VN 22 Test 9 Flashcards
- Antacids K,H,K
Aluminum is for constipation
Magnesium is for diarrhea
Fluid retention
Electrolyte imbalance
1 -2 hr before or after other medication
Avoid patients with heart problems
Monitor kidney function
- 1-2 hr after meals
- Gastrectomy nursing considerations/client Education
Dumping syndrome: due to rapid emptying after surgery*
(Diarrhea, sweating, palpating, abdominal cramps)
Can cause B12 deficiency; you may need B12 shots for life*
Gastric acid provides components necessary for b12 absorption*
- Barium swallow nursing considerations and client education
Monitor the passage of the stool and color. It will come out white, streaky or color clay at first then going to normal*
Fast must fast after midnight the night before the test
2 to 3 days client place on a low-residue diet before the test
NPO for 8 to 12 hours
Do not smoke for 12 to 24 hours before the procedure
All medications are withheld on the day of procedure
After the procedure encourages client to drink fluids for constipation
•Is fluroscopic observation of the client actually swallowing a flavored barium solution and its progress down the esophagus. The patient will first receive a thick mixture, then a thin one; the patient must drink 12 to 14 oz (360 to 420mL) during the examination, typically oblique position
- G-tube/NG tube: Assessment and Implementation
Assessment:
Good mouth care to counter tastes/odor*
Frequent assessment of Bowel Sounds*
Implementation:
Flush tube every 4hr*
Elevate HOB to 45 degrees/ semi-fowlers/ repositioning frequent*
Change bag and tubing daily*
Include drainage in I&Os*
Monitor labs (electrolytes and hematocrit)*
- EGD nursing considerations
Left side-lying with head of bed elevates
NPO for 6-8hr prior to the exam
Remove dentures prior to procedure
Monitor vital signs and respiratory status. Maintain an open airway until the client is awake
Notify the provider of bleeding, abdominal or chest pain, and any evidence of infection
Withhold fluids until return of gag reflex
Discontinue IV fluids therapy when the client tolerates oral fluids without nausea and vomiting
Instruct the client not to drive or use equipment for 12 to 18 hours after the procedure
Reinforce teaching with the client to use throat lozenges if a sore throat or hoarse voice persists following the procedure
- during the procedures monitor pain and discomfort
- after the procedure monitor gag reflex
- Dysphagia nursing considerations
Montior for aspiration
Place food on unaffected side
Tuck in chin to chest while swallowing
Have suction equipment available
Avoid distractions to prevent chocking
Check gag reflux
- Esomeprazole and omeprazole K,H,K
-Prazole: to reduce gastric acid
-GERD, gastric/duodenal ulcers, erosive esophagitis
-Limited 4-8 week of treatment
Avoid NSAIDS*
Monitor for electrolyte imbalance and hypoglycemia in clients who have diabetes mellitus (Monitor blood sugar)
Digoxin level increase (monitor digoxin levels 0.8-2)
Avoid Alcohol
Complete the prescribed regimen, even when manifestations subside
Rabeprazole (take with or without food) and Pantoprazole are enertic coated tablets (Not crush)
Long term use can have a development of pneumonia and C-diff. (Monitor stool and asses for lung sounds)*
Long term use of more than 14 days have risk for bone fractures especially in older adults (increase vitamin D & calcium)*
Can be be given prophylactic*
- PUD manifestations
Manifestations
Severe pain (upper abdomen and back)*
Bleeding Hematmesis (bloody emesis) Melena (bloody stools)*
Relieve after eating*
Weight loss
If severe could mean perforation?*
- PUD complications
Perforation/Hemorrhage (when peptic ulcer perforate or bleed, it is an emergency situation)
Pernicious anemia (occurs due to a deficiency of the intrinsic factor normally secreted by the gastric mucous)
Dumping syndrome (This can occur following gastrectomy surgery)
- Hemorrhoids manifestations
External hemorrhoids:
Soreness*
Lumps*
Itching*
Internal hemorrhoids:
Bleeding*
Anemic *
- Protrrusion*
- Colonoscopy recommended screenings/criteria
The American Cancer Society recommended that beginning at age 50, average-risk adults get a colonoscopy every 10 years*
- Anorexia nervosa manifestations and Priority
Manifestations:
Absence of hunger*
Nausea*
Constipation*
Amenorrhea*
Priority:
Hypokalemia electrolyte imbalance*
Signs:
Muscle weakness*
Fatigue*
Set up on patient on EKG*
- Sulfasalazine K,H,K
Use: reduces inflammation of the intestinal mucosa and inhibits prostaglandins
Take with full glass of water after meals
Avoid exposure to sunlight
Urine may be orange yellow. Contacts can turn yellow tint as well
Caution with chronic kidney and hepatic function
Contraindication with patient allergic to sulfa or salicylate
Increase fluids intake to 2L/day
AE: nausea fever, and rash
- Colon cancer manifestations and risks
Manifestations:
Bowel habit change*
Occult blood in stool*
Distended abdomen*
Risks:
Genetics*
Life*
Environment/ age uncommon under 40*
Polyps*
- Ulcerative colitis manifestations
Diarrhea*
Blood*
Pain*
Dehydration*
Anorexia*
Weight loss*
- Endoscopy nursing considerations
-verify consent form has been signed
-obtain vitals & verify client’s allergies
-Report unexpected findings of laboratory tests, chest x-ray, ECG, and ABG’S
- review client’s medical history for increased risk of complications.
-notify physician if dietary restrictions weren’t followed
-Ensure client is NPO prior to procedure
-Ensure client followe proper bowel preparation
- Adalimumab K,H,K
Use for suppresses the immune response and Inhibits tumo necrosis factor, an antibody found in Chron’s disease
Self administered by SQ injection
AE: chills, fever, hypotension/hypertension, dysrhythmias, and blood dyscrasias
Monitor Liver enzymes, coagulation and CBC
Avoid crowds and other exposures to infectious disease
Monitor and report bleeding, or infection and transfusion or allergic reaction
- Corticosteroids K,H,K
Use for reduce inflammation and pain
Not for long-term use due to AE
Prolonged use can lead to adrenal suppression, osteoporosis, risk for infection, and Cushing syndrome)
Monitor BP, electrolytes and glucose
Take oral dose with food
Avoid discontinuing dose suddenly
Report unexpected increase in weight or other indications of fluid retention
Avoid crowds and other exposures to infectious disease
Report evidence of infection (Chrons disease can mask infection)
- FOBT client education (Fecal Occult Blood Test)
No Aspirin or NSAIDS/ASA prior*
Avoid raw fruits, vegetables, red meat, yeast, vitamin C rich foods, poultry, fish, beets for 3 day prior to obtain sample*
- Ulcerative colitis and Crohn’s disease nursing considerations
Monitor and schedule colonoscopies*
Find triggering foods*
Monitor for electrolyte imbalance*
Assess for dehydration with good I&Os*
Monitor for anemia*
Monitor for mega colon*
Avoid high fiber intake*
Educate cleint may have exacerbations and remissions*
Mega colon: from inactivity of the colon risk for perforation
- Peritonitis manifestations
Lack go bowel motility*
Rapid respiration*
Tachycardia*
Rigid abdomen*
- Nursing interventions for hiatal hernia
Sit upright for 2 hours*
Raise head of bed*
Avoid Valsalva*
Avoid spicy foods*
Avoid alcohol/smoking*
- Sucralfate K,H,K
Use for Ulcer
Allow 30 minutes before or after to give antacids
Take on empty stomach, 1 hr before meal. Needs to coat lining*
Do not smoke or drink alcohol
Continue to take medication even if manifestations subside
Can cause constipation
Cautions with patient with chronic kidney and diabetes
- Appendectomy nursing considerations
Assess pain level*
Prep for surgery NPO status*
Delivered IV fluids*
Obtain surgical consent*
If you come to ER with pain with a appendicitis and out of nowhere you have no pain, it be a sign for a ruptured so you need to call the provider*
- Gastric bypass nursing considerations
Gradually progress to 5-6 smal; meals a day-less than open cup*
Chew food slowly take an hour to eat*
Withhold fluids 15 minutes before and during meals*
Less than 2g fiber per serving*
Stop eating when full*
- Diverticulitis client education
Avoid food containing seeds (nuts, popcorn,seeds) ‘don’t get fooled with healthy choices’*
- High fiber *
Consume a clear liquid diet until manifestations subside
Avoid foods or drink that can irritate the bowel (Avoid alchol. Limit fat to 30%of daily calories intake
- Diarrhea complications
Electrolyte imbalance hypokalemia*
Increase high in potassium*
- Constipations complications
Decrease narcotics*
Encourage exercises*
Increase fluids*
Increase fiber*
- Upper GI series (with small bowel series) Nursing priorities
During the procedure: Monitor pain/ discomfort*
After the procedure: Monitor gag reflex*
- GERD Nusring Management
Radiating pain to neck, jaw, neck*
Burning in esophagus*
Pain worsens with positions*
Throat irritation*
Relieved by sitting upright after eating for at least 2 hours*
Avoid large meals; Carbonated beverages*
GERD can cause esophagus Cancer*
- Esophageal Cancer Implementation
Improve nutrition and weight loss*
Soft or semi-liquid foods with high protein*
Avoid gassy foods*
Avoid straws*
Small frequent meals*
Straws causes gas*
- Irritable Bowel Syndrome Implementation/Client education
Increased risk of colon cancer*
Exacerbation and remission common*
Avoid high fiber quickly*
Monitor daily weight, I&O, and Bowel sounds*
(Medical Management)Anti-cholinergic: reduces spasms or contractions in the intestines. By block the action of a neurotransmitter called acetylcholine*
- Crohn’s Disease Assesment Findings
RLQ distention (near ileum) and pain*
Chronic diarrhea*
Fever*
Growth failure*
Malnourishment*
Weight loss*
