Med Surg Chapter 42 Lower GI

When evaluating the patient's understanding about the care of the ileostomy, which statement by the patient indicates the patient needs more teaching? I will be able to regulate when I have stools." "I will be able to wear a pouch until it leaks." "The drainage from my stoma can damage my skin." "Dried fruit and popcorn must be chewed very well."

"I will be able to regulate when I have stools." Rationale: An ileostomy is in the ileum and drains liquid stool frequently, unlike a colostomy, which has more formed stool the farther distal the ostomy is in the colon. The ileostomy pouch is usually worn for 4 to 7 days or until it leaks. It must be changed immediately if it leaks because the drainage is very irritating to the skin. *To avoid obstruction, popcorn, dried fruit, coconut, mushrooms, olives, stringy vegetables, food with skin, and meats with casings must be chewed extremely well before swallowing because of the narrow diameter of the ileostomy lumen.

The nurse is preparing to administer a dose of bisacodyl to a patient with constipation and the patient asks how it will work. What is the best response by the nurse? "It will increase bulk in the stool." "It will lubricate the intestinal tract to soften feces." "It will increase fluid retention in the intestinal tract." "It will increase peristalsis by stimulating nerves in the colon wall."

"It will increase peristalsis by stimulating nerves in the colon wall." Rationale: Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. Fiber and bulk-forming drugs increase bulk in the stool. Water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.

The nurse is preparing to administer famotidine to a patient after a laparotomy. The patient states they do not have heartburn. What response by the nurse would be the most appropriate? "It will prevent air from accumulating in the stomach, causing gas pains." "It will reduce the amount of acid in the stomach while you are not eating." "It will prevent the heartburn that occurs as a side effect of general anesthesia." "The stress of surgery is likely to cause stomach bleeding if you do not receive it."

"It will reduce the amount of acid in the stomach while you are not eating." Rationale: Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.

The nurse identifies that which patient is at highest risk for developing colon cancer? A 28-yr-old man who has a body mass index of 27 kg/m2 A 32-yr-old woman with a 12-year history of ulcerative colitis A 52-yr-old man who has followed a vegetarian diet for 24 years A 58-yr-old woman taking prescribed estrogen replacement therapy

A 32-yr-old woman with a 12-year history of ulcerative colitis Rationale: Risk for colon cancer includes personal hx of IBD (especially ulcerative colitis for longer than 10 years); obesity; family (1st-degree relative) or personal hx of colorectal cancer, adenomatous polyposis, or hereditary nonpolyposis colorectal cancer syndrome; eating red meat; cigarette use; & drinking alcohol.

A patient is planned for discharge home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? An UAP on the unit who has hospice experience An LPN that has worked on the unit for 10 years An RN with 6 months of experience on the surgical unit An RN who has floated to the surgical unit from pediatrics

An RN with 6 months of experience on the surgical unit Rationale: The patient needs ostomy care directions and reinforcement at discharge and should be assigned to a registered nurse with experience in providing discharge teaching for ostomy care. Teaching should not be delegated to a LPN/VN or UAP.

Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease? (Select all that apply) Restricted to rectum Strictures are common Bloody, diarrhea stools Cramping abdominal pain Lesions penetrate intestine

Bloody, diarrhea stools (not common in Crohn's???) Cramping abdominal pain Rationale: Manifestations of UC and Crohn's dz include bloody diarrhea, cramping abdominal pain, & nutritional disorders. Intestinal lesions associated w/UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's dz.

The nurse is preparing to administer a scheduled dose of docusate sodium when the patient reports an episode of loose stool and does not want to take the medication. What is the appropriate action by the nurse? A. Write an incident report about this untoward event. B. Attempt to have the family convince the patient to take the ordered dose. C. Withhold the medication at this time and try to administer it later in the day. D. Chart the dose as not given on the medical record and explain in the nursing progress notes

D. Chart the dose as not given on the medical record and explain in the nursing progress notes

The nurse is admitting a patient with severe dehydration and frequent watery diarrhea. A 10-day outpatient course of antibiotic therapy for bacterial pneumonia has just been completed. What is the most important for the nurse to take which action? Wear a mask to prevent transmission of infection. Have visitors use the alcohol-based hand sanitizer. Wipe down equipment with ammonia-based disinfectant. Don gloves and gown before entering the patient's room.

Don gloves and gown before entering the patient's room. Rationale: C-diff is an antibiotic-associated diarrhea transmitted by contact, & spores are extremely difficult to kill. Patients w/suspected or confirmed infection w/ C. difficile should be placed in a private room, & gloves & gowns should be worn by visitors and HCPs. Alcohol-based hand cleaners and ammonia-based disinfectants are ineffective and do not kill all the spores. Equipment cannot be shared with other patients, and a disposable stethoscope and individual patient thermometer are kept in the room. Objects should be disinfected with a 10% solution of household bleach.

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? White bread, cheese, and green beans Fresh tomatoes, pears, and corn flakes Oranges, baked potatoes, and raw carrots Dried beans, All Bran (100%) cereal, and raspberries

Dried beans, All Bran (100%) cereal, and raspberries Rationale: high-fiber diet is recommended for diverticular dz. Dried beans, All Bran (100%) cereal, & raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots.

After an exploratory laparotomy, a patient on a clear liquid diet reports severe gas pains and abdominal distention. Which action by the nurse is most appropriate? Return the patient to NPO status. Place cool compresses on the abdomen. Encourage the patient to ambulate as ordered. Administer an as-needed dose of IV morphine sulfate.

Encourage the patient to ambulate as ordered.

A patient after a stroke who primarily uses a wheelchair for mobility has developed diarrhea with fecal incontinence. What is a priority assessment by the nurse? Fecal impaction Perineal hygiene Dietary fiber intake Antidiarrheal agent use

Fecal impaction Rationale: Patients w/limited mobility are at risk for fecal impactions caused by constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

A patient is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? Nausea and vomiting Hyperactive bowel sounds Firmly distended abdomen Abrasions on all extremities

Firmly distended abdomen Rationale: Manifestations of abdominal trauma are guarding and splinting of the abdominal wall; a hard, distended abdomen (indicating possible intraabdominal bleeding); decreased or absent bowel sounds; contusions, abrasions, or bruising over the abdomen; abdominal pain; pain over the scapula; hematemesis or hematuria; and signs of hypovolemic shock (tachycardia and decreased b/p).

Nursing Management of appendicitis

Goals include -relieving pain (after being seen by surgeon) -preventing fluid volume deficit, -reducing anxiety, -eliminating infection -maintaining skin integrity, -NPO, IV LR or NS, attaining optimal nutrition.

The nurse is caring for a patient admitted with a suspected bowel obstruction. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? Low-pitched and rumbling above the area of obstruction High-pitched and hypoactive below the area of obstruction Low-pitched and hyperactive below the area of obstruction High-pitched and hyperactive above the area of obstruction

High-pitched and hyperactive above the area of obstruction Rationale: 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.

The nurse is developing a plan of care for a patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history does the nurse recognize as increasing the patient's risk for colorectal cancer? Osteoarthritis History of colorectal polyps History of lactose intolerance Use of herbs as dietary supplements

History of colorectal polyps

What information would have the highest priority for the nurse to include in preoperative teaching for a patient scheduled for an exploratory laparotomy? How to care for the wound How to deep breathe and cough The location and care of drains after surgery Which medications will be used during surgery

How to deep breathe and cough

Two days after a bowel resection for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result what event? Impaired peristalsis Irritation of the bowel Nasogastric suctioning Inflammation of the incision site

Impaired peristalsis

A hospitalized patient has just been diagnosed with diarrhea due to C. difficile. Which nursing interventions should be included in the patient's plan of care? (Select all that apply.) Initiate contact isolation precautions. Place the patient on a clear liquid diet. Teach any visitors to wear gloves and gowns. Disinfect the room with 10% bleach solution as needed. Use hand sanitizer before and after any bodily fluid contact.

Initiate contact isolation precautions. Teach any visitors to wear gloves and gowns. Disinfect the room with 10% bleach solution as needed. Rationale: Initiation of contact isolation precautions must be done immediately w/a patient w/C. difficile, which includes washing hands w/soap & water before & after patient or bodily fluid contact. Alcohol-based sanitizers are ineffective. Visitors need to be taught to wear gloves and gowns and wash hands. A clear liquid diet is not necessary. The room will be disinfected w/10% bleach solution when the patient is dismissed and may be done periodically during the patient's stay, depending on the agency policy.

The nurse is administering a cathartic agent to a patient with renal insufficiency. Which order will the nurse question? Bisacodyl Lubiprostone Cascara sagrada Magnesium hydroxide

Magnesium hydroxide Rationale: MOM may cause hypermagnesemia in patients w/renal insufficiency. nurse should question this order w/HCP. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients w/renal insufficiency as long as the patient is not currently dehydrated.

Appendicitis S/S

RLQ pain with rebound tenderness (pain between rt hip & belly button area), low grade fever,

A patient with an intestinal obstruction has a nasogastric (NG) tube to suction but reports of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse? Notify the provider. Auscultate for bowel sounds. Reposition the tube and check for placement. Remove the tube and replace it with a new one.

Reposition the tube and check for placement. Rationale: The tube may be resting against the stomach wall. The first action by the nurse is to reposition the tube and check it again for placement. The provider does not need to be notified unless the nurse cannot restore the tube function. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

A patient with ulcerative colitis is scheduled for a colon resection with placement of an ostomy. The nurse should plan to include which prescribed measure in the preoperative preparation? Selecting the stoma site Where to purchase ostomy supplies Teaching about how to irrigate a colostomy Following a high-fiber diet the day before surgery

Selecting the stoma site Rationale: Care that is unique to ostomy surgery includes selecting the best site for the stoma. Instructions to irrigate the colostomy and where to purchase ostomy supplies will be done postoperatively. A clear liquid diet will be used the day before surgery with the bowel cleansing.

A patient with ulcerative colitis is scheduled for a total proctocolectomy with permanent ileostomy. The wound, ostomy, and continence nurse is selecting the site where the ostomy will be placed. What should be included in site consideration? Protruding areas make the best sites. The patient must be able to see the site. The site should be outside the rectus muscle area. The appliance will need to be placed at the waist line.

The patient must be able to see the site.

Salmonella poisoning

a. bacteria - very common, intestines b. source: poultry, and dairy products, reptiles c. symptoms: abdominal cramps, fever last 4-7days d. found in undercook meats, & foods prepared w/eggs d. prevention: remove carriers, sanitation, proper cooking

Although M.B.'s ileostomy is temporary and will be closed in the second stage of the surgery, it is important that she be able to care for the ileostomy at home. When teaching her about ileostomy care, you determine that M.B. needs further instruction when she states: a ."The appliance should be changed whenever it is about one-third full to prevent leaking." b. "A skin barrier or stoma paste should be used to prevent leaking of contents onto the skin." c. "The skin around the stoma should be checked for irritation when the appliance is changed." d. "The skin around the stoma should be cleaned with warm water and dried well when changing the appliance."

a ."The appliance should be changed whenever it is about one-third full to prevent leaking." Rationale: An ostomy appliance should be kept in place as long as possible before it begins to loosen or leak onto the skin, usually 4 to 7 days, to prevent skin breakdown from frequent application. The pouch that attaches to an appliance is emptied when it is about one-third full and can be removed and rinsed to control odors. The appliance should fit snugly around the stoma, and the skin should be protected with a skin barrier or stoma paste.

Patient With Ulcerative Colitis: When planning care for M.B., you prioritize assessment of the patient's ___________status. a. cardiovascular b. respiratory c. psychosocial d. skin integrity

a. cardiovascular

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 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 to 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."

a. "The tube will help to drain the stomach contents and prevent further vomiting."

Patient With Ulcerative Colitis: M.B. undergoes an exploratory laparotomy and the first stage of a total proctocolectomy and ileal pouch/anal anastomosis (IPAA) procedure. A perforation in the descending colon is found with a localized abscess. She returns to the surgical unit with the double lumen PICC, a nasogastric tube (NG) to suction, a urinary catheter, a Jackson-Pratt drain to bulb suction in the left lower abdomen, dressings over a midline abdominal incision, and an opened loop ileostomy on the right abdomen below the waist. Select the interventions that you would expect to implement for M.B. during the immediate postoperative period. There are 6 correct answers a. Advise M.B. that any incontinence of mucus from the anus is expected and transient. b. Assess her abdomen q4hr including dressings, incision, and bowel sounds. c. Maintain PN as ordered postoperatively. d. Measure the drainage from the Jackson-Pratt drain q8hr. e. Monitor character and amount of nasogastric drainage q8hr. f. Monitor v/s q8hr g. Notify HCP if ileostomy drains > 1000 mL in first 24hr h. Replace temporary ostomy pouch with a nontransparent collecting bag. i. Assess M.B.'s pain and administer as-needed IV pain medication.

a. Advise M.B. that any incontinence of mucus from the anus is expected and transient. b. Assess her abdomen q4hr including dressings, incision, and bowel sounds. c. Maintain PN as ordered postoperatively. d. Measure the drainage from the Jackson-Pratt drain q8hr. e. Monitor character and amount of nasogastric drainage q8hr. i. Assess M.B.'s pain and administer as-needed IV pain medication.

Following confirmation of the PICC placement, a three-in-one PN solution containing IV fat emulsion, dextrose, and amino acids is started at 60 mL/hr. Select all the appropriate interventions you would implement related to the PN administration for M.B. There are 7 correct answers. a. Check blood glucose levels q4-6hr during PN administration. b. Check the amount of solution infused and the infusion rate q4hr. c. Give sliding scale insulin coverage to maintain glucose levels 110 to 150 mg/dL. d. Discontinue any PN solution older than 24 hours & replace it with a new solution. e. If a new PN solution is not available when a bag is empty, infuse normal saline until the solution is ready. f. Add newly ordered electrolytes to existing PN solutions using strict sterile technique. g. Change the IV tubing used with PN with lipids q24hr. h. Monitor patient's wt on a daily basis. i. Monitor v/s q4hr while patient is receiving PN. j. When changing tubing, have the patient inhale as the tubing is disconnected from the catheter. k. Use a 1.2-micron filter on the infusion tubing.

a. Check blood glucose levels q4-6hr during PN administration. c. Give sliding scale insulin coverage to maintain glucose levels 110 to 150 mg/dL. d. Discontinue any PN solution older than 24 hours & replace it with a new solution. g. Change the IV tubing used with PN with lipids q24hr. h. Monitor patient's wt on a daily basis. i. Monitor v/s q4hr while patient is receiving PN. k. Use a 1.2-micron filter on the infusion tubing.

Most appropriate therapy for patients with acute diarrhea caused by viral infection is to: a. increase fluid intake b. administer antibiotics' c. administer antimotility drug d. quarantine patients to prevent spread of virus

a. increase fluid intake

Which of the following nursing interventions would be appropriate to delegate to a licensed practical nurse (LPN) (Select all that apply.)? a. Provide skincare around the ostomy. b. Assess and document stoma appearance. c. Develop plan of care for skincare around the ostomy. d. Monitor the skin around the ostomy for breakdown. e. Teach ileostomy care and skincare to M.B.

a. Provide skincare around the ostomy. d. Monitor the skin around the ostomy for breakdown. Rationale: As an RN, you must assess the patient, and develop and monitor the plan of care. However, interventions that the LPN has been trained to provide may be appropriately delegated.

Using Scenario #2:Evidence-based practice identifies which flushing technique is the most effective method for maintaining peripherally inserted central line catheter (PICC) patency? a. Push-pause flushing b. Gradual flushing c. Rapid flushing

a. Push-pause flushing RATIONALE: The push-pause technique creates turbulence within the catheter lumen, promoting the removal of debris that adheres to the catheter lumen and decreasing the chance of occlusion. This technique involves injecting saline with a rapid alternating push-pause motion, instilling 1 to 2 mL with each push on the syringe plunger.

Using Scenario #2: For which observed action by the unlicensed assistive personnel (UAP) would you need to intervene? a. Taking M.B.'s blood pressure on her right arm b. Soaking a toothette used for M.B.'s oral care in ice water c. Assisting M.B. to the bathroom after insertion of the PICC d. Measuring and recording the amount of M.B.'s liquid stools

a. Taking M.B.'s blood pressure on her right arm RATIONALE: An arm with a PICC should not be used for blood pressure or venipuncture. All the other actions are appropriate for the UAP to perform.

Patient With Ulcerative Colitis: 3 days after admission, M.B. develops severe pain localized in the LLQ of abdomen. The HCP suspects that she has a perforation and discusses the necessity of immediate surgery with her. He recommends that she consider a total colectomy because of the increasing exacerbations of her illness & her declining health status. M.B. tells him that surgery does not seem like such a negative alternative anymore, but that she wants to have as normal bowel function as possible. You recognize that the surgical procedure that provides the most normal bowel function for her is a: a. total proctocolectomy and ileal pouch/anal anastomosis b. total proctocolectomy with a permanent ileostomy

a. total proctocolectomy and ileal pouch/anal anastomosis

During an initial assessment, you note that M.B. has red, painful nodules on her legs and the skin on her abdomen is inflamed. You recognize these findings as: a. a systemic (extraintestinal) complication occurring as a result of circulating cytokines. b. characteristic of poor personal hygiene that is often present in patients with ulcerative colitis. c. an opportunistic infection that occurs when chronic illness causes compromised immunologic function. d. manifestations of the stress and ineffective coping that are factors in the development of ulcerative colitis.

a. a systemic (extraintestinal) complication occurring as a result of circulating cytokines. RATIONALE: These findings are characteristic of erythema nodosum and pyoderma gangrenosum, which are systemic (extraintestinal) complications associated with circulating products of inflammation (e.g., cytokines).

Characteristics of Crohn's Disease:

abdominal pain (cramping), diarrhea, fatigue, c-diff, anal abscesses & fistulas, malabsorption, weight loss, common recurrence after surgery, Cobblestone mucosa, "skip" lesions, involves all lays of the bowel wall

Characteristics of Ulcerative Colitis:

abdominal pain, diarrhea, fatigue, c-diff, rectal bleeding, high incidence of colorectal cancer, spread in a continuous pattern, Tenesmus, pseudopolyps, involves a mucosal layer or innermost lay of the bowel wall, protein loss

Complications of appendicitis

abscesses, peritonitis, gangrene, death

Define IBD (Inflammatory Bowel Disease)? a. IBS (irritable bowel syndrome) b. Chronic inflammation of GI tract characterized by periods of remission interspersed with periods of exacerbation. Exact cause is unknown. c. Crohn's disease and Ulcerative colitis d. Intestinal disorder affects large intestines causing cramping/abdominal pain or discomfort, bloating, and either constipation or diarrhea.

b. Chronic inflammation of GI tract characterized by periods of remission interspersed with periods of exacerbation. The exact cause is unknown

The nurse should administer an as-needed dose of magnesium citrate after noting what information when reviewing a patient's medical record? a. Abdominal pain and bloating b. No bowel movement for 3 days c. A decrease in appetite by 50% over 24 hours d. Muscle tremors and other signs of hypomagnesemia

b. No bowel movement for 3 days

Name the two inflammatory bowel disease's (IBD) a. Ulcerative Colitis & GERD b. Ulcerative Colitis & Crohn's disease c. irritable bowel syndrome & GERD d. Gastroenteritis & Diarrhea

b. Ulcerative Colitis & Crohn's disease

Patient With Ulcerative Colitis: Upon entering M.B.'s room, you find her returning to bed from the bathroom. She tells you that her bottom is very sore and the skin around her perianal area is bleeding. She is washing the area with warm water after each stool and applied ointment containing zinc oxide to the skin. You identify a nursing diagnosis of impaired skin integrity of the perianal area related to diarrhea and recognize that healing of the skin is going to be complicated by M.B.'s: a. impaired mental state b. altered nutritional status c. inability to maintain normal mobility d. lack of knowledge of skincare techniques

b. altered nutritional status RATIONALE: Altered nutritional status, especially negative nitrogen balance, contributes to her skin breakdown and will impair healing, and she is not currently receiving any protein source.

Patient With Ulcerative Colitis: Laboratory testing is ordered for M.B. Based on M.B.'s signs and symptoms, you expect the laboratory results to reveal leukocytosis, electrolyte imbalance, hypoalbuminemia, and: a. thrombocytopenia b. anemia c. decreased erythrocyte sedimentation rate (ESR) d. decreased C-reactive protein (CRP) level

b. anemia

In addition to teaching M.B. how to care for the ileostomy, you must also reinforce dietary teaching. You teach M.B. that fiber-containing foods must be reintroduced gradually and should be chewed extremely well to avoid obstruction. Identify foods high in fiber. There are 6 correct answers. Eggs, blackberries, canned peas, ice cream, fish, nuts, lima beans, popcorn, raw veggies, white bread

blackberries, canned peas, nuts, lima beans, popcorn, raw veggies

Humira (abalimumab) a Immunosuppressive drug is used to treat:

both Ulcerative Colitis & Chron's Disease -biologic therapy drug (inhibits cytokine tumor necrosis factor (TNF) -binds to TNF molecules & blocks them. -helps reduce inflammation that leads to symptoms of Crohn's disease or UC.

Define IBS (irritable bowel syndrome): a. Disorder of bowels b. a chronic inflammation of the GI tract characterized by periods of remission interspersed with periods of exacerbation c. Intestinal disorder affects large intestines causing cramping/abdominal pain or discomfort, bloating, and either constipation or diarrhea.

c. Intestinal disorder affects large intestines causing cramping/abdominal pain or discomfort, bloating, and either constipation or diarrhea.

Considering M.B.'s condition before surgery and the expected ileostomy output the first few days after surgery, you recognize that in the early postoperative period M.B. is at greatest risk for a. infection b. hemorrhage c. fluid volume deficit d. small bowel obstruction

c. fluid volume deficit Rationale: Following surgery, ileostomy output initially may be as high as 1500 to 2000 mL/day. This output will gradually decrease to about 500 mL/day, but during the immediate postoperative period, dehydration and a fluid deficit are major risks. She is also at increased risk because of her preoperative diarrhea and dehydration.

Scenario #2: After 2 days of treatment, M.B.'s diarrhea is unrelieved and her primary health care provider decides to start parenteral nutrition (PN) to restore positive nitrogen balance and improve M.B.'s immunologic status. The IV therapy nurse places a double-lumen peripherally inserted central catheter (PICC) in M.B.'s right upper arm, M.B. is taken to x-ray to confirm the tip of the catheter is in the: a. right atrium b. subclavian vein c. superior vena cava

c. superior vena cava RATIONALE: Following insertion of a central catheter, the patient is taken to x-ray for confirmation of placement of the catheter tip in the superior vena cava. The superior vena cava is a central location in which there is a large amount of blood flow and extravasation is rare. If the catheter is in the right atrium, it is in too far and can cause dysrhythmias. Placement in the subclavian vein does not have adequate blood flow to be considered a central catheter.

Characteristics of both "Ulcerative colitis" & "Crohn's disease":

diarrhea, abdominal pain, c-diff, perforation, fatigue, fever, Periods of exacerbation, and remission

A patient had NG tube placed at 0400 AM; how often should it be check for patency?

every 4 hours

DEFINE: APPENDICITIS

inflammation of appendix, narrow blind tube extends from inferior part of cecum

diagnostic studies for appendicitis

leukocytosis -- 10, 000 to 20,000** higher levels -- perforation and peritonitis microscopic hematuria & pyuria CT-- confirm dx

Crohn's disease can be located anywhere in GI tract from____ to ____: a. mouth to small intestines b. upper abdomen to lower abdomen c. small to large intestines d. mouth to anus

month to anus

Ulcerative colitis and Crohn's disease usual age-onset: a. newborn to teens and after 60 b. mid 20's to 60's c. teens to mid-'30s & after 60 d. teens to mid-'40s & after '70s

teens to mid-'30s & after 60