommendations for someone with cirrhosis
High-cal, low-sodium-moderate fat diet
Patient presents with RUQ pain that radiates to the right shoulder after eating a high fatty meal. They also state they have a burning in the chest indicative of indigestion (dyspepsia). Upon abd assessment, you note they have rebound tenderness. What do you suspect?
Gallbladder disease
A patient with gallbladder disease is unable to have surgery as a treatment option. What treatment do you anticipate?
Gallstone stabilizing agents
A patient with gallbladder disease underwent a lapcholey, but reports feeling hungry after. What should you do next?
Determine if gag reflex has returned because they have to remain NPO until gag reflex returns and educate them about introducing one fatty food at a time
Diet recommendations for someone with gallbladder disease
High fiber, low fat diet. Eat small frequent meals. Avoid high-fat/high-cholesterol foods.
What procedure can be done to diagnose and also remove gallstones?
ERCP
Patient reports severe flank pain and sitting still makes the pain worse, dysuria, and hematuria. You notice that they are diaphoretic and appear pale. What do you suspect?
Kidney stones
What is the priority intervention for a patient with kidney stones?
Pain management (IV opioids can be used in combination with NSAIDs)
Why should a patient who is passing a kidney stone strain all urine?
To catch the stone or fragments of the stone so that it can be tested to see what is the cause of the kidney stones
How much should a patient with kidney stones be advised to drink daily?
3L/day
True or False: A patient with kidney stones can take a hot bath or apply moist heat to ease pain and promote comfort
True
What medicine is given for increased uric acid levels in someone with kidney stones?
Allipurinol
What procedure can be done to break up stones for someone with kidney stones?
Lithotripsy
What should be done preoperatively for someone undergoing a lithotripsy?
Should be placed in supine position and a topical anesthetic should be applied over the area of the stone 45 minutes prior to the procedure
What should be monitored closely in someone who is taking an antispasmolytic medication?
I&O for hydration status because antispasmolytic medications have anticholinergic effects
Ketoralac medication increases the risk of what complication?
Bleeding
What post-op education should be given to a patient undergoing a lithotripsy?
Bruising for up to 1 week and temporary hematuria are expected
What education should be given to someone taking Gentamicin or Cephalexin?
Take with food. Take the full course of medication. These can cause urine to have a foul odor.
When is an IVP contraindicated to diagnose kidney stones?
If there is a urinary obstruction, allergy to shellfish or iodine, or if they are taking metformin
When taking oxybutynin, what problems should the patient report to the HCP?
Palpitations, problems with voiding, or constipation
What should be monitored in patients taking gentamicin?
Nephrotoxicity and ototoxicity
Diet recommendations for a patient who had kidney stones due to calcium phosphate build up
Limit intake of food high in animal protein. Limit sodium intake. Reduce calcium intake (dairy products)
Diet recommendations for a patient who had kidney stones due to calcium oxolate build up
Avoid spinach, black tea, rhubarb, cocoa, beets, pecans, stawberries, peanuts, okra, and chocolate. Limit sodium intake.
Diet recommendations for a patient who had kidney stones due to magnesium ammonium phosphate build up
Avoid dairy products, red and organ meats, and whole grains
Diet recommendations for a patient who had kidney stones due to uric acid build up
Avoid organ meats, poultry. fish, gravies, red wine, sardines.
Diet recommendations for a patient who had kidney stones due to cystine build up
Limit animal protein intake
This condition injures and inflames the glomerulus. It can be acute or chronic. Acute infection comes from strep infection. Chronic infection comes from another disease/infection. It can occur at any age.
Glomerulonephritis
Patient presents with periorbital edema, fatigue, and painful urination. Patient recently had strep and has a low grade fever. What do you suspect?
Glomerulonephritis
Why would a patient with glomerulonephritis have respiratory fluid overload symptoms?
Urinary retention due to the inflammation of the glomerulus can cause fluid overload, which can then cause fluid overload in the respiratory tract
What would the lab levels look like in someone with glomerulonephritis? UA, GFR, BUN/Creatinine,K+
Urinalysis may show hematuria and proteinuria. The glomerular filtration rate may be decreased. BUN/Creatinine may be increased. Potassium may be increased.
What is the priority assessment for someone with glomerulonephritis?
FVO
What are the priority interventions for someone with glomerulonephritis?
Daily weights, fluid restriction, low sodium and low potassium diet, diuretics, antihypertensives
This 60 year old man presents with urinary frequency with a weak stream. Reports that he can not sleep because of getting up at night so often to void. Patient is obese. Reports that he used to drink coffee everyday but stopped a week ago to try to help him sleep better. What do you suspect?
Benign Prostatic Hyperplasia
What procedure would you anticipate for a patient with BPH that has tried other noninvasive treatments with no success?
TURP
Post-TURP teaching for patient
Avoid heavy lifting, drink 12 or more 8 ounce glasses of water a day unless CI, avoid NSAIDS,. If urine appears bloody, stop activity, rest, and increase fluids. Avoid meds that cause decreased bladder tone. Once cleared, frequent ejaculation helps decrease the size of the prostate.
A patient has a 3 way catheter after having a TURP procedure. The urine in the catheter is bright red with large blood clots. What should you do?
Increase CBI rate
A patient with a 3 way catheter is complaining of abdomen pain and urine output is decreased. What does this indicate and what should you do?
Obstruction; Turn off the CBI and irrigate with 50 mL irrigation solution. Contact the surgeon if unable to dislodge the clot.
True or false: A patient with a 3 way catheter will feel a continuous need to void.
True
Your patient with BPH reports difficulty urinating. What medication would you anticipate administering and how should it be taken?
Alpha 1-adrenergic antagonists (Tamulosin aka Flomax). Take with a full glass of water.
What education should you give a patient on 5-ARI (Finasteride)?
May take 6 months before medicine effects are evident. Impotence and low libido are possible adverse effects. Teratogenic to a male fetus.
The HCP wants to prescribe a medicine to reduce the size of the prostate in a patient. What medicine do you anticipate?
5-ARIs (Finasteride)
Education for a client with BPH
Avoid drinking large amounts of fluid in a short time. Avoid drinking fluids before going out or at bedtime. Limit caffeine and alcohol due to diuretic effect. Avoid drugs that can cause urinary retention (anticholinergics, antihistamines, antipsychotics, muscle relaxants)
This condition causes chronic inflammation of the rectum and rectosigmoid colon but can extend to the entire colon when the disease is extensive.
Ulcerative Colitis
Your patient reports having 10-20 bloody stools a day and pain in the LLQ, and loss of appetite. What do you suspect?
Ulcerative Colitis
Your patient is set to have a barium enema. What should you monitor for during this procedure?
Signs and symptoms of bowel perforations (rectal bleeding, firm abdomen, tachycardia, hypotension)
Findings from the barium enema shows ulcerations and narrowing of the small intestine. What does this indicate?
Crohn’s Disease
Findings from the barium enema shows ulcerations and inflammation of the sigmoid colon and rectum. What does this indicate?
Ulcerative Colitis
What diet recommendations should be given to patients with UC or CD?
High-protein, high-calorie, low-fiber diet. Avoid caffeine and alcohol. Small, frequent meals
Why would you put a patient NPO and on TPN if they have ulcerative colitis?
For extreme or long exacerbations, to promote bowel rest while providing adequate nutrition
Education for a patient with UC or CD
Take a MVI with iron, weigh 1-2 times a week
Aminosalicylates are given for UC and CD to reduce inflammation but are CI in patients who are allergic to sulfa. What education should you give the patient?
Take with folic acid. It can cause urine, skin, and contact lenses to have a yellow-orange color. Avoid sun exposure. Take with a full glass of water. Increase fluid intake to 2L/day.
Corticosteroids are given for inflammation and pain in UC and CD. What lab values should you monitor closely?
Increased sodium, decreased potassium, increased glucose, decreased calcium.. indicates Cushings Syndrome
Corticosteroids are given for inflammation and pain in UC and CD. What education should you give the patient?
Take with food. Avoid crowds and other exposures to infections.
Antidiarrheals are given to aid in control of bowel movements in UC and CD. What should you monitor for?
Hypotension, fever, abdominal distension, decrease or absence of bowel sounds.. indicates toxic megacolon
What are immunomodulators used for in UC?
To suppress the immune response because UC is an autoimmune disorder
A patient may have to have an ostomy as treatment for UC or CD. When should you empty the pouch and when should it be changed?
The pouch should be emptied when it is 1/3 to 1/2 full. Change the pouch every 3-7 days and wash the skin around it with warm water.
What should the stoma of an ostomy look like? and when should you report the condition of it to the HCP?
The stoma should be red or pink and beefy. Report to the HCP if the stoma is pale, dusky, purple, black, does not bleed when gently washed, shows rash and/or blisters.
What should be considered when fitting an ostomy for a patient?
Location, size, amount of drainage, contour of the abdomen, condition of the skin around the stoma, activities of the patient, patient’s personal preferences, age and dexterity, and cost of the equipment
Patient reports having 5-6 bloody stools a day, stool that appears white(steatorrhea), weight loss, and pain in the RLQ. What do you suspect?
Crohn’s Disease
This condition is a chronic inflammatory disease of the small intestine, the colon, or both but can involve the entire GI tract.
Crohn’s Disease
An Xray of the GI tract shows a cobblestone appearance. What does this indicate?
Crohn’s Disease
Immnosuppressants are given to clients with Crohn’s Disease. What should you monitor for?
Pancreatitis and neutropenia
Immunosuppressants are given to clients with Crohn’s Disease. What should you tell the patient that is taking this?
It can take up to 6 months to see therapeutic effects
If an abscess and fistula form from Crohn’s Disease, what are the nursing interventions?
Monitor F&E and for dehydration. Provide high protein and high calorie (at least 3000 calories/day), low fiber diet. Administer a vitamin supplement. Monitor for infection.
Your patient on antidiarrheals develops toxic megacolon and is now at risk for perforation. What are your nursing interventions?
Maintain nasogastric suction, administer IV fluids and electrolytes, administer antibiotics and corticosteroids, and prepare client for ileostomy placement if no improvement is shown within 72 hours.
