Unit 3 exam
Is GERD a disease?
no its a syndrome most common GI disorder in adults
Tx for cholelithiasis
none if asymptomatic elective cholecystectomy if recurrent bouts of biliary colic ERCP: scope that goes in and takes stone out
Sx of HYPERnatremia include
seizures, delirium and lethargy
appendicitis sx
steady pain, gets worse and worse
What is a non-invasive way to dx PUD?
stool, breath test or blood test for H Pylori
for hernias, what is tx of choice? what is discouraged post-op? what is nursing priority post-op?
surgery coughing, heavy lifting discouraged nurses should manage swelling, monitor I/Os
What position should pt legs be in after total hip replacemnt surgery? Abduction adduction extension
abduction- pillow should be placed to keep legs slightly apart
Ankylosis refers to __________ contractures refer to___________ crepitation refers to_________
ankylosis: stiffness or fixation of a joint (Ankylysing spondylosis usually refers to axial frame) contracture: reduced mvmnt as response to fibrosis of soft tissue crepitation: grating or crackiling sound of joint
H2 receptor agonists end in what
-dine
Pt presenting to ER with poss peritonitis? what do first Make NPO rEDUCE FEVER REDICE PAIN
make npo
What is one of the best measures of vital organ perfusion
urine output
A nurse is caring for a client who has a new diagnosis of gastroesophageal reflux disease (GERD). The nurse should expect prescriptions for which of the following medications? (Select all that apply.) A. Antacids B. Histamine2 receptor antagonists C. Opioid analgesics D. Fiber laxatives E. Proton pump inhibitors
. A. CORRECT: Antacids neutralize gastric acid which irritates the esophagus during reflux. B. CORRECT: Histamine2 receptor antagonists decrease acid secretion, which contributes to reflux. C. Opioid analgesics are not effective in treating GERD. D. Fiber laxatives are not effective in treating GERD. E. CORRECT: Proton pump inhibitors decrease gastric acid production, which contributes to reflux.
A nurse is completing discharge teaching with a client who is postoperative following fundoplication. Which of the following statements by the client indicates understanding of the teaching? A. "When sitting in my lounge chair after a meal, I will lower the back of it." B. "I will try to eat three large meals a day." C. "I will elevate the head of my bed on blocks." D. "I will avoid eating within 1 hour before bedtime."
. A. The client is instructed to remain upright after eating following a fundoplication. B. The client is instructed to avoid large meals after a fundoplication. C. CORRECT: After a fundoplication, the client is instructed to elevate the head of the bed to limit reflux. D The client should avoid eating 2 hr before bedtime to reduce the risk for reflux.
A nurse is reviewing bowel prep using polyethylene glycol with a client scheduled for a colonoscopy. Which of the following instructions should the nurse include? A. Check with the provider about taking current medications when consuming bowel prep. B. Consume a normal diet until starting the bowel prep. C. Expect the bowel prep to not begin acting until the day after all the prep is consumed. D. Discontinue the bowel prep once feces start to be expelled.
1. A. CORRECT: Instruct the client to check with the provider about taking current medication, because some medications can be withheld when taking polyethylene glycol due to their lack of absorption. B. Instruct the client to consume a clear liquid diet prior to starting the bowel prep. C. Instruct the client that the actions of polyethylene glycol begin within 2 to 3 hr after consumption. D. Instruct the client to consume the full amount prescribed.
Serum Sodium (Na+)
135-145 mEq/L
metabolic syndrome
A syndrome marked by the presence of usually three or more of a group of factors: high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, high fasting levels of blood sugar) this syndrome is linked to increased risk of cardiovascular disease and Type 2 diabetes.
The nurse is caring for a client following a Billroth II procedure. On review of the post-operative orders, which of the following, if prescribed, would the nurse question and verify? A) Irrigating the nasogastric tubeB) Coughing a deep breathing exercisesC) Leg exercisesD) Early ambulation
A) Irrigating the nasogastric tube In a Billroth II procedure the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse would clarify the order.
A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated with a histamine receptor antagonist (cimetidine), antacids, and diet. The nurse doing discharge planning will teach him that the action of cimetidine is to: A) Reduce gastric acid outputB) Protect the ulcer surfaceC) Inhibit the production of hydrochloric acid (HCl)D) Inhibit vagus nerve stimulation
A) Reduce gastric acid output These drugs inhibit action of histamine on the H2 receptors of parietal cells, thus reducing gastric acid output.
The nurse is caring for a patient in the emergency department with complaints of acute abdominal pain, nausea, and vomiting. When the nurse palpates the patient's left lower abdominal quadrant, the patient complains of pain in the right lower quadrant. The nurse will document this as which of the following diagnostic signs of appendicitis? A) Rovsing signB) Referred painC) Chvostek's signD) Rebound tenderness
A) Rovsing sign In patients with suspected appendicitis, Rovsing sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant.
A nurse is completing an assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? (Select all that apply.) A. Client reports pain relieved by eating. B. Client states that pain often occurs at night. C. Client reports a sensation of bloating. D. Client states that pain occurs 30 min to 1 hr after a meal. E. Client experiences pain upon palpation of the epigastric region.
A. A client who has a duodenal ulcer will report that pain is relieved by eating. B. Pain that rarely occurs at night is an expected finding. C. CORRECT: A client report of a bloating sensation is an expected finding. D. CORRECT: A client who has a gastric ulcer will often report pain 30 to 60 min after a meal. E. CORRECT: Pain in the epigastric region upon palpation is an expected finding.
A nurse is caring for a client following a paracentesis. Which of the following findings indicate the bowel was perforated during the procedure? A. Client report of upper chest pain B. Decreased urine output C. Pallor D. Temperature elevation
A. A report of sharp, constant abdominal pain is associated with bowel perforation. B. Decreased urine output is associated with bladder perforation during a paracentesis. C. Pallor may indicate hypovolemia related to fluid removal of ascites fluid during the procedure. D. CORRECT: Fever is an indication of bowel perforation during a paracentesis.
Antacids do what
Aluminum hydroxide, magnesium hydroxide, calcium carbonate, and sodium bicarbonate neutralize excess acid and increase LES pressure
A nurse is reviewing the health record of a client who has a suspected tumor of the jejunum. The nurse should expect a prescription for which of the following tests? (Select all that apply.) A. Blood alpha‑fetoprotein B. Endoscopic retrograde cholangiopancreatography (ERCP) C. Gastrointestinal x‑ray with contrast D. Small bowel capsule endoscopy (M2A) E. Colonoscopy
A. Blood alpha‑fetoprotein is a laboratory test used in cases of suspected liver cancer. B. An ERCP is used to visualize the duodenum, biliary ducts, gall bladder, liver, and pancreas. C. CORRECT: A gastrointestinal x‑ray with contrast involves the client drinking barium, which is then traced through the small intestine to the junction with the colon. This would identify a tumor in the jejunum. D. CORRECT: M2A is a procedure in which the client swallows a capsule with a glass of water for a video enteroscopy to visualize the entire small bowel over an 8‑hr period. E. A colonoscopy is the use of a flexible fiberoptic colonoscope, which enters through the anus, to visualize the rectum and the sigmoid, descending, transverse, and ascending colon.
A nurse in the emergency department is completing an assessment of a client who has suspected stomach perforation due to a peptic ulcer. Which of the following findings should the nurse expect? (Select all that apply.) A. Rigid abdomen B. Tachycardia C. Elevated blood pressure D. Circumoral cyanosis E. Rebound tenderness
A. CORRECT: Manifestations of perforation include a rigid, board‑like abdomen. B. CORRECT: Tachycardia occurs due to gastrointestinal bleeding that accompanies a perforation. C. Hypotension is an expected finding in a client who has a perforation and bleeding. D. Circumoral cyanosis is not a manifestation of perforation. E. CORRECT: Rebound tenderness is an expected finding in a client who has a perforation
A nurse is teaching a client who has a duodenal ulcer and a new prescription for esomeprazole. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Take the medication 1 hr before a meal. B. Limit NSAIDs when taking this medication. C. Expect skin flushing when taking this medication. D. Increase fiber intake when taking this medication. E. Chew the medication thoroughly before swallowing.
A. CORRECT: Take the medication 1 hr before meals. B. CORRECT: Limit taking NSAIDs when on this medication. C. Skin flushing is not an adverse effect of this medication. D. Fiber intake does not need to be increased when taking this medication. E. Swallow the capsule whole. It should not be crushed or chewed.
A nurse is teaching a client who will undergo a sigmoidoscopy. Which of the following information about the procedure should the nurse include? (Select all that apply.) A. Increased flatulence can occur following the procedure. B. NPO status should be maintained preprocedure. C. Conscious sedation is used. D. Repositioning will occur throughout the procedure. E. Fluid intake is limited the day after the procedure.
A. CORRECT: Teach the client that increased flatulence can occur due to the instillation of air during the procedure. B. CORRECT: Instruct the client to remain NPO after midnight the night before the procedure. C. Inform the client that sedation is not indicated for a sigmoidoscopy. D. Inform the client that the position to lie for the procedure is on the left side. E. Instruct the client to increase, not limit fluid intake following the procedure.
A nurse is planning care for a client who has a new prescription for total parenteral nutrition (TPN). Which of the following interventions should be included in the plan of care? (Select all that apply.) A. Obtain a capillary blood glucose four times daily. B. Administer prescribed medications through a secondary port on the TPN IV tubing. C. Monitor vital signs three times during the 12‑hr shift. D. Change the TPN IV tubing every 24 hr. E. Ensure a daily aPTT is obtained
A. CORRECT: The client is at risk for hyperglycemia during the administration of TPN and can require supplemental insulin. B. No other medications or fluids should be administered through the IV tubing being used to administer TPN due to the increased risk of infection and disruption of the rate of TPN infusion. C. CORRECT: Vital signs are recommended every 4 to 8 hr to assess for fluid volume excess and infection. D. CORRECT: It is recommended to change the IV tubing that is used to administer TPN every 24 hr. E. aPTT measures the coagulability of the blood, which is unnecessary during the administration of TPN.
A nurse is caring for a client who is receiving TPN solution. The current bag of solution was hung 24 hr ago, and 400 mL remains to infuse. Which of the following is the appropriate action for the nurse to take? A. Remove the current bag and hang a new bag. B. Infuse the remaining solution at the current rate and then hang a new bag. C. Increase the infusion rate so the remaining solution is administered within the hour and hang a new bag. D. Remove the current bag and hang a bag of lactated Ringer's.
A. CORRECT: The current bag of TPN should not hang more than 24 hr due to the risk of infection. B. A bag of TPN should not infuse for more than 24 hr due to the risk of infection. C. The rate of TPN infusion should never be increased abruptly due to the risk of hyperglycemia. D. Administration of TPN should never be discontinued abruptly. If the solution needs replacing and another bag is not available, use dextrose 10% in water to maintain blood glucose levels.
. A nurse is having difficulty arousing a client following an esophagogastroduodenoscopy (EGD). Which of the following is the priority action by the nurse? A. Assess the client's airway. B. Allow the client to sleep. C. Prepare to administer an antidote to the sedative. D. Evaluate preprocedure laboratory findings.
A. CORRECT: When using the airway, breathing, and circulation priority‑setting framework, assessing and maintaining an open airway is the priority action the nurse should take. B. Continue to allow the client to rest. However, another action is the priority. C. Prepare to administer an antidote to the sedative used during the procedure. However, another action is the priority. D. Evaluate the preprocedure laboratory findings. However, another action is the priority.
A nurse is teaching a client who has a hiatal hernia. Which of the following client statements indicates an understanding of the teaching? A. "I can take my medications with soda." B. "Peppermint tea will increase my indigestion." C. "Wearing an abdominal binder will limit my manifestations." D. "I will drink hot chocolate at bedtime to help me sleep." E. "I can lift weights as a way to exercise."
A. Carbonated beverages decrease LES pressure and should be avoided by the client who has a hiatal hernia. B. CORRECT: Peppermint decreases LES pressure and should be avoided by the client who has a hiatal hernia. C. Tight restrictive clothing or abdominal binders should be avoided by the client who has a hiatal hernia, as this increases intra‑abdominal pressure and causes the protrusion of the stomach into the thoracic cavity. D. The client should avoid consuming anything immediately prior to bedtime. Additionally, chocolate relaxes the lower esophageal sphincter and should be avoided by a client who has a hiatal hernia. E. Heavy lifting and vigorous activities are to be avoided in the client who has a hiatal hernia
A nurse in a clinic is instructing a client about a fecal occult blood test, which requires mailing three specimens. Which of the following statements by the client indicates understanding? A. "I will continue taking my warfarin while I complete these tests." B. "I'm glad I don't have to follow any special diet at this time." C. "This test determines if I have parasites in my bowel." D. "This is an easy way to screen for colon cancer."
A. Clients are instructed to stop taking anticoagulants prior to obtaining stool specimens for fecal occult blood testing because they can interfere with the results. B. Clients are instructed to avoid consuming red meat, chicken, and fish prior to obtaining stool specimens for fecal occult blood testing because this can interfere with the results. C. Fecal occult blood testing does not identify parasites present in stool. D. CORRECT: Fecal occult blood testing is a screening procedure for colon cancer.
A nurse is teaching a client who has a new diagnosis of dumping syndrome following gastric surgery. Which of the following information should the nurse include in the teaching? A. Eat three moderate‑sized meals a day. B. Drink at least one glass of water with each meal. C. Eat a bedtime snack that contains a milk product. D. Increase protein in the diet
A. Consume small, frequent meals rather than moderate‑sized meals. B. Eliminate liquids with meals and for 1 hr prior to and following meals. C. Avoid milk products. D. CORRECT: Eat a high‑protein, high‑fat, low‑fiber, and moderate‑ to low‑carbohydrate diet.
A nurse is completing discharge teaching for a client who has an infection due to Helicobacter pylori (H. pylori). Which of the following statements by the client indicates understanding of the teaching? A. "I will continue my prescription for corticosteroids." B. "I will schedule a CT scan to monitor improvement." C. "I will take a combination of medications for treatment." D. "I will have my throat swabbed to recheck for this bacteria."
A. Corticosteroid use is a contributing factor to an infection caused by H. pylori. B. An esophagogastroduodenoscopy is done to evaluate for the presence of H. pylori and to evaluate effectiveness of treatment. C. CORRECT: A combination of antibiotics and a histamine2 receptor antagonist is used to treat an infection caused by H. pylori. D. H. pylori is evaluated by obtaining gastric samples, not a throat swab.
A nurse is providing care to a client who is 1 day postoperative following a paracentesis. The nurse observes clear, pale‑yellow fluid leaking from the operative site. Which of the following is an appropriate nursing intervention? A. Place a clean towel near the drainage site. B. Apply a dry, sterile dressing. C. Apply direct pressure to the site. D. Place the client in a supine position.
A. Cover the operative site to prevent infection and allow for assessment of drainage. B. CORRECT: Application of a sterile dressing will contain the drainage and allow continuous assessment of color and quantity. C. Application of direct pressure can cause discomfort and potential harm to the client. D. Place the client with the head of the bed elevated to promote lung expansion
A nurse is completing an assessment of a client who has GERD. Which of the following is an expected finding? A. Absence of saliva B. Painful swallowing C. Sweet taste in mouth D. Absence of eructation
A. Hypersalivation is an expected finding in a client who has GERD. B. CORRECT: Painful swallowing is a manifestation of GERD due to esophageal stricture or inflammation. C. A client who has GERD would report a bitter taste in the mouth. D. Increased burping is an expected finding in a client who has GERD.
A nurse is completing discharge teaching with a client who is 3 days postoperative following a transverse colostomy. Which of the following should the nurse include in the teaching? A. Mucus will be present in stool for 5 to 7 days after surgery. B. Expect 500 to 1,000 mL of semiliquid stool after 2 weeks. C. Stoma should be moist and pink. D. Change the ostomy bag when it is ¾ full.
A. Mucus and blood can be present for 2 to 3 days after surgery. B. Output should become stool‑like, semi‑formed, or formed within days to weeks. C. CORRECT: A pink, moist stoma is an expected finding for a colostomy. D. The ostomy bag should be changed when it is ¼ to ½ full
A nurse is admitting a client who has bleeding esophageal varices. The nurse should expect a prescription for which of the following medications? A. Propranolol B. Metoclopramide C. Ranitidine D. Vasopressin
A. Propranolol is not used for clients who are actively bleeding. It can be given prophylactically to decrease portal hypertension. B. Metoclopramide decreases motility of the esophagus and stomach. C. Histamine2‑receptor antagonists are administered following surgical procedures for bleeding esophageal varices. D. CORRECT: Vasopressin constricts blood vessels and is used to treat bleeding esophageal varices.
Most common reason for ABD surgery
Appendicitis
PPIs end in A. ine B. azole
B Pantoprazole, omeprazole, esomeprazole, rabeprazole, and lansoprazole
A 61-year-old patient with suspected bowel obstruction has had a nasogastric tube inserted at 4:00 am. The nurse shares in the morning report that the day shift staff should check the tube for patency at which of the following times? A) 7:00 am, 10:00 am, and 1:00 pmB) 8:00 am and 12:00 pmC) 9:00 am and 3:00 pmD) 9:00 am, 12:00 pm, and 3:00 pm
B) 8:00 am and 12:00 pm A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 am, it would be due to be checked at 8:00 am and 12:00 pm.
Which of the following tests is most commonly used to diagnose cholecystitis? A) Abdominal CT scanB) Abdominal ultrasoundC) Barium swallowD) Endoscopy
B) Abdominal ultrasound An abdominal ultrasound can show if the gallbladder is enlarged, if gallstones are present, if the gallbladder wall is thickened, or if distention of the gallbladder lumen is present. An abdominal CT scan can be used to diagnose cholecystitis, but it usually isn't necessary. A barium swallow looks at the stomach and the duodenum. Endoscopy looks at the esophagus, stomach, and duodenum.
Which of the following assessments is essential for the nurse to make when caring for a client who has just had an esophagogastroduodenoscopy (EGD)? A) Auscultate bowel sounds B) Check gag reflex C) Monitor gastric pH D) Measure abdominal girth
B) Check Gag Reflex The posterior pharynx is anesthetized for the easy passage of the endoscope into the esophagus. The return of the gag reflex indicates that normal function is returning and that your patient is able to swallow.
The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750 ml of green-brown drainage. Which nursing intervention is most appropriate? A) Notify the physicianB) Document the findingsC) Irrigate the T-tubeD) Clamp the T-tube
B) Document the findings Following cholecystectomy, drainage from the T-tube is initially bloody and then turns to green-brown. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 ml per day. The nurse would document the output.
A 32 year old client is admitted to the hospital with a BMI of 24.7. The nurse interprets this to mean the client: A) Is undernourished B) Has an optimal amount of body fat C) Is 10% overweight D) Is morbidly obese
B) Has an optimal amount of body fat BMI is an estimation of total body fat in relation to height and weight. An optimal BMI is 20-25.
Which of the following factors should be the main focus of nursing management for a client hospitalized for cholecystitis? A) Administration of antibioticsB) Monitor for complicationsC) Preparation for lithotripsyD) Preparation for surgery
B) Monitor for complications The client with acute cholecystitis should first be monitored for perforation, fever, abscess, fistula, and sepsis. After assessment, antibiotics will be administered to reduce the infection. Lithotripsy is used only for a small percentage of clients. Surgery is usually done after the acute infection has subsided.
A female client complains of gnawing epigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out: A) Cancer of the stomachB) Peptic ulcer diseaseC) Chronic gastritisD) Pylorospasm
B) Peptic ulcer disease Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the back. Vomiting usually reflects pyloric spasm from muscular spasm or obstruction. Cancer would not evidence pain or vomiting unless the pylorus was obstructed.
Which of the following best describes the method of action of medications, such as ranitidine (Zantac), which are used in the treatment of peptic ulcer disease? A) Neutralize acid B) Reduce acid secretions C) Stimulate gastrin release D) Protect the mucosal barrier
B) Reduce acid secretions Ranitidine is a histamine-2 receptor antagonist that reduces acid secretion by inhibiting gastrin secretion.
A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The nurse knows that the client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times? A) Before mealsB) With mealsC) At bedtimeD) When pain occurs
C) At bedtime Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime.
When a client has peptic ulcer disease, the nurse would expect a priority intervention to be: A) Assisting in inserting a Miller-Abbott tubeB) Assisting in inserting an arterial pressure lineC) Inserting a nasogastric tubeD) Inserting an I.V.
C) Inserting a nasogastric tube An NG tube insertion is the most appropriate intervention because it will determine the presence of active GI bleeding. A Miller-Abbott tube (A) is a weighted, mercury-filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client; therefore, an arterial line (B) is not appropriate at this time and an IV (D) is optional.
What do hypotonic fluids do?
Moves water into cells and expands them, can cause hyponatremia by pulling fluids from GI tract into cells. Has lower concentration of solutes
Peptic ulcer tx will include what? NG tube EGD with biopsy clear liquids
NG tube (EGD is for upper GI tract examining, PT woul dbe NPO SO NO CLEAR LIQUIDS)
What foods decrease esophageal pressure/ make GERD worse?
Caffeine chocolate carbonated beverages peppermint fatty foods tea
Sucrafate
Carafate Antiulcer Agent
With an external fixation device, what does the patient need to do when at home
Check and clean the pin insertion sites
With what dx cause stools to be fatty and tan or clay colored?
Cholelithiasis
Finger joint deformity from RA is caused by what? Chronic inflammaiton of joints formation of stones in synovial fluid
Chronic inflammation
Naproxen is an_____prescribed to relieve and control inflammation
NSAID
A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid? A) "I should take my antacid before I take my other medications."B) "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid."C) "My antacid will be most effective if I take it whenever I experience stomach pains."D) "It is best for me to take my antacid 1 to 3 hours after meals."
D) "It is best for me to take my antacid 1 to 3 hours after meals." Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an antacid is taken on an empty stomach, the duration of the drug's action is greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action of the drug. Antacids should be administered about 2 hours after other medications to decrease the chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids.
With an ankle sprain, should you alternate cold and heat immediately after the injury?
No. Apply ice to sprains as soon as possible and leave in place for 20 to 30 minutes at a time. Moist heat may be applied 24 to 48 hours after the injury.
What sounds would you hear early on in an intestinal obstruction? What would you hear later on? A) Low pitched and rumbling above the area of obstruction B) High pitched and hypoactive below the area of obstruction C) Low pitched and hyperactive below the area of obstruction D) High pitched and hyperactive above the area of obstruction
D) High pitched and hyperactive above the area of obstruction Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling" above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.
A client being treated for chronic cholecystitis should be given which of the following instructions? A) Increase restB) Avoid antacidsC) Increase protein in dietD) Use anticholinergics as prescribed
D) Use anticholinergics as prescribed Conservative therapy for chronic cholecystitis includes weight reduction by increasing physical activity, a low-fat diet, antacid use to treat dyspepsia, and anticholinergic use to relax smooth muscles and reduce ductal tone and spasm, thereby reducing pain.
Name two hypotonic fluids
D5W 1/2 NS
A 54- year old man should receive what at their annual exam
DRE- Digital rectal examinaiton
LIVER CHICKEN SALMON EGGS Which food is not high in purine?
Eggs
Sx of HYPOnatremia
First seen in the CNS, fluid shifts in to brain cells causing irritability, apprehension, confusion, seizures and even death
A patient who had a leg cast applied in the morning asks to walk at dinnertime. Why should the nurse say no?
For the first 24 hours after a lower extremity cast is applied, the leg should be elevated on pillows above heart level to avoid excessive edema and compartment syndrome.
What is fundoplication surgery?
Fundoplication is a surgical procedure used to treat stomach acid reflux. During fundoplication, the top part of your stomach — called the fundus — is folded and sewn around the lower esophageal sphincter, a muscular valve at the bottom of your esophagus.
Differences between duodenal or gastric ulcers
GASTRIC ULCERS Less common n Pain occurs 1-2 hours after meals n Normal or decreased acid secretion n Occasional nausea and vomiting n Higher in females and older adults n H. Pylori infection in 80% DUODENAL ULCERS n 80% of ulcers n Pain occurs 2-4 hours after meals secondary to hypersecretion of acid n The pain usually relieved by food or antacids n Occasional nausea and vomiting n H. Pylori infection in 90-95%
Difference between PPIs and H2 receptor antagonist
H2 blockers (histamine blockers) block one of the first stimuli for acid production. PPIs block the final step in the pathway of acid secretion in the stomach. Both medications work by blocking and decreasing the production of stomach acid, but PPIs are considered stronger and faster in reducing stomach acids. However, H2 receptor blockers specifically decrease the acid released in the evening, which is a common contributor to peptic ulcers. This is why H2 receptor blockers are specifically prescribed to people who have ulcers or who are at risk for getting them. PPIs are more often prescribed for people who have GERD or acid reflux.
Cimetidine, ranitidine, famotidine, nizatidine
H2 receptor antagonists
What is a side effect of prednisone?
Hyperglycemia
Standard tx for osteomyelitis?
IV antibiotics for several months
Who should the nurse assess first? Pt with OA, fell and cannot move leg Pt who just had hip replacment and is in pain
OA pt- BECAUSE COULD BE FRACTURED
Low-grade fever is or is not, common with RA?
Is, because of inflammatory response
Joint space narrowing found in RA or OA?
Joint space narrowing with osteophytes is consistent with osteoarthritis.
lONG TERM USE OF PPIs increases risk of what TWO THINGS?
Long‑term use of PPIs increases the risk for fractures, especially in older adults. Long‑term use has been related to the development of community‑acquired pneumonia and Clostridium difficile infections.
Patient with Lupus should get all of these except... Pepcid Aleve MMR vaccination Anti-DNA titer
MMR because its a live virus
Sx of HYPERcalcemia
Manifestations of hypercalcemia include nausea, vomiting, and altered mental status (e.g., lethargy, decreased memory, confusion, personality changes, psychosis, stupor, coma).
With an intestinal obstruction, what can occur? metabolic alkalosis or acidosis? Why?
Metabolic alkalosis can occur due to vomiting and losing too much HCL
Prokinetics do what?
Metoclopramide increases the motility of the esophagus and stomach.
Monitor for what with PPIs
Monitor for electrolyte imbalances and hypoglycemia in clients who have diabetes mellitus.
Osteomyelitis caused by S.aureus and S. EPIDERMIDIS IS CAUSED BY WHAT?
Osteomyelitis caused by S. aureus is usually associated with a pressure ulcer or vascular insufficiency related to diabetes. Osteomyelitis caused by Staphylococcus epidermidis is usually associated with indwelling prosthetic devices from joint arthroplasty.
What is Nexium/ omeprazole?
PPI, lowers gastric acid secretion
PPIs Antacids H2 blockers sucralfate Describe the action of each
PPI- reduce stomach acid production Antacid- absorbs gastric acid H2 Blocker- same as PPI sucralfate- covers the ulcer with protective material
6 P's of compartment syndrome
Pain Paresthesias Pallor Pressure Paralysis Pulselessness
PPIs do what?
Pantoprazole, omeprazole, esomeprazole, rabeprazole, and lansoprazole reduce gastric acid by inhibiting the cellular pump of the gastric parietal cells necessary for gastric acid secretion.
In OA or RA do you have fever and weight loss?
RA
Sx of : Presence of nodules Subluxation of joints without fibrous ankyloses ...RA or OA?
RA
What do h2 receptor antagonists do
Ranitidine, famotidine, cimetidine, and nizatidine reduce/ inhibit the secretion of acid. The onset is longer than antacids, but the effect has a longer duration.
Dumping syndrome
Rapid emptying of gastric contents into small intestines. Client experience ab pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia. The stomach no longer has control over the amount of chyme entering the intestine - a large bolus of hypertonic fluid causes fluid to be drawn into the bowel lumen, distention, and rapid transit. Symptoms begin within 15 to 30 minutes after eating. The patient usually describes feelings of generalized weakness, sweating, palpitations, and dizziness. These symptoms are due to the sudden decrease in plasma volume. The patient complains of abdominal cramps, borborygmi (audible abdominal sounds produced by hyperactive intestinal peristalsis), and the urge to defecate. These manifestations usually last less than 1 hour after eating. A short rest period after each meal reduces the chance of dumping syndrome Very common after gastric suregery and is a complication
Over 50% of lupus pt have what on their skin?
Rash/ butterfly rash
How can intestinal obstruction cause hypovolemic shock? sEPTIC SHOCK?
Small-bowel distension can cause lymphatic compression that leads to bowel wall lymphedema. Increasing intraluminal pressure can result in reduced venous and arterial blood flow and severe fluid loss, , hypotension, dehydration (which can lead to hypovolemic shock and death), and electrolyte imbalance. Perforation of bowel can cause septic shock
When should pt take antacids?
Take antacids when acid secretion is the highest (1 to 3 hr after eating and at bedtime), and separate from other medications by at least 1 hr
When do you take your H2 receptor antagonist and can you take them with antacids at same time?
Take with meals and at bedtime. ● Separate dosages from antacids (1 hr before or after taking antacid).
Pt in traction, an LPN can... -monitor pain, admin meds? -assess skin integrity? -determine proper alignment? -remove weights?
The LPN/VN can monitor pain intensity and administer analgesics. Assessment of skin integrity and determining correct alignment to enhance traction are within the RN scope of practice. Removing weights from the traction should not be delegated or done. Removal of weights can cause muscle spasms and bone misalignment and should not be delegated or done.
Once a cast is put on, should it be supported or lie flat? And elevated or no elevation for the first 24 hours?
The casted extremity should be elevated at or above heart level for 24 hours to reduce swelling or inflammation. The cast should be supported on pillows during the drying period to prevent denting and flattening of the cast.
Post op care for pt with total knee arthroplasty... which one? -bed rest with leg in extension -PROGRESSIVE LEG EXERCISES UNTIL 90 DEGREE
The patient is encouraged to engage in progressive leg exercises until 90-degree flexion is possible; continuous passive motion also may be used based on surgeon preference.
What drug can help prevent gout from recurring?
To prevent future attacks of gout, the urate-lowering drug allopurinol may be administered.
Cholecystitis sx
Upper right quadrant tender Dark/ amber urine Hightemp pain worse when laying down jaundice right shoulder pain
Naproxen should be taken with food or without?
With
Are absence of bowel sounds of for first 24-48 hours after surgery?
Yes
should a pt admitted with acute diverticulitis be NPO? What should they have?
Yes, NPO -D5W -NG tube -bedrest with bathroom proveleges
Most ulcers are duodenal or gastric?
duodenal (80%)
Most important info to obtain with pt vomiting bright red blood? Meds they are taking sx of hypovolemia med hist
evaluate for s/s of shock (hypovolemia)
A 64-year old pt with fractured pelvis on second day suddenly develops confusion. What might this be a sign of?
fat embolus due to broken bone- check 02 sats ASAP
cholelithiasis is what?
gallstones in the gallbladder
Pt has just arrived in recovery after endoscopy. What sx is important to notify provider of? Sore throat drowsiness oral temp of 101 P 104 BPM
high temp- indicates a perforation may have occurred during the procedure
Osteomyelitis
infection of the bone
diverticulitis versus diverticulosis
itis: lower left pain, gas osis: fever, leukocytosis, N/V, absent bowel sounds
What intervention helps in post op extremity amputation
keep affected limb in extension
How to calculate BMI
weight in kg/height in meters squared
