Week 7

Question 1

What is the presenting symptom of greatest relevance

Answer 1

pain

Question 2

Bowel sounds that are diminished, absent or hyperactive in one quadrant may indicate

Answer 2

a complete bowel obstruction, acute peritonitis or paralytic ileus

Question 3

short bowel syndrome

Answer 3

results from extensive resection of the small intestine. Causes rapid intestinal transit, impaired digestion/absorption and electrolyte imbalances

Question 4

Clinical manifestations of short bowel syndrome

Answer 4

diarrhea, weight loss, malnutrition and multiple vitamin deficiencies

Question 5

What diet is recommended for short bowel syndrome

Answer 5

a diet high in carbs and low in fat

Question 6

How many meals should a patient with SBS eat per day?

Answer 6

6-8 small meals per day to increase the time food is present and in contact with the small intestine

Question 7

intestinal obstruction

Answer 7

occurs when a partial or complete obstruction of the intestine prevents intestinal contents from passing through GI tract. Requires prompt treatment

Question 8

Mechanical obstruction

Answer 8

may be caused by occulsion of the lumen of the intestinal tract

Question 9

what is the most common cause of large bowel obstruction?

Answer 9

carcinoma

Question 10

Nonmechanical obstruction

Answer 10

may result from a neuromuscular or vascular disorder

Question 11

what is the most common cause of nonmechanical obstruction?

Answer 11

paralytic ileus (lack of intestinal peristalsis)

Question 12

best way to avoid nonmechanical obstruction?

Answer 12

early feeding and early ambulation

Question 13

what happens when the obstruction is located in the small bowel?

Answer 13

dehydration occurs rapidly

Question 14

If the obstruction is high, as in the pylorus, what may result?

Answer 14

metabolic alkalosis may result from a loss of HCL from the stomach through vomiting or NG suction

Question 15

what usually relieves pain in high intestinal obstructions

Answer 15

vomiting

Question 16

what is a common manifestation of intestinal obstruction?

Answer 16

abdominal distension

Question 17

with intestinal obstruction, tenderness and rigidity are often?

Answer 17

absent unless strangulation or peritonitis has occurred.

Question 18

what would you find upon auscultation of intestinal obstruction?

Answer 18

high pitched sounds above the area of obstruction

Question 19

Treatment for intestinal obstruction

Answer 19

decompression of the intestine by removal of gas and fluid, correction and maintenance of fluid and electrolyte balance and relief of removal of the obstruction

Question 20

What should be given to maintain fluid and electrolyte balances when there is intestinal obstruction?

Answer 20

IV infusions of NS and K+

Question 21

Mechanical obstruction are treated?

Answer 21

surgically

Question 22

Once an NG tube is inserted, it is extremely important to?

Answer 22

confirm placement of the tube (X-ray), ensure the tube is properly secured, provide appropriate nasal and mouth care

Question 23

What is an excessive volume of NG loss?

Answer 23

more than 500-1000 mL in 24 hrs

Question 24

what is the most common symptom of colorectal cancer

Answer 24

rectal bleeding which most commonly occurs with left-sided lesions

Question 25

cancers of the right side of the colon are usually

Answer 25

asymptomatic

Question 26

what is a clinical manifestation of colorectal cancer

Answer 26

alternating constipation and diarrhea

Question 27

what is the most important aspect of the physical exam for colorectal cancer?

Answer 27

the digital rectal exam because most rectal cancers can be within the reach of a finger

Question 28

informed consent

Answer 28

is an active, shared decision making process between the provider and the recipient of care

Question 29

who is responsible for obtaining consent?

Answer 29

the physician/surgeon

Question 30

in the immediate post anesthetic period, what will most commonly compromise airway?

Answer 30

obstruction, hypoxemia and hypoventilation

Question 31

Airway obstruction is most commonly caused by

Answer 31

blockage of the airway by the patients tongue when the patient is extremely sleepy after surgery

Question 32

common causes of respiratory problems for postoperative patients?

Answer 32

atelectasis and pneumonia especially after abdominal and thoracic surgeries

Question 33

The postoperative development of mucous plugs and decreased surfectant production are directly related to?

Answer 33

hypoventilation, constant recombant position, ineffective coughing and history of smoking

Question 34

How often should the patient perform deep breathing?

Answer 34

10 times every hour while awake

Question 35

PE should be suspected in any patient complaining of?

Answer 35

tachypnea, dyspnea, tachycardia, chest pain, hypotension, hemoptysis, dysrhythmias and heart failure

Question 36

Low molecular weight heparins

Answer 36

moxaparin and lovenae

Question 37

Advantages of LMWH over unfractionated heparin

Answer 37

less major bleeding, decreased incidence of thrombocytopenia, better absorption, longer duration of action, no laboratory monitoring

Question 38

What do you have to monitor when using unfractionated heparin?

Answer 38

PTT which is a measurement of how long it takes for platelets to stop bleeding, Normal PTT is 20-40 seconds

Question 39

postoperative pain is most severe?

Answer 39

within the first 48 hours after surgery

Question 40

what is required to relieve pain within the first 48 hours after surgery?

Answer 40

Narcotics, after this non-narcotic analgesics may be sufficient

Question 41

incidence of wound sepsis is higher in patients who are?

Answer 41

malnourished, immunosuppressed, elderly or those who have had a prolonged hospital stay/ surgical procedure lasting longer than 3 hours

Question 42

surgical site infections occur within?

Answer 42

30 days of surgery or within 1 year of implant surgery

Question 43

wound dehisence

Answer 43

separation and disruption of previously joined wound edges

Question 44

evisceration

Answer 44

medical emergency. Protrusion of visceral organs through a wound opening

Question 45

Treatment for evisceration

Answer 45

cover organs with sterile saline soaked surgical towels, keep patient NPO, monitor vitals and observe for signs of shock and call surgeon immediately

Question 46

postoperative oliguria

Answer 46

a decrease in urine output ( <500 ml) in the first 24 hrs after a major operation regardless of fluid intake

Question 47

causes of postoperative oliguria

Answer 47

stress of surgery, fluid restriction before surgery, loss of fluids during surgery, drainage and diaphoresis

Question 48

what does persistent oliguria indicate

Answer 48

inadequate renal perfusion and pending renal failure