MEDSURG 2 EXAM #3 Flashcards
Weeks 5, 6, & 7
What to study for EXAM #3
— Diarrhea, constipation, and incontinence
— What is the purpose and what does the RN need to do to help with issue
— Distinguish the process of food breakdown
— What to include in teaching for a procedure (pre/intra/post)
— Objective 1 for sureeee
— How to assess (order and direction)
— Difference b/w ostomies and kind of stools to expect; tx
— Types of hernias, location, which type is an considered an emergent event
— B12, Niacin for vitamin therapy with Cirrhosis patients
— Short gut syndrome
— Metabolic syndrome: detect DM
— Management for UGI if patient comes in = color of stool/vomitus vs. lower GI
— Guaiac test: detect if blood in stool + EGD = NPO + clear liquids + bowel prep (Go-Lytely), have gag reflux to make sure they can eat again
— Peptic Ulcer Disease
— Projectile vomiting may mean what? = ICP
— Protein formula = 0.8 * kg
- Describe the structures and functions of the organs of the gastrointestinal tract.
Hepatitis or Cirrhosis lab findings
— Elevated AST, ALT levels
- Describe the structures and functions of the liver, gallbladder, biliary tract, and pancreas.
Elevated ALP levels indicates ________ damage
liver
- Distinguish the processes of ingestion, digestion, absorption, and elimination.
- Explain the processes of biliary metabolism, bile production, and bile excretion.
- Link the age-related changes of the gastrointestinal system to the differences in assessment findings.
- Obtain significant subjective and objective assessment data related to the gastrointestinal system from a patient.
- Perform a physical assessment of the gastrointestinal system using appropriate techniques.
- Distinguish normal from abnormal findings of a physical assessment of the gastrointestinal system.
- Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the gastrointestinal system.
- Describe the etiology, clinical manifestations, and interprofessional and nursing management of malnutrition.
- Describe the components of a nutrition assessment.
What is malabsorption syndrome + results from?
Malabsorption Syndrome: impaired absorption of nutrients from the GI tract
May result from:
— ↓ enzymes
— Drug side effects
— ↓ bowel surface area
— Fever increases BMR
- Explain the indications, complications, and nursing management related to the use of enteral nutrition.
- Explain the indications, complications, and nursing management related to the use of parenteral nutrition.
- Compare the etiology, clinical manifestations, and nursing management of eating disorders.
- Discuss the epidemiology and etiology of obesity.
- Explain the health risks associated with obesity.
- Use classification systems to determine body size.
- Discuss comprehensive therapy for the patient with obesity.
- Distinguish among the bariatric surgical procedures used to treat obesity.
- Describe the nursing and interprofessional management related to surgical therapies for obesity.
- Describe the etiology, complications, and interprofessional and nursing management of nausea and vomiting.
- Describe the etiology, clinical manifestations, and nursing and interprofessional management of metabolic syndrome.
- Discuss the etiology, clinical manifestations, and interprofessional and nursing management of common oral inflammations and infections.
- Describe the etiology, clinical manifestations, complications, and interprofessional and nursing management of oral cancer.
- Explain the types, pathophysiology, clinical manifestations, complications, and interprofessional and nursing management of gastroesophageal reflux disease and hiatal hernia.
- Relate the pathophysiology, clinical manifestations, complications, and interprofessional management of esophageal cancer, diverticula, achalasia, and esophageal strictures.
- Compare acute and chronic gastritis, including etiology, pathophysiology, and interprofessional and nursing management.
- Distinguish gastric and duodenal ulcers, including etiology, pathophysiology, clinical manifestations, complications, and interprofessional and nursing management.
- Outline the clinical manifestations and interprofessional and nursing management of stomach cancer.
- Explain the common etiologies, clinical manifestations, and interprofessional and nursing management of upper gastrointestinal bleeding.
- Identify common types of foodborne illnesses and nursing responsibilities related to food poisoning.
- Explain common causes and interprofessional and nursing management of diarrhea, fecal incontinence, and constipation.
- Describe common causes of acute abdominal pain and nursing management of the patient after a laparotomy.
- Describe the interprofessional and nursing management of acute appendicitis, peritonitis, and gastroenteritis.
- Compare and contrast the inflammatory bowel diseases of ulcerative colitis and Crohn’s disease, including pathophysiology, clinical manifestations, complications, and interprofessional and nursing management.
- Distinguish among small and large bowel obstructions, including causes, clinical manifestations, and interprofessional and nursing management.
Ulcerative Colitis
Onset: teens to mid-30s. >60YO
Abdominal pain = common, severe constant
Diarrhea = common
Fever = during acute attacks
Malabsorption/nutritional deficiencies = minimal
Rectal bleeding = common
Tenesmus [gotta go, gotta poooo!] = common
Weight loss = rare
Location/distribution: usually starts in RECTUM and spreads in continuous pattern UP the colon; continuous areas of inflammation
Cobblestoning of mucosa? NOPE, rare
Depth of involvement = just mucosa
Peudopolyps = common, minimal small bowel movements
Increased risk of C.diff
Perinatal abscess/fistulas = rare
Strictures = occasional
Toxic mega colon = more common = common perforations
- Describe the clinical manifestations and interprofessional and nursing management of colorectal cancer.
Crohn’s Disease
Onset: teens to mid-30s. >60yo
Abd pain/diarrhea/fever: common w/ cramping; common
Malabsorption: common
Rectal bleeding + tenesmus: sometimes/rare
Weight loss = common, may be severe
Location = occurs anywhere along the GI tract; most common site = distal ileum
Cobblestoning of mucosa = common
Pseudopolyps = rare
Small bowel involvement = common
Increased risk of C.diff
Perforation = common (b/c inflammation involves entire bowel wall)
Abscess/fistulas/strictures = common
- Select nursing interventions to manage the care of the patient after bowel resection and ostomy surgery.
- Distinguish between diverticulosis and diverticulitis, including clinical manifestations and interprofessional and nursing management.
- Compare and contrast the types of hernias, including etiology and surgical and nursing management.
— Inguinal = most common
— Femoral
— Umbilical
— Ventral
— Incisional
- Describe the types of malabsorption syndromes and interprofessional care of celiac disease, lactase deficiency, and short bowel syndrome.
Celiac disease — AID that causes damage to small intesting
Lactase deficiency — condition in which the lactase enzyme is deficient or absent
Short gut syndrome — small intestestine doesn’t have enough S.A. to absorb nutrients, —> unable to meet E, F/E, nutritional needs to stay healthy on a normal diet | Tx: complex carbs (e.g. starch, white/brown rice, bread), high protein, moderate fat
- Describe the types, clinical manifestations, and interprofessional and nursing management of anorectal conditions.
- Distinguish among the types of viral hepatitis.
- Describe the interprofessional and nursing management of the patient with viral hepatitis.
- Explain the pathophysiology, clinical manifestations, complications, and interprofessional and nursing management of the patient with cirrhosis.
- Describe the clinical manifestations and management of liver cancer.
- Distinguish between acute and chronic pancreatitis related to pathophysiology, clinical manifestations, complications, and interprofessional and nursing management.
- Explain the clinical manifestations and interprofessional and nursing management of the patient with pancreatic cancer.
- Describe the pathophysiology, clinical manifestations, and interprofessional care of gallbladder disorders.
- Describe the nursing management of the patient undergoing surgical treatment of cholecystitis and cholelithiasis.
Cholecystitis: inflammation of gallbladder r/t gallstones
__________
Cholethiasis:
— BMI must be WNL
— Must have small, cholesterol-based stones
Know the Assessment of the GI system and ORDER
start from RLQ in zig-zag; end at LLQ
Inspection
Auscultate
Percuss
Palpate
Preparing patient for colonoscopy. What are the expectations for the nurse?
– Check stool to make sure they passed it
– Bowel prep to ensure intestines are cleared out
— Consent!
Steps for placing NG tube
What to check for tube feedings
Flush the tube with 30 mL of water
- tell patient what you are doing
- gather and dispose of all waste in the proper receptacle
- lower the head of the bed to no less than 30 degrees
-document the feeding, dose, solution, volume, time, and your initials
- be sure to document the patients response including any adverse reactions
Complications of enteral nutrition/feedings
Vomiting
Diarrhea
Constipation
Dehydration
— More calorically dense, less water formula contained
— Check for high protein content
Formula for protein intake
0.8 to 1g/kg of body weight
Example: Patient weighs 70kg x 0.8 = 56g protein DAILY
Which patients cannot tolerate a high protein diet?
Liver disease patients (cannot process protein well)
Which tubes will be least the risk for aspiration?
J-tube, because it is at the furthers distance
– Located in the small intestine
– Formula: pre-digested food b/c bypassing stomach (acid contents)
What must the RN do when preparing a parenteral nutrition (hanging TPN)? SATA
Slide 19 – hypovolemic shock
Scenario
Bland diet
NO SODAS
Hiatal Hernia Complications
–GERD
–Esophagitis
–Hemorrhage from erosion (= emergency)
–S
Labs, Dx, RN responsibility in the Dx tests, esophageal varices
Causes of diarrhea