Adults 1 Exam 3 Study Set

What signs and symptoms might we expect to see in a patient with a DVT?

- Slightly elevated temperature - Leukocytosis - Unilateral extremity edema - Tenderness on palpation - Feeling of "fullness" in affected limb - Skin warm to touch - Redness of skin - Numbness and Tingling (parasthesia)

What nursing interventions would you anticipate for a person in hypovolemic shock from a massive GI bleed?

-2, large bore IVs for fluid resuscitation. -Supplemental O2 -Record Is and Os -Monitor ABCs -Measure Urine output hourly -ECG for cardiac monitoring -Elevate head of bed to prevent aspiration -Auscultate breath sounds (listening for pulmonary edema) -IV PPI to decrease acid secretion - Administer IVF, packed RBCs, FFPs as needed. -NG tube as needed (to remove blood pooling in GI tract or to prevent spillage from a perforation).

What are some nursing interventions for Raynaud's Phenomenon? What medications can help?

-Avoid Extreme Cold - Wear loose, warm clothing - Smoking cessation Meds: Basically vasodilators -Calcium channel blockers -Nitroglycerin

What are some nutritional modifications to treat GERD?

-Avoid foods that lower LES pressure. These include fatty foods, coffee, alcohol, chocolate, peppermint, and tea. -Avoid foods that might irritate the esophagus: Tomato products, orange juice, cola, red wine, urine, battery acid. -Avoid late night snacking and milk at bedtime (it increases gastric acid secretion) -Chew gum or take oral lozenges to help with mild symptoms.

Which of the following assessment findings would you expect in a patient with a gastric outlet obstruction caused by PUD? (SATA) A. Grunting respirations B. Nausea/Vomiting C. Sudden, severe pain D. Abdominal distention despite NG suction

-B and D are correct. (N/V and Abdominal distention w/NG tube). -Grunting respirations and sudden, severe pain are signs of peritonitis, which is another complication of PUD.

Which statement by the nurse to the patient during NG tube removal demonstrates an understanding of proper removal technique? A. "Take a sip of water and swallow when you feel the tube in the back of your throat. B. "Please hold your breath while I remove the tube". C. "You will feel suction in your throat as I remove the tube" D. "I'm going to lay you flat to make removing the tube easier".

-B is correct. The patient should hold their breath while the tube is removed to reduce the risk of aspiration. -A represents instructions for tube placement, not removal. -C is BAD. Suction should not be running while the tube is being removed. -D you do not lay patients flat while they have an NG tube in place.

What are some S/S of GI bleeding?

-Bright red or coffee-ground emesis -Melena (Black, tarry stools) -Peritonitis (From fluid leaking into peritoneum) -Tachycardia -Weak pulse -Hypotension -Prolonged cap refill -Cool extremities -Low urine output

Inflammatory Bowel Disease (IBD) is an umbrella term for inflammatory bowel disorders including...

-Crohn's Disease -Ulcerative Colitis

What are three preventative strategies to reduce the risk of DVTs? What are some preventative medications?

-Early mobility post-op - Thrombo-Embolic Deterrent (TED) hose - Sequential Compression Devices (SCDs) - Sub-Q heparin/Enoxaparin (Lovanox)

What are some lifestyle modifications to treat GERD?

-Elevate the head of the bed at night (helps prevent reflux) - Don't lie supine for 2-3 hours after meals. -Smoking cessation -Exercise (Obesity increases intrabdominal pressure and contributes to GERD). - Stress management (meditation, breathing exercises, cathartic pickleball)

What are some treatments and nursing interventions for a GI bleed?

-Endoscopy/Endoscopic hemostasis therapy (mechanical, thermal ablation, drug injection). Endoscopy is used for both diagnostic and therapeutic purposes. - PPIs to neutralize stomach acid. Platelet stability and clotting are negatively affected by an acidic environment. PPIs raise the Ph, allowing natural clotting to occur and reducing the amount of bleeding. -Antacids (same reasoning as PPIs) -IV fluids (lactated ringers) -NPO -Prophylactic antibiotics if perforation has occured.

Which type of ulcer (gastric or duodenal) has a higher mortality rate?

-Gastric ulcers tend to have a higher mortality rate, even though they perforate at lower rates than duodenal ulcers. This is because patients with gastric ulcers tend to be older (50-60yrs vs. 35-45yrs) and have comorbid or concurrent medical problems. -Gastric ulcers also increase cancer risk, whereas duodenal ulcers do not.

What are the three major complications of chronic PUD?

-Hemorrhage (upper GI bleeding) -Perforation (the ulcer penetrates the serosa and spills gastric contents into the peritoneal cavity). -Gastric Outlet Obstruction (edema, inflammation, pylorospasm, and/or fibrous scar formation result in obstruction of the GI tract).

A patient with a new ileostomy experiences a return of peristalsis. Should the nurse expect ileostomy output to be higher or lower than normal?

-Higher than normal. When peristalsis returns, output may be as high as 1500-1800mL/day -Normal output is around 500mL/day

A patient presents to the ED with nausea, fecal-smelling vomit, abdominal pain and distention, and an inability to pass gas. They are unable to have a bowel movement. -What is the likely issue with this patient? -What would conservative treatment involve? -What would non-conservative treatment involve?

-Intestinal Obstruction is the most likely problem. -Conservative treatment involves pain management, fluid resuscitation, and close monitoring for hypovolemia and septic shock. Most likely, this patient will also have an NG tube inserted. -Non-conservative treatment will involve surgery. This is typically done with complete and/or strangulated obstructions.

What are some priority interventions for a patient with a bowel perforation?

-NG tube suction to prevent spillage of gastric contents into the peritoneum. -NPO. -IV fluids to restore fluid volume -Monitor electrolytes -Monitor for infection.

What are some important features of peri-operative care for a client who has had a gastrectomy?

-NPO until treatment -Expect dark, bloody secretions up to 24 hrs post-op. -After 24 hours, secretions should become more bile-like. -Frequent abdominal assessments. -Ask about passing gas to determine when abdominal peristalsis resumes. -Discuss incisional splinting to manage pain.

What are some risk factors for Peptic Ulcer Disease?

-Nicotine use. -NSAID use. -H. pylori infection. -Alcohol. -Stress.

During handoff to night shift, the day nurse gives you report on a patient who had an active lower GI bleed yesterday that was treated through endoscopic hemostasis in the morning. The nurse informs you that the patient just had a bowel movement with a dark, tarry stool. Does this finding warrant calling the provider?

-No. Dark, tarry stools are not always indicative of an active GI bleed. They may occur for some time after a GI bleed has been resolved. This patient warrants further assessment, but not an immediate call to the provider. -Bright red blood would be concerning, as it indicates an active bleed.

What are some potential complications of Crohn's Disease and Ulcerative Colitis?

-Nutritional Deficits (Especially Crohn's) -Hemorrhage -Strictures -Perforation -Fistulas (Especially Crohn's) -C. diff -Colorectal Cancer

What are some risk factors for developing a GI bleed?

-PUD -Esophagitis (result of GERD, smoking, alcohol, some drugs) -Esophageal varices (result of liver cirrhosis) -NSAIDs -Corticosteroids -Mallory-Weiss Tear -Cancer -Diverticula

What are some medications that can be used to treat GERD?

-Proton Pump Inhibitors (PPIs) such as omeprazole: Raise stomach pH with a long duration (up to 3 days). Helps prevent/heal esophagitis and prevents strictures. -H2 receptor blockers (Famotidine, Cimetidine). Basically do the same thing as PPIs, but with a shorter onset and duration of action. -Antacids: Provide short-term relief by neutralizing stomach acid. Best taken 1-3 hours after meals to maximize effect duration.

A patient who recently had a gastrectomy for stomach cancer complains of dizziness, weakness, sweating, and palpitations after eating. They also have abdominal cramping and borborygmi (audible abdominal sounds) within 30 minutes of eating and up to an hour after eating. What post-gastrectomy complication do you suspect, and what is the basic etiology?

-This fits the symptom picture of Dumping Syndrome. -DS results from removal of the pyloric sphincter and resultant lack of control over the movement of chyme into the duodenum. This results in large boluses of hypertonic chyme being dumped into the SI, which causes a massive fluid shift into the intestinal lumen. -The S/S of DS are caused by loss in plasma volume (dizzy, weak, diaphoretic, palpitations) and intestinal hypermotility (abdominal cramping, borborygmi, urge to defecate).

An 11-year-old patient presents to the ED. They suddenly developed periumbilical pain yesterday. Their parents decided to bring their child to the ED when they started experiencing nausea and vomiting. The pain is persistent and continuous, eventually shifting to the right lower quadrant and localizing at McBurney's point. What is their likely Dx? What is the most likely intervention?

-This matches the description of appendicitis. -Standard intervention is an appendectomy. -The patient may also require antibiotics and IV fluids. -Pain can be treated with Ice Packs and medication.

A patient recently underwent a gastrectomy that involved removal of the pyloric sphincter. They come into the hospital complaining of continuous epigastric distress that increases after meals. They have vomited intermittently, which temporarily relieves the pain. -Which post-gastrectomy complication are they experiencing? -What is the etiology and treatment?

-This patient is experiencing bile reflux gastritis, which occurs when bile refluxes back into the stomach from the duodenum through a damaged or missing pyloric sphincter. This can cause damage to the gastric mucosa and result in chronic gastritis and PUD. -Taking cholestyramine (a bile salt binder) before meals helps to treat this problem.

A patient with a duodenal ulcer experiences sudden, severe abdominal pain which radiates to their back and shoulders. Neither food nor antacids are able to relieve the pain. Their abdomen is rigid and boardlike. Their respirations are shallow and rapid. They are tachycardic, with a weak pulse. Bowel sounds are absent. -What complication of PUD do you suspect? -What interventions do you anticipate?

-This patient is most likely experiencing a perforation of their duodenal ulcer, causing spillage of gastric contents into the peritoneum. -Interventions for perforation are focused on stopping spillage of gastric contents and restoring fluid volume. Interventions include: 1. NG tube on continuous suction to suck up gastric contents before they can spill out. 2. IV lactated Ringer's and albumin 3. If blood loss is severe, packed RBCs may be administered. 4. Antibiotics for prophylaxis of bacterial peritonitis.

A patient with an acute exacerbation of their PUD is NPO and placed on a NG tube suction to help heal their ulcer. When you enter their room for a vitals check, you find that the NG suction container contains a significant amount of red aspirate. The patient is tachycardic and dizzy, with 1+ peripheral pulses. Their blood pressure is 84/53 mmHg. The patient states that their pain has improved since the last pain assessment. -What PUD complication do you suspect? -What interventions do you anticipate?

-This patient is presenting with manifestations of a hemorrhage (upper GI bleed) resulting from massive bleeding from their ulcer. -Interventions include IV fluids replacement (lactated Ringer's) and supplemental oxygen to increase blood oxygen saturation. If this is a massive hemorrhage, packed RBCs and FFPs may also be given. - IV PPI can help to reduce damage and prevent further bleeding. - Endoscopic hemostasis therapy can target the source of the bleed. This may involve clips or bands, thermal ablation, or chemical injection. - If the patient is refractive to the above treatments, surgical interventions may be attempted.

Which Inflammatory Bowel Disease has primary symptoms of bloody diarrhea and abdominal pain, and affects only the mucosal layer of the rectum and colon?

-Ulcerative Colitis presents with abdominal pain and severe diarrhea (pts may have up to 20 stools a day). -Ulcerative colitis only affects the mucosal layer of the bowel. Contrast this to Crohn's, which can affect all layers of the bowel wall.

What are some potential complications arising from NG tubes placed on suction?

1. Aspiration. 2. Metabolic alkalosis. 3. Electrolyte imbalances. 4. Skin breakdown in nare. 5. Nausea/vomiting 6. Xerostomia

What are two postoperative complications that can result from a gastrectomy?

1. Dumping syndrome: A direct result of removal of a large part of the stomach and pyloric sphincter. Gastric chyme no longer enters the duodenum in small amounts through the PS, but is instead dumped (see what I did there?) into the small intestine. The influx of a large bolus of hypertonic fluid into the SI causes fluid to osmose into the SI lumen. As a result, you get decreased plasma volume, distention of bowel lumen, and rapid intestinal transit. S/S: Start 15-30 minutes postprandial. Weakness, sweating, palpitations, dizziness, abdominal cramps, borborygmi, and the urge to defecate. 2. Post-prandial hypoglycemia. Will discuss details on another card since this one is already bloated (get it? I'm hilarious : {).

What are some important steps to take during NG tube removal?

1. Turn off suction. 2. Flush the tube with at least 30mL air. 3. Pinch off the tube 4. Have the patient hold their breath 5. Remove the tube slowly and steadily.

When running an irrigation for a colostomy, how high should you hang the bag above the stoma?

18-24 inches

What is the difference between a simple and a strangulated bowel obstruction?

A simple obstruction has an intact blood supply. A strangulated bowel obstruction does not have an intact bowel supply.

Is a total colectomy a valid treatment for Crohn's or UC?

A total colectomy is a valid treatment for Ulcerative Colitis. Surgery is a last resort for Crohn's because recurrence rates are high and there's a risk of developing short bowel syndrome.

Which of the following are potential complications of GERD? A. Esophagitis B. Perforation C. Barrett's Esophagus D. Dental Erosion

A, C, D are all correct. -Esophagitis can lead to several complications on its own, including strictures, dysphagia, and esophageal ulcers. -Barrett's esophagus, AKA esophageal metaplasia, is a precancerous cell alteration from squamous to columnar in response to repeated insult from gastric juices.

Which of the following are risk factors for developing GERD? A. Obesity B. High stress C. Drinking tomato sauce straight from the jar. D. Smoking

A,B,D are all risk factors. (Obesity, stress, smoking) Acidic foods such as tomato sauce can cause irritation to the esophagus and worsen GERD, but do not cause GERD.

Which of the following are S/S of GERD? A. Heartburn B. Regurgitation (hot, bitter, sour liquid in throat or mouth) C. Angina-like chest pain D. Globus sensation

A-D are all correct. -Patients with GERD may have Angina-like chest pain; described as burning or squeezing and radiating to the back, arms, neck, or jaw. However, GERD chest pain can be relieved by antacids, unlike angina. - Globus sensation: A sense of a lump in the throat.

Which of the following foods should be avoided by a patient who has GERD, and why? (SATA) A. Coffee B. Alcohol (yes, I consider this a food. Don't send me to AA pls). C. Chocolate D. Fried Butter

A-D are all correct. Coffee, tea, alcohol, chocolate, and fatty foods all decrease pressure on the Lower Esophageal Sphincter (LES) which can increase the likelihood of gastric contents refluxing into the esophagus.

Which assessment data would support that the patient has a venous stasis ulcer? A. A superficial pink open area on the medial part of the ankle B. A deep, pale open, area over the top side of the foot. C. A reddened, blistered area on the heel of the foot D. A necrotic, gangrenous area on the dorsal side of the foot

A. (A superficial pink open area on the medial part of the ankle) Venous ulcers are most commonly found near the medial malleolus. They tend to be well-perfused, so are ruddier in color than arterial ulcers.

A patient with previously undiagnosed GERD is admitted to the hospital. An endoscopy reveals esophagitis. Which of the following drugs would be MOST appropriate for use with this patient? A. Omeprazole (a PPI) B. Cimetidine (an H2-receptor blocker) C. Sucralfate (a cytoprotectant) D. Gaviscon (a combination antacid with alginate/alginic acid)

A. (Omeprazole). -PPIs are the best choice for patients with active esophagitis, as they promote esophageal healing. -H2 receptor blockers and Gaviscon are appropriate choices for GERD without esophagitis. -Sucralfate is useful for peptic ulcer disease, but is not a commonly used drug for GERD.

A patient is bleeding from a mallory-weiss tear (located in the esophagus) what color/consistency do you expect their emesis to be? A. Bright-red B. Coffee-Grounds

A. (bright red) is correct. Coffee-grounds emesis is a result of blood being in contact with stomach contents (acid and enzymes) for a prolonged period.

The nurse is unable to assess a pedal pulse in the patient diagnosed with arterial occlusive disease/peripheral artery disease. Which intervention should the nurse implement first? A. Complete a focused neurovascular assessment B. Notify the provider immediately C. Instruct the client to hang the feet off the side of the bed D. Wrap the legs in a blanket

A. Complete a focused neurovascular assessment. This follows the nursing process: ADPIE An absent pulse is not uncommon in a client diagnosed with arterial occlusive disease, but the nurse must ensure that the feet can be moved and are warm, which indicates adequate blood supply to the feet.

The nurse is assessing the patient diagnosed with long-term peripheral artery disease (PAD). Which assessment data supports the diagnosis? A. Hairless skin on legs B. A foot ulcer with copious drainage C. Petechiae on the soles of feet D. Nonpitting ankle edema

A. Hairless skin on legs is correct. Poor perfusion over time leads to hair loss d/t hypoxemia. This is a common manifesation of PAD. Wet ulcers are indicative of CVI, so B is incorrect. Petechiae are indicative of bleeding disorders, not PAD, so C is incorrect. Ankle edema is more likely with CVI, not PAD.

You are providing patient education on antacids, H2 receptor blockers, and PPIs. What should you mention regarding a possible consequence of overuse, or of abrupt discontinuation after chronic use?

All of these drugs may cause rebound acid hypersecretion.

The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected small intestinal obstruction that is vomiting. The patient asks the nurse why this procedure is necessary. What response by the nurse is the most appropriate? A. "The tube will help to drain the stomach contents and prevent further vomiting" B. "The tube will push past the area that is blocked and help stop the vomiting" C. "The tube is just a standard procedure before many types of surgery to the abdomen" D. "The tube will let us measure your stomach contents so we can give you the right IV fluid replacement"

Answer: A - "The tube will help to drain the stomach contents and prevent further vomiting". Rationale: The NG tube allows for drainage and decompression of stomach contents, allowing for symptom reduction.

Which physical examination should the nurse implement first when assessing the client diagnosed with PUD? A. Auscultate the client's bowel sound in all four quadrants. B. Palpate the abdominal area for tenderness C. Percuss the abdominal borders to identify organs. D. Assess the tender area progressing to non-tender.

Answer: A - Auscultate the client's bowel sound in all four quadrants. Rationale: Auscultation should be used prior to palpation or percussion when assessing the abdomen. Manipulation of the abdomen can alter bowel sounds and give false information.

A male client tells the nurse he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? A. "How much weight have you gained recently?" B. "What have you done to alleviate the heartburn?" C. "Do you consume many milk and dairy products?" D. "Have you been around anyone with a stomach virus?"

Answer: B - "What have you done to alleviate the heartburn?" -Rationale: Most clients self-medicate with over the counter medications prior to seeking advice from a health care provider. It is important to know what the client has been using to treat the problem.

Which patient should the nurse assess first after receiving change-of-shift report? A. A patient who is crying after receiving a diagnosis of colon cancer. B. A patient with esophageal varices who has a rapid heart rate C. A patient with a history of gastrointestinal bleeding who has melena. D. A patient with abdominal pain that has a dose of analgesic due.

Answer: B - A patient with esophageal varices who has a rapid heart rate. Rationale: A patient with esophageal varices and a rapid heart rate indicate possible hemodynamic instability caused by GI bleeding. The other patients do not indicate acutely life-threatening complications.

After change-of-shift report, which patient should the nurse assess first? A. A patient with GERD who experiences frequent heartburn B. A patient who has acute gastritis and ongoing abdominal cramping C. A patient with nausea and vomiting who is lethargic and difficult to arouse D. A patient who has postprandial syndrome after a recent partial gastrectomy.

Answer: C - A patient with nausea and vomiting who is lethargic and difficult to arouse. Rationale: This patient is at high risk for problems such as aspiration, dehydration, and fluid and electrolyte disturbances. The other patients will also need to be assessed, but the information about them indicates symptoms that are typical for their diagnoses and are not life threatening.

Which assessment should the nurse perform first for a patient who just vomited bright red blood? A. Auscultating the abdomen for bowel sounds B. Send a sample of the emesis to the laboratory C. Taking the blood pressure (BP) and pulse D. Palpating the abdomen for rigidity

Answer: C - Taking the blood pressure (BP) and pulse. Rationale: The nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal bleeding. BP and pulse are the best indicators of these complications. The other information is important to obtain, but BP and pulse rate are the best indicators for assessing intravascular volume.

A patient was admitted with epigastric pain because of a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? A. Back pain 3 or 4 hours after eating a meal B. Chest pain resolved with eating or drinking water C. Burning epigastric pain 90 minutes after breakfast D. Rigid abdomen and vomiting following indigestion

Answer: D - Rigid abdomen and vomiting following indigestion. Rationale: Rigid abdomen and vomiting following indigestion is a sign of perforation and is a medical emergency. This needs to be addressed immediately.

A patient with PVD has an ulcer on their big toe. The ulcer is round and smooth with well-defined edges. It contains some black eschar but produces minimal exudate. The wound bed is pale, and the patient complains of severe pain. The foot and leg are not edematous. Is this an arterial or a venous ulcer?

Arterial Ulcer Key words: Dry, well-defined edges, pale, black eschar, no edema.

What is the leading cause of Peripheral Arterial Disease? What are some risk factors for PAD?

Atherosclerosis is the leading cause. Risk factors include hypertension, tobacco use, hyperlipidemia, diabetes, and old age.

A patient has nausea and vomiting of unknown etiology. They are alert and oriented. Which of the following nursing interventions do you anticipate implementing? (SATA) A. Lay the patient flat to reduce nausea. B. Put the patient on an NPO diet. C. Lay the patient on their side if they experience a reduced LOC D. Administer IV fluids to prevent dehydration.

B, C, and D are correct. Laying the patient flat increases aspiration risk and does not necessarily reduce nausea. Keep the patient upright to reduce risk of aspiration.

A patient is diagnosed with PUD related to H. Pylori infection. What two pharmacological interventions do you anticipate being prescribed for this patient? A. Aspirin for pain and antibiotics. B. Omeprazole (a PPI) with Amoxicillin (an antibiotic). C. Omeprazole and misoprostol (a synthetic prostaglandin) D. Tylenol and sucralfate.

B. (a PPI and an antiobiotic) is correct. Patients with H. pylori-related PUD are prescribed a 14-day course of antibiotics (typically amoxicillin) with a proton pump inhibitor. The antibiotic kills the H. pylori, while the PPI increases the stomach pH (making it more alkaline) which allows the ulcer(s) to heal.

You are running an irrigation for a patient with a colostomy at a rate of 100mL per minute (500-1000mL over 5-10 minutes). The patient experiences cramping. What is the best response by the nurse? A. Administer morphine for pain. B. Slow the administration rate. C. Administer an antiemetic. D. Document pain assessment.

B. Slow the administration rate.

A patient with GERD reports wheezing, coughing, and dyspnea. Which of the following responses correctly informs the patient of the cause of their symptoms? A. "Do you smoke? It sounds like you have COPD" B. "Gastric contents can reflux into your airway, causing irritation and inflammation". C. "You probably have an upper respiratory tract infection; I will ask the doctor for some antibiotics". D. "That sounds like esophageal cancer; the doctor will need to perform a biopsy"

B. is correct. With GERD, gastric contents may reflux and be aspirated, causing irritation and inflammation in the airways. Gastric contents may even travel down into the lungs.

A patient with an NG tube on suction complains of abdominal distension, nausea, and vomiting. What is the priority action by the nurse? A. Administer an antiemetic. B. Check for kinks in the tubing and make sure the suction is on. C. Contact the provider. D. Document findings.

B. is correct. Always check to make sure the device is functioning properly before moving on to the next intervention.

A client complains of "burning" and "gaseous" pain in the upper epigastrium, which typically occurs between 1-2 hours after meals. Food tends to worsen the pain. Is this likely to be a gastric or duodenal ulcer? What diagnostic test would be used to definitively identify the ulcer location?

Based on the client's description, this is likely a GASTRIC ulcer. The pain from gastric ulcers occurs higher up than the pain from duodenal ulcers. The pain tends to be worsened by food and occurs within 1-2 hours after meals. The definitive diagnostic procedure for determining ulcer presence and location is an endoscopy.

A patient with an NG tube in place complains "I can't sleep with my bed up like this, can you lower it?" How should you respond? A. "Sure! how flat would you like it?" B. "If I lower the head of the bed, the NG tube might perforate your stomach" C. "We need to keep the head of your bed up to reduce the risk of stomach contents backflowing into your airway". D. "Would you be more comfortable if I pulled out the NG tube?"

C is correct. The NG tube bypasses the lower esophageal sphincter. If you lower the head of the bed, gastric contents may backflow, causing the patient to aspirate stomach contents.

After finishing your assessment on a male client with a GI bleed, you get the lab results back. They are: Hbg 15.6 g/dL, Hct 45% Your assessment data are as follows: Patient is pale, diaphoretic, and apprehensive. Extremities are cool to the touch. BP: 78/50 mmHg, HR: 130 bpm, Capillary refill: >3s All extremities Which of the following is the BEST action? A. Document your assessment findings B. Call the provider about the lab results C. Call the provider and give them an SBAR report on your assessment findings. D. Both B and C

C, is correct. -Reasoning: Your assessment data indicates hypovolemic shock, most likely from the GI bleed. The MAP is less than 60 mmHg, the SBP is less than 90 mmHg, and the HR is tachycardic. Cap refill is prolonged. However, the hemoglobin and hematocrit are within the normal range (this can happen with hypovolemia). Therefore, calling the provider regarding the lab results would not be the BEST action. If they ask about labs, you can provide that information. However, the assessment data are the only abnormal results that warrant calling the provider.

A patient is being admitted with Coumadin (Warfarin) toxicity. Which laboratory data should the nurse monitor that is specific to this medication? A. Blood urea nitrogen (BUN) B. Unfractionated heparin (UFH) C. International normalized ratio (INR) D. Partial thromboplastin time (PTT)

C. INR is correct PTT and UFH are for heparin

A patient is receiving Lovenox subcutaneously to prevent DVT following a hip replacement and states that there are some small bruises on their upper abdomen. Which action should the nurse implement? A. Notify the HCP immediately B. Check the patient's aPTT levels C. Explain that this is an expected side effect from the medication D. Assess the patient's vital signs

C. This is an expected side effect

The nurse is caring for a patient with a recent history of deep vein thrombosis (DVT) who is scheduled for an emergency appendectomy. The patient has been taking warfarin. Vitamin K is ordered for immediate administration. The international normalized ratio (INR) is 1.0. Which nursing action is most appropriate? A. Administer the medication as ordered B. Hold the medication and record in the electronic medical record C. Hold the medication and assess if the patient has been taking the warfarin as prescribed at home D. Administer the medication and seek an increased dose of warfarin from the health care provider

C. is correct. This INR is very low for a patient on warfarin (it's within the reference range for patients not on anticoagulation therapy). Either this patient is not taking their warfarin, or this is an erroneous lab result.

A postoperative patient asks the nurse why the provider ordered daily administration of enoxaparin (Lovenox). Which reply by the nurse is accurate? A."This medication will help prevent breathing problems after surgery, such as pneumonia" B."This medication will help lower your blood pressure to a safer level, which is very important after surgery" C."This medication will help prevent blood clots from forming in your legs until your level of activity, such as walking, returns to normal" D."This medication is a narcotic pain medication that will help take away any muscle aches caused by positioning on the operating room table"

C."This medication will help prevent blood clots from forming in your legs until your level of activity, such as walking, returns to normal"

Chronic Venous Insufficiency (CVI) represents another type of peripheral vascular disease. What are some manifestations of CVI that can help us differentiate it from PAD?

CVI and PAD manifest very differently. Patients with PAD have trouble getting blood TO the extremity, whereas patients with CVI have trouble getting blood OUT of the extremity. Manifestations include: Stasis dermatitis (Brown, leathery skin) Edema Eczema Wet ulcers, especially over the medial malleolus Pain that worsens when affected limb is dependent. Difficulty with ADLs

What are some of the serious consequences of long-term PPI use?

Consequences of long-term PPI use include: -Decreased bone density (Osteoporosis) -Kidney disease -Magnesium deficiency -B12 deficiency -Increased risk for dementia

What are some respiratory complications of GERD?

Cough, Laryngospasm, cricopharyngeal spasm. -Chronic: Asthma, chronic bronchitis, pneumonia

What are some complications of PAD?

Critical limb ischemia Gangrene Infection Amputation

Diarrhea and colicky abdominal pain are common symptoms of...

Crohn's Disease

A 39-year-old woman with a history of smoking and oral contraceptive use is admitted with a deep vein thrombosis (DVT) and is placed on a continuous heparin drip. What laboratory test should the nurse review to evaluate the expected effect of the heparin? A.Platelet count B.Activated clotting time (ACT) C.International normalized ratio (INR) D.Activated partial thromboplastin time (aPTT)

D. Activated partial thromboplastin time (aPTT)

A nurse is educating a patient with PAD on lifestyle and medical interventions to help reduce complications and prevent worsening symptoms. What might be included in this education?

DASH diet Smoking Cessation ACE Inhibitors Anti-platelet medications (Plavix/Clopidogrel, Aspirin) Exercise Keep extremities clean and dry Protect heels Choose roomy, well-padded footwear.

What are some complications of Chronic Venous Insufficiency?

DVTs PEs Infections Ulcers

Which type of ulcer (gastric or duodenal) has pain that manifests as mid-epigastric, and may radiate to the back?

Duodenal ulcers.

What is the gold standard for assessing LES competence, degree of inflammation, and the presence of strictures in patients with GERD?

Endoscopy. GERD is typically diagnosed based on symptom picture and response to meds and lifestyle interventions. However, when the usual therapies are not proving effective or complications are suspected, diagnostic procedures such as endoscopy may be performed.

True or False: Surgery is necessary to treat GERD.

False. -Most patients with GERD can manage their symptoms through lifestyle modifications, drug therapy, and nutritional therapy. -When therapies are ineffective or their are serious complications, surgery is an option. - The most common surgery for GERD is are fundoplications, which wrap the fundus of the stomach around the lower esophagus to reinforce and repair the LES. -A LINX system is another option: a ring of magnets implanted into the LES which helps to hold it closed. The pressure of swallowing forces the LES open (at least theoretically). Patients may report nausea, dysphagia, and pain when swallowing.

The patient with an ileostomy should be observed for signs and symptoms of...

Fluid and electrolyte imbalances, particularly potassium, sodium, and fluid deficits.

For a patient on Vitamin K antagonists (Warfarin/Coumadin) and Factor Xa Inhibitors (Apixiban/Eliquis) we would monitor (aPTT or INR) to establish therapeutic dosing.

For Vitamin K antagonists and Factor Xa inhibitors, we typically monitor INR. Normal range: 0.75-1.25 For VTE risk, we want INR 2-3 For Mechanical Valves: 2.5-3.5

-What are some indications for performing a gastrectomy? (Removal of part of the stomach, usually the lower 2/3rds). -What are some complications that may occur?

Gastrectomy indications: -Stomach ulcers refractive to other treatment. -Stomach cancer -Perforations -Chronic gastritis Complications: -Dumping syndrome -Postprandial hypoglycemia -Bile reflux gastritis

With which type of ulcer (gastric or duodenal) does the pain become worse with food? Which ulcer has pain improved by food?

Gastric Ulcers have Greater Eating Pain. Remember "GEP"' Duodenal Ulcers have Decreased Eating Pain "DEP" (Johnny Depp probably has a duodenal stress ulcer after the Depp/Heard trials) I'm sure you can make some fun mnemonics out of this. Alas, I don't care enough to do it. If you come up with a good one, I'll put it on my flashcards and pay you half of my royalties.

Peptic ulcers can be classified by their location as either...

Gastric ulcers (occurring in the stomach) or Duodenal Ulcers (occurring in the duodenum of the small intestine).

Which type of ulcer (gastric or duodenal) has pain that manifests as high epigastric dyspepsia?

Gastric ulcers.

What are the two GREATEST risk factors for PUD?

H. pylori infection is the single greatest risk factor; it's present in roughly 85% of all patients with PUD. NSAID use is responsible for almost all other incidences of PUD where H. pylori is not involved. A person who pops NSAIDS on the regular and has H. pylori disease is basically a walking ulcer factory. Another risk factor for ulcers is that terrible Obi Wan Kenobi show. I'm pretty sure I got an ulcer from that, and I didn't even watch it.

What are some signs and symptoms of peripheral arterial disease?

Intermittent Claudication (Pain when exercising) Hair loss on the affected extremity. Thick, brittle nails. Diminished or absent pulses Cool temperature Thin, shiny, taut skin. Dry ulcers Eschar

Is irrigation mostly used with colostomies, ileostomies, or both?

Irrigation is mostly used with colostomies. Ileostomies produce more liquid stool, so irrigation is not needed on a routine basis.

For a patient on Indirect Thrombin Inhibitors such as enoxaparin (Lovenox) or unfractionated Heparin, we would check (aPTT or INR) to monitor the therapeutic range and adjust dosing as needed.

Monitor aPTT for ITIs and Heparin Normal range: 30-40s Therapeutic range: 46-70s

One of the reasons that older adults are particularly vulnerable to dehydration is that they have a decreased...

Older adults have a decreased thirst mechanism.

What are the 6 Ps of acute limb ischemia?

Pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia (coolness).

Which Upper GI condition is best described as an erosion of GI mucosa due to the digestive actions of HCl and Pepsin?

Peptic Ulcer Disease (PUD).

A patient with a perforated ulcer has shallow respirations and a rigid, board-like abdomen. Their knees are drawn up and flexed, and they resist any movement. They have a fever. What complication do you suspect?

Peritonitis

This variant of dumping syndrome is the result of consuming a high-carb meal after a gastrectomy. It results in the release of excessive insulin which leads to reflex hypoglycemia. S/S include diaphoresis, weakness, confusion, palpitations, tachycardia, and anxiety. What is this condition called?

Postprandial hypoglycemia Note that s/s are similar to standard hypoglycemia.

A patient who had a gastrectomy becomes diaphoretic, tachycardic, and confused within an hour after eating a meal of baked potatoes, toast with jam and whipped cream, and an ice cream sundae. They complain of palpitations and anxiety. What post-gastrectomy complication do you suspect?

Postprandial hypoglycemia. This is a variant of dumping syndrome that occurs with carb-rich meals.

What is the greatest complication that we are worried about in patients with DVTs?

Progression to a Pulmonary Embolism (PE)

Weight loss and nutritional problems are common problems in Crohn's disease when there is inflammation in the (name the portion of the GI tract).

Small intestine involvement. -If there is inflammation in the small intestine, malabsorption can be a problem, leading to weight loss and nutritional problems. -Nutritional deficiencies are less common in ulcerative colitis because UC does not affect the small intestine where most nutrients are absorbed.

What are some risk factors for CVI? Which risk factors are unique to CVI, and which are shared with PAD?

Smoking, old age (PAD & CVI) Edema (CVI) Pregnancy (CVI) Trauma (CVI) Varicose veins (CVI) Prolonged periods of sitting or standing (CVI)

A patient with GERD has developed a gastric ulcer. They are placed on sucralfate as a short-term treatment. Their MAR shows that they currently take Gaviscon (an antacid) for GERD. What education do you anticipate giving the client regarding administration of these two medications?

Sucralfate works best in an acidic environment, so it should not be taken at the same time as an antacid. Best practice is to take sucralfate at least an hour apart from any antacid. Also avoid taking it with warfarin or cimetidine, since it binds to these drugs.

A patient complains of "cramp-like" and "burning" pain in the midepigastric region (right around the xiphoid process) which radiates to the back. The pain generally occurs between 2-5 hours after meals, and improves with food. Is this a gastric or duodenal ulcer?

This description fits that of a DUODENAL ulcer. Pain occurs later, lower, and may involve back pain. The pain may feel more cramp-like. Pain tends to improve with food, which buffers the acid from the stomach which is the source of discomfort (when acid contacts the ulcer, it causes burning, cramping pain). Pain tends to occur later in duodenal ulcers since they are located further down.

Which inflammatory bowel disease (Crohn's or UC) can occur anywhere in the GI tract from the mouth to the anus and often manifests as sections of healthy bowel alternating with diseased portions? (skip lesions).

This sounds like Crohn's Disease. Unlike Ulcerative Colitis, which only affects the colon and rectum, Crohn's disease can manifest throughout the GI tract.

Describe the basic pathophysiology of Raynaud's Phenomenon

Triggers such as cold, stress, caffeine, or tobacco induce vasospasm in finger, toes, and/or ears. This causes a color change from pallor --> Cyanosis --> Rubor (as perfusion is restored). The affected regions may be cool, and episodes may be accompanied by throbbing, aching pain that can last for hours.

A patient with PVD has a sore on their medial malleolus. It has poorly defined edges and produces copious exudate. The sore is superficial with a red wound bed. The ankles are edematous. Is this an arterial or venous ulcer?

Venous Ulcer

-Virchow's Triad describes risk factors for what condition? -What are the three components of Virchow's Triad?

Virchow's Triad describes risk factors for DVT. 1. Venous Stasis (immobility, CVI, pregnancy) 2. Endothelial damage (Diabetes, smoking, trauma, burns, previous DVTs, chemotherapy) 3. Hyper-coagulability

A patient is POD-3 with an active DVT. A family member who has done internet research on the topic asks about placement of SCDs. What should you tell them?

We don't place SCDs on patients with an active DVT, because it could cause the clot to become dislodged and travel to the lungs. We also do not recommend ambulation with an active DVT for the same reason.

Which type of ulcer (gastric or duodenal) has pain that occurs 1-2 hours after meals? Which type of ulcer (gastric or duodenal) has pain that occurs 3-5 hours after meals?

people with gastric ulcers tend to experience pain sooner (1-2 hours postprandial) because the food itself aggravates the ulcer. Patients with duodenal ulcers experience pain aggravation 3-5 hours after meals when the food is gone. While the food is present, it buffers duodenal contents and actually improves pain.