NCLEX 6/7 part 2

celiac disease

an inherited autoimmune disorder characterized by a severe reaction to foods containing gluten

continent urostomy

an internal reservoir (pouch) constructed from a segment of intestine that diverts urine through an opening (stoma) that is brought through the abdominal wall; a valve is created internally to prevent leakage, and the patient empties the pouch by catheterization; continent refers to the ability to hold or retain urine

Sengstaken-Blakemore tube

used for tx of esophageal varices, keep scissors at bedside • First need to intubate. • Tube has three openings • Decompress / lavage or suck out • You don't want a pt to cough or vomit a lot. Holding your breath sometimes with a pt who has cirrhosis. You wan tot treat that b/c you don't want them to rupture the varices. • They are going to be vomiting blood so they will need the tube. • Calling OR / RRT • They need to cauterize the varices. • Could be going to emergent endoscopy for OR • Or going to intensive care. • They will probably get to hypovolemic shock. • Remember mass transfusion replace fluid • They need mass transfusion need to replace packed cells, platelets • If you get them too much cystalloid that's problematic see drecording for 32 minutes.

Nursing endoscopy ERGP pre-procedure: Nursing is there preprocuedure and GI focused exam and education IV fluids, V/S neuro assessment pain assessment, education on procedure, consent for procedure, type and screen,• any heart disase? Ekg before procedure, why? b/c moderate sedation or deep sedation up until general anesthesia.

• Ercp - into duodenum and then thread a wire into common bile duct. Nurse is right next to physician handing right scope, anticipating wire physician needs you need to anticipate all that. • Pt's develop all types of things there too arrythmias codes etc in endoscopy.

analysis interpreting: Weight loss due to complications associated with inflammation of the liver Fatigue due to decreased metabolic energy production Potential for infection related to state of immunocompromise

• With liver disease the key is the elimination. • What we should promote is absence with alcohol. • Pt we want them to have increase energy decrease fatigue • Meet energy requirements • Remaining infection free

nasogastric tube feeding

A method of feeding a patient through a tube channeled down the nose and throat and into the stomach; also called gavage.

Peptic Ulcer Disease (PUD)

Chronic irritation, burning pain, and erosion of the mucosa to form an ulcer Smoking cigarettes increases the acidity of gastrointestinal secretions, which damages the mucosal lining HBP and Obesity are not directly related / risk factors for PUD

Liver Transplantation

For patients with end-stage liver disease or acute liver failure Transplantation considerations Life style changes, comorbities Transplantation complications Rejection, bleeding

cancer of the liver one of the most fatal types cirrhosis increases risk

May be asymptomatic early in disease process Later signs include weight loss, anorexia, weakness, abdominal discomfort (RUQ). Jaundice, bleeding, ascites, and edema develop Elevated AFP and alkaline phosphatase are common. alpha-fetoprotein (AFP) high US and contrast-enhanced CT are used.

colitis

Medical treatment is directed toward reducing motility of the inflamed bowel, restoring nutrition, and preventing and treating infection; surgery is used selectively for those who are acutely ill or have excessive exacerbations. surgical intervention is not curative.

Hepatitis assessment Ask about exposure to someone with hepatitis. Ask about chemical exposure. inquire about alcohol, drug, herbal use. Inquire about travel, sexual activities, needlestick exposure, drug (IV) use, military service. Assess for family history of liver disease.

Physical assessment/signs and symptoms Abdominal pain Changes in skin or sclera (icterus) Arthralgia (joint pain) or myalgia (muscle pain) Diarrhea/constipation Changes in color of urine or stool Fever Lethargy Malaise Nausea/vomiting Pruritus (itching)

liver biopsy

Right side position post procedure to prevent patient from bleeding.

cancer of the liver interventions: Interventions: Responding

Surgical resection and liver transplantation are only treatments. TACE Transcatheter arterial chemoembolization SIRT Selective Internal Radiation Therapy RFA and cryotherapy Palliative approaches

A client is admitted to the hospital after taking an overdose of aspirin. A nasogastric tube is inserted for lavage. Which solution would the nurse obtain for the gastric lavage?

saline solution of 0.9% is considered a physiological or isotonic solution appropriate for gastric lavage because it will not detrimentally influence the client's acid-base balance.

cholecystectomy

surgical removal of the gallbladder

T-tube

tube placed in the bile duct for drainage into a small pouch (bile bag) on the outside of the body

esophageal varices treatment

replacement of blood, endoscopic sclerotherapy and ligation, emergency portal decompression Sengstaken-Blakemore tube in place for the emergency treatment of hemorrhage from esophageal varices. The tube has three openings for (1) gastric aspiration, (2) inflating the esophageal balloon, and (3) inflating the gastric balloon. The esophageal balloon is inflated to a pressure of 20 to 40 mm Hg (monitored by attachment to a gauge or a sphygmomanometer) that compresses the esophageal veins. The gastric balloon, inflated with 250 cc of air, applies pressure to the fundal veins when slight traction is applied.

pancreatic ducts

ducts coming into the duodenum and transports enzymes from the pancreas

thrombophlebitis

inflammation of a vein associated with a clot formation

stomatitis

inflammation of the mouth

pancreatitis

inflammation of the pancreas

Low residue diet means:

low fiber.. It is similar to a low-fiber diet, but typically includes restrictions on foods that increase bowel activity; such as milk, milk products, and prune juice. A low residue diet typically contains less than 7-10 grams of fiber per day.Long term use of this diet, with its emphasis on processed foods and reduced intake of fruits and vegetables, may not provide required amounts of nutrients including potassium, vitamin C, calcium, and folic acid

pancreatectomy

removal of the pancreas