Exam 1
diet for patients suffering from chronic pancreatitis
low fat high calories small/frequent meals no alcohol
diet for patients who have cholecystitis
low fat diet - due to inflammation of the gallbladder
diet for patient with cirrhosis of the liver and ascites
low sodium moderate/low protein low fat bc pt cannot digest fat without bile
Pain management for patients suffering from acute pancreatitis
opioids (morphine IV) combined with: Antispasmodic agents and H2 blockers: Famotidine Ranitidine
know dietary restrictions for renal patients on hemodialysis
restrict fluid restrict sodium restrict potassium
SATA: What are some assessment complications of peritoneal dialysis?
tachycardia abdominal pain cloudy outflow
Nursing interventions for patients receiving peritoneal dialysis and the dialysate edrainage slows down or stops
turn the patient from side to side
Most important test to determine kidney funciton after kidney transplantation
Creatinine
Nursing interventions to prevent uremia in patients iwth end stage renal disease (ESRD)
Fluid restriction
SATA: Modes of transmission for hepatitis A, B, C, D, E,
Hepatitis A: fecal--> oral Hepatitis B: blood--> blood hepatitis C: blood--> blood Hepatitis D: requires Hepatitis B to replicate, co-infection = high risk. Ex. blood/body fluids/mucosal Hepatitis E: fecal--> oral; contaminated food and water
Indications of hemodialysis
Hyperkalemia as well as: hypervolemia, hypertension, increased urea, hyperkalemia, increased creatinine, fluid overload
A client is admitted to the hospital with slight jaundice and reports of pain on the left side and back. A diagnosis of acute pancreatitis is made. Which common response to acute pancreatitis should the nurse monitor in the client? A. Crackles B. Hypovolemia C. Gastric reflux D. Jugular vein distention
Hypovolemia
Priority when caring for a patient with pancreatic cancer
Opioids IV (morphine) **no meperidine** causes seizures
Normal lab values
RBC: 80-100 WBC: 4,500-10,000 Platelets: 150,000-450,000 Hemoglobin: 11-16 Hematocrit: 35-49% BUN: 8-23
Complications of hemodialysis
- disequilibrium syndrome - fluid shift - thrombosis - infection - Hepatitis - bleeding from fistula
Nursing interventions for patients complaining of dribbling after removal of indwelling catheter in patients who had a TURP
-kegal exercises - to help with urinary incontinence -urinate on a schedule - ex. q3hrs -adivse dribbling is expected
A client with ESRD is receiving continuous ambulatory peritoneal dialysis. The nurse should monitor the patient for which complications? Select all that apply A. Abdominal pain B. Oliguria C.Pruritus D. Tachycardia E. Cloudy outlflow
A. Abdominal pain D. Tachycardia E. Cloudy outlflow
Which clinical findings indicate to the nurse that a 6-year-old child has nephrotic syndrome (NS) rather than acute poststreptococcal glomerulonephritis (APGN)? Select all that apply A. Generalized edema B. Reddish-brown or cola-colored urine C. Hypoalbuminemia D. Massive proteinuria E. Gross hematuria
A. Generalized edema C. Hypoalbuminemia D. Massive proteinuria
The nurse is caring for a client who has been diagnosed with Acute post streptococcal glomerulonephritis. Which initial urinary finding supports this dx? Select all that apply A. Reddish-brown or cola-colored urine B. Polyuria C. Mild proteinuria D. Anuria E. Hematuria
A. Reddish-brown or cola-colored urine C. Mild proteinuria E. Hematuria
Medications that cause hepatitis/liver damage
Acetaminophen (tylenol)
Risk factors for acute pancreatitis
Alcohol (mostly in men) Biliary obstruction (mostly in women)
A nurse is caring for a client with acute pancreatitis. Which elevated lab test result is most indicative of acute pancreatitis? A. Bilirubin B. Serum Lipase C. WBC D. glucose
B. Serum Lipase
A nurse is caring for a client with a dx of CHF, who just has been told by the primary HCP that hemodialysis is necessary. Which clinical manifestation indicates the need for hemodialysis? A. Alkalosis B. Hypotension C. Ascites D. Hyperkalemia
D. Hyperkalemia
purpose of lactulose in patients suffering from cirrhosis of the liver
Decreases level of ammonia. It is an osmotic laxative
know hepatitis: modes of transmission for Hepatitis A
Fecal-->oral place patient on contact precaution; don gown and gloves
Patient teaching for synthetic pancreatic enzyme, Pancrelipase (Viokase)
Give with food
patient positioning to alleviate shoulder pain after laparoscopic cholecystectomy
Left Sim's position Warm compress on the shoulder Ambulation
Measure to prevent stimulation of the pancreas
NPO NG suction near pyrus to pull out acid no speaking of food use antacids PPI or H2 blockers
Normal amount of biliary drainage from t-tube during first 24 hours. What is the troubleshooting method if drainage is less than expected?
Normal: 300-500cc Less than normal means kings, dislodgements, or obstructions
SATA: In AKI, what are the lab findings?
Potassium: >5.1 Calcium: <8.6 Phosphate: >4.5 Creatinine: >1.2
know rationale for warming up dialysate before it is infused to the peritoneal cavity in patients receifing peritoneal dialysis
Prevents muscle cramps/discomfort and dilates vessels facilitating the exchange of urea
Reason for protein restricted diet in patients with AKI
Protein increases BUN level and cannot be processed and filtered by the kidneys.
SATA: S/s of cholecystitis
RUQ pain that radiates to right shoulder intolerant to fat
Patients prep for paracentesis
Semi-Fowler's position Ask patient to void prior to procedure (to avoid puncturing the bladder)
A client who has been receiving hemodialysis for several years is to receive a kidney transplant. What should the nurse share in the client's preoperative teaching plan? SATA
The kidneys may not function immediately. Precautions are needed to prevent infections. A urinary catheter will be present postoperatively.
What is the rationale for the insertion of an NG tube with suction and placing the patient NPO during acute pancreatitis?
To decrease pain
Purpose of erythropoietin
Treatment of anemia S/s: chronic fatigue, lethargy, pale, SOB
For which clinical indicators should the nurse monitor when caring for a client with cholelithiasis and obstructive jaundice? A. yellow skin b. Clay-colored stool C. Coffee-ground vomitus D. Pain on urination E. Dark urine
Yellow skin Clay-colored stool Dark urine
Confirmatory test for BPH
biopsy
SATA: S/s of hyponatremia:
confusion lethargy diarrhea seizures
Diet for patients with hepatic encephalopathy
low protein high carb (needs energy)
A client is admitted to the hospital with a diagnosis of cirrhosis of the liver. For which assessment signs of hepatic encephalopathy should the nurse assess this client? Select all that apply. 1 Mental confusion 2 Increased cholesterol 3 Brown-colored stools 4 Flapping hand tremors 5 Musty, sweet breath odor
1 Mental confusion 4 Flapping hand tremors 5 Musty, sweet breath odor
When assessing a client during peritoneal dialysis, a nurse observes that drainage of the dialysate from the peritoneal cavity has ceased before the required volume has returned. What should the nurse instruct the client to do? 1Turn from side to side 2Deep breathe and cough 3Drink a glass of water 4Rotate the catheter periodically
1Turn from side to side
Normal potassium level
3.5-5.1
A client with cholelithiasis has a laser laparoscopic cholecystectomy. Postoperatively it is most appropriate for the nurse to: 1. Maintain the client's nothing by moth status for the first 24 hours 2. Monitor the client's abdominal incision for bleeding 3. Offer clear carbonated beverages to the client 4. Ambulate the client when the client is alert and oriented
4. Ambulate the client when the client is alert and oriented
TURP - indwelling catheter and continuous bladder irrigation
After TURP surgery, they will place an indwelling catheter and continuous bladder irrigation
Which pancreatic enzyme should be monitored in order to determine the patients response to the treatment
Amylase
What assessments should you perform on a patient with acute pancreatitis is receiving parenteral nutrition?
Be cautious of level of glucose in the patient with TPN (high levels) Hyperglycemic
How do you identify the normal return of bile flow to the GI tract?
Brown stool
A client is admitted to the hospital for medical management of acute pancreatitis. Which nursing action is most likely to reduce the pancreatic and gastric secretions of a client with pancreatitis? A. obtaining a prescription of morphine B. Encourage clear liquids C. Assisting client into a Semi-Fowler position D. Administering prescribed anticholinergic medication
D. Administering prescribed anticholinergic medication
A client with history of excessive alcohol use develops hepatic portal hypertension and an elevated serum aldosterone level. For which complications should the nurse assess this client for? A. Chloride depletion and hypovolemia B. Potassium retention and dysrthmias C.Calcium depletion and pathologic fractures D. Sodium retention and fluid accumulation
D. Sodium retention and fluid accumulation
SATA: Assessment findings in the skin of patients with cirrhosis of the liver
Ecchymosis and petechiae telengectasis (spider veins and angiomas) Caput medussa Peripheral dependent edema Dry skin with rash (deposits of biliary salt)
Assessment before and after hemodialysis
baseline of weight, creatinine, BP, potassium assess for thrill or bruit over the vascular access site each shift
know hepatitis: modes of transmission for Hepatitis C
blood-->blood - needles, tattoos, sex
post-op care after cholecystectomy
breathing! cough, deep breathe to prevent atelectasis this may be difficult because of the incision using q1hr incetive spirometer
A client with chronic kidney disease is admitted to the hospital with severe infection and anemia. The client is depressed and irritable. The client's spouse asks the nurse about the anticipated POC. Which is an appropriate nursing response?
"The intake of meat, eggs, and cheese will be restricted so the kidneys can cleat the body of waste."
The nurse administers 2 units of salt-poor albumin to a client with portal hypertension and ascites. The nurse explains to the client that the purpose of the albumin is to: 1 Provide nutrients. 2 Increase protein stores. 3 Elevate the circulating blood volume. 4 Divert blood flow away from the liver temporarily.
3 Elevate the circulating blood volume.
SATA: S/s of AKI during diuresis phase:
Dehydration (fluid loss) Hypovolemia
SATA: Assessment findings associated with kidney transplant rejection
Fever weight gain oliguria elevated potassium elevated creatinine elevated phsphate hypertension fluid retention
electrolyte disturbance to monitor in patients with ascites from cirrhosis of the liver and receiving spironolactone
Hyperkalemia (increased potassium; >5.0) It is a potassium-sparing diuretic
how to improve patients compliance with deep breathing exercises and coughing after abdominal cholecystectomy
give pain meds and encourage use of incentive spirometer
Know purpose of peritoneal dialysis
management of BP, hypovolemia, remove waste products and electrolytes S/s: Person is accumulating water, gaining weightm increased BP, hyperkalmia, hyperphshatemia, increase o furea, and increased creatinine. purpose is to reduce one of those
A client with a long history of alcohol abuse develops acute pancreatitis. What should be done to prevent stimulation of the pancreas? A. Ensure that the NG tub remains in the fundus of the stomach B. Administer the Histamine H2-receptor antagonis as prescribed C. Maintain the gastric pH at a level less than 3.5 D. Encourage the resumption of activities of daily living
B. Administer the Histamine H2-receptor antagonis as prescribed
Reason for the prescription of bile salts in patients with chronic pancreatitis
Helps absorb fat soluble vitamins such as: A D E K
know renal complications of BPH
hydronephrosis - increased pressured backed up by urine
Know assessment for peritonitis in peritoneal dialysis
peritonitis - cloudy effluent (dialysate), abdominal pain protein loss (albumin) infection at insertion site of catheter
s/s of hepatic encephalopathy
-Asterixis - sleep disturbances - mood changes - mental status changes - speech problems - Altered LOC - Neuromuscular problems
Following an abdominal cholecystectomy, the client refuses to take deep breaths and coughs, saying "it's too painful." :( What action does the nurse take? A. Substitute incentive spirometry for coughihng and deep breathing B. Give pain medicaiton regularly as soon as possible C. Medicate the client for pain before coughing and deep breathihng D. Obtain a prescription to increase the client's medication
C. Medicate the client for pain before coughing and deep breathihng
S/s of kidney insufficiency in CKD
hypertension, edema, fluid overload, increased BUN (urea), increased creatinine, uremic frost causing itching (pruritis), hyperkalemia, hyperphosphatemia, metabolic acidosis, hypocalcemia, hypermagneseia
know nursing interventions for patients complaining of nausea, headaches, and confusion during hemodialysis
slow down rate of infusion
A nurse is preforming a health history and physical assessment of a client with cholelithiasis and obstructive jaundice. Which clinical finding should the nurse expect this client to exhibit? A. Pain in the RUQ B. straw-colored urine C. Bloody stools D. Hematuria
A. Pain in the RUQ
Lab findings after receiving Hepatitis B vaccine - and vaccine was effective
Anti-HBS Meaning: antigen surface; means the patient is positive to having the immunity by vaccine
Purpose of neomycin in patients with cirrhosis
broad-spectrum antibiotic to reduce ammonia
Nursing interventions for patients receiving peritoneal dialysis complaining of severe respiratory difficulty during infusion of dialysate
drain fluid from peritoneal cavity
purpose of t-tube after abdominal cholescystectomy
drain the bile otherwise, it will be painful for the patient because of the occlusion
cause of ascites in patients with cirrhosis of the liver
portal hypertension increased hydrostatic pressure decreased amount of albumin
Nursing care for AV fistula in patients receiving hemodialysis
No BP readings no sleeping on arm no tight clothes nothing administered through access site on fistula
how to assess patients with cirrhosis of the liver for fetor hepaticus
Sweet breath, with musty odor, slightly fecal odor
Duration of immunosuppressive drug therapy after kidney transplantation
for life
Potassium level: spironolactone versus furosemide
if potassium is high, give furosemide if potassium is low, give spironolactone
A client is admitted to the hospital in the oliguric phase of acute kidney injury. The nurse estimates that the urine output for the last 12 hours is about 200 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. What does the nurse conclude about the amount of fluid prescribed? 1. It equals the expected urinary output for the next 24 hours. 2. It will prevent the development of pneumonia and a high fever. 3. It will compensate for both insensible and expected output over the next 24 hours. 4. It will reduce hyperkalemia, which can lead to life-threatening cardiac dysrhythmias.
3. It will compensate for both insensible and expected output over the next 24 hours.
Before a transurethral resection of the prostate (TURP), a client asks about what to expect postoperatively. The most appropriate response by the nurse is: 1 "You will have an abdominal incision and a dressing." 2 "Your urine will be pink and free of clots." 3 "There will be an incision between your scrotum and rectum." 4 "There will be an indwelling urinary catheter and a continuous bladder irrigation in place."
4 "There will be an indwelling urinary catheter and a continuous bladder irrigation in place."
A client who had a kidney transplant develops leukemia 3 week after surgery. What does the nurse conclude is the leukopenia probably is caused by: A. Antirejection medications B. Bacterial infection C. High creatinine levels D. Rejection of the kidneys
A. Antirejection medications
A client had a kidney transplant. The nurse should monitor for which assessment findings associated with rejection of the transplant? SATA A. Fever B. Jaundice C. Polydipsia D. Weight gain E. Oliguria
A. Fever D. Weight gain E. Oliguria
A school nurse is teaching a health class of 12-year-olds about hepatitis C. Which statement by a student indicates an understanding of the origin of the disease? A: "You can catch it while you're getting a tattoo." B: "You're more likely to get it in crowded living conditions." C: "The disease is passed from person to person by casual contact." D: "People working at restaurants can give it to you if they don't wash their hands.
A: "You can catch it while you're getting a tattoo."
A nurse is caring for a client with hepatic encephalopathy. Which elements are important to include in this clients care? Select all that apply A. High carbs diet B. Increase protein in diet C. Administration of oral Lactulose D. Administration of broad spectrum antibiotic E. Low protein diet F. Increased sodium consumption
C. Administration of oral Lactulose E. Low protein diet
Know effects of antirejection medications over WBCs in kidney transplantation patients
Cyclosporine causes a decrease in WBC (leukopenia) therefore, patient is placed on neutropenic precautions due to risk for infection
SATA: A patient with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple Procedure). During health educaiton, the patient should be informed that this procedure will involve the removal of which of the following?
Gallbladder Part of the stomach Duodenum Part of the common bile duct Head of the pancreas part of jejunum
S/s of hypocalcemia in acute pancreatitis
muscle twitches tingling around mouth and fingers Trousseau's sign Chvostek's sign (facial nerve twitch) **first check Calcium level then report to HCP**
purpose of lactated ringers in its use with T-tube for biliary drainage
replenishes loss in bile; in which lactated ringers and bile contain same components and have similar osmolarity and contains bicarb
