Unit Two- Spring

Which of the following might occur if serum potassium level increases and becomes symptomatic? (Select All) -An irregular heart rhythm -Tachycardia -Weakness of the legs -Increased abdominal cramping

-An irregular HR -Weakness of the legs -Increased abdominal cramping

Megadoses of vitamin A are taken by a patient. Why should the nurse question this practice?

-Ask the patient if they are experiencing vision problems, growth deficiency, dry skin/mucus membranes, and why they would be taking such high doses of this Vitamin. -Fat soluble can build up and become toxic.

When administering sodium bicarbonate IV, recognize that you must: (Select All) -Confirm that the IV catheter is in the vein -Flush the IV line before and after the administration -Allow the infusion to run on a gravity drip -Observe for signs of alkalosis -Observe for signs of hypernatremia

-Confirm that the IV catheter is in the vein -Flush the IV line before and after the administration -Observe for signs of alkalosis -Observe for signs of hypernatremia

Which of the following assessment data are consistent with metabolic acidosis? (Select All) -Drowsiness -HA -Confusion -Pallor

-Drowsiness -HA -Confusion

Compare the transmission of Hepatitis A to Hepatitis B. If a health care worker who has never been immunized for Hepatitis B receives a needle stick with a Hepatitis B contaminated needle, how can they prevent contracting hepatitis?

-Hepatitis A is transmitted by the fecal à oral route whereas Hepatitis B is transmitted through contact with blood and/or body fluids -If exposed, the best way to prevent HPV is to get the Hepatitis B vaccine and Hepatitis B immunoglobulins right away.

What electrolyte imbalance is common with metabolic alkalosis?

-Hypocalcemia -Hypokalemia

The nurses writes the patient problems as "Imbalanced nutrition: less than body requirements" for the patient diagnosed with hepatitis. Describe an intervention related to nutrition the nurse should include in the plan of care.

-Interview the patient about current nutritional habits and recommended changes; diet low in sodium and fats should be advised; if alcoholism is present, discuss importance of discontinuing. Try to accommodate to current food likes and dislikes. Adequate carbohydrate intake.

Ascites can be a complication of liver disease and can place pressure on the lungs and internal organs, which then places the patient at risk for ineffective breathing. A paracentesis may need to be performed by the physician to relieve this pressure. What are the nursing responsibilities associated with this procedure? What kind of diet should this patient be on?

-Making sure that the patient understands the procedure is important; asking if they have any questions or concerns, obtain weight before and after, monitor dressing, document output, vital signs (BP), monitoring dressing post procedure, examining/documenting fluid color and amount, elevate HOB -Diet low in fluid and sodium

What is the focus of collaborative care for hepatitis?

-Monitor blood levels such as AST, ALT, GGTP, AP, CBC -Use precaution when handling bodily fluids0- -Nutritional supplements

Certain body systems also function to compensate for acid-base imbalances, if they occur. The main systems involved in this process include the: (Select All) -Circulatory -Respiratory -Endocrine -Renal -GI

-Respiratory -Renal

Hepatic encephalopathy is also a major complication of liver disease, how can a nurse assess for this complication? How do you treat this?

-Results because of toxins (ammonia) circulating through and build up in the blood causing cerebral edema and interferes in neural transmission -Drink more water, decrease high protein with low protein diet, stay away from alcohol -Tx: Neomyacin, Rifaximin, Lactulose to remove the toxic substances -Confusion, agitation, tremors, restless

The normal acid-base ratio in body fluids is: -1:20 acid to base OR -20:1 acid to base

1:20 Acid to Base

Build and repair body tissues, regulate fluid balance, maintain acid-base balance, produce antibodies, provide energy, produce enzymes and hormones

Proteins

Why are clients who have pancreatic surgery at risk for developing respiratory tract infections?

Proximity of the incision to the diaphragm. Decreased expansion of the lungs and pain with coughing/deep breathing.

How can an acute attack of pancreatitis be precipitated by heavy drinking?

Alcohol is the other common cause. How alcohol actually triggers the inflammation in the pancreas is not clear. Symptoms typically begin about 6-12 hours after a heavy drinking session. In some people pancreatitis can develop even after a small amount of alcohol. In these people, a 'sensitivity' to alcohol develops in their pancreas. Has to do with not being able to metabolize properly. Alcohol increases pressure in pancreatic duck.

A patient on a mechanical ventilator may become ____________, if ventilator settings are too high for the patient

Alkalotic

The nurse teaches the client that amino acids are involved in total body metabolism, building and rebuilding various tissues. The nurse identifies that the client understands information about essential amino acids when the client says, "Amino acids do what"?

Amino acids aid in the synthesis of proteins, enzymes, hormones, and neurotransmitters for our bodies to use. They also break down glucose to be used

Carbs=

Amylase

The nurse is administering morning medications at 0730. What type of gastric medication would have priority?

Antacids should be administered right away, needs to be given 1 hour before meals. As well as Carafate. Keep other medications in mind

The nurse is caring for a patient 1st post-op day from a bowel resection. He has an NG tube to LCS. During the assessment, he complains of nausea. How should this problem be resolved?

Antiemetics, normal saline flush, check placement

SpO2 measures the: -partial pressure of oxygen -arterial oxygen content -arterial oxygen saturation

Arterial Oxygen Saturation

Accumulation of fluid in the peritoneal cavity that results fro venous congestion of the hepatic capillaries

Ascites

The doctor orders morphine sulfate for pain to the patient with pancreatitis. Why would you as the nurse question this?

Because morphine can cause spasms which may make the pain worse rather than better. It may relieve for a little bit but it will not provide the relieve it is known to provide.

Promote normal fat metabolism spare protein, and enhance lower GI function

Carbohydrates

Act quickly to prevent major changes in body fluid pH by removing or releasing hydrogen ions

Chemical Buffers

Discoloration of the abdomen and periumbilical area

Cullen's Sign

When doing an assessment on a client with pancreatitis the nurse may notice a Cullen's sign and/or a Turner's sign. Describe these.

Cullens—-bruising in the fatty tissue around the umbilicus Turner's—bruising on the flank area.

The nurse is planning the care for a patient diagnosed with lower esophageal sphincter dysfunction. What dietary modifications should be included in the plan of care?

Eat small frequent meals, stay away from spicy foods, limit caffeine, no chocolate, no alcohol, no smoking, sit up after meals, don't eat 3 hours before bed. Take medications.

Play a major role in osmolarity and body water regulation, acid-base balance, enzyme reaction, and neuromuscular activity

Electrolytes

A patient is recovering from an open cholecystectomy, describe the signs and symptoms that the nurse should report to the health care provider

Epigastirc pain with nausea and vomiting, repeated abdominal pain—-which can be s/s of postcholecystectomy syndrome, can have a blockage of the common bile duct, clay colored stools starting, dark urine, fever

Fragile, thin-walled, distended esophageal veins that become irritated and rupture

Esophageal Varices (Bleeding)

Provide a concentrated source and a stored form of energy

Fats

The client diagnosed with acute pancreatitis is in pain. What type of position should the nurse assist the client to help decrease the pain and why?

Fetal side lying position. Knee to shoulder.

Bile is released by the _________ to help digest lipids so they can be absorbed by the intestines

Gallbladder

Reservoir for bile

Gallbladder

The most common peptic ulcers are?

Gastric and Duodenal Ulcers

The nurse is administering a pancreatic enzyme to the client diagnosed with chronic pancreatitis. Explain the rationale for this.

In pancreatitis, the enzymes become activated while still in the pancreas. This causes the enzymes to irritate the cells of your pancreas, causing inflammation and the signs and symptoms associated with pancreatitis. With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning pancreas can cause digestion problems and diabetes. Pancreatic enzyme supplements can help your body break down and process the nutrients in the foods you eat. Pancreatic enzymes are taken in tablet form with each meal

Strict and frequent hand washing is key to preventing the spread of ALL types of

Hepatitis

What electrolyte imbalance can occur with respiratory acidosis?

Hyperkalemia

Which of the following often occurs with metabolic acidosis and should be observed for? -Hypocalcemia -Hypercalcemia -Hyperatremia -Hyperkalemia -Hypokalemia

Hyperkalemia

A patient is admitted to the hospital with a diagnosis of intestinal obstruction. The physician orders intestinal suction via nasoenteric decompression tube. What is a serious danger associated with intestinal suctioning that would cause an excessive loss of?

Hypokalemia -dysrhythmias

In compensating for a severe metabolic acidosis, deep, rapid, respirations occur eliminate CO2 an H20. This breathing pattern is called _____________ breathing

Kussmaul's

Fats=

Lipase

Bile is produced were

Liver

Helps to metabolize carbs, proteins, and fats

Liver

What might you as a nurse, notice if the patient has inadequate digestion and nutrition as a result of chronic esophageal problems?

Low weight, malnourished, with dry skin and mucous membranes, chest pain and nausea.

Vomiting can make a patient prone to which acid-base imbalance?

Metabolic Alkalosis

Explain why a patient with acute pancreatitis has an NG tube for low, intermittent suction.

Nasogastric drainage and suction are reserved for more severely ill patients who have continuous vomiting or biliary obstruction. Prevents gastric juices from flowing into the duodenum. Promotes Bowel rest. Prevent distention

What should you as the nurse assess if the patient is experiencing impaired digestion and nutrition as a result of a stomach disorder?

Onset, what makes it worse or better, skin integrity, pain—location, intensity, weight, history of intake, BMI, hair, mental status, epigastric pain, reflux, bowel sounds

Respiratory alkalosis results from conditions that cause _________ of the respiratory system

Overstimulaton

Secretes enzymes into the small intestine for digestion of carbs/fats/proteins

Pancreas

Persistent increase in pressure in the portal vein that develops as a result of obstruction to flow

Portal HTN

The medical resident prepares to draw blood gases from a patient. The blood gases should be drawn from the: -Central Venous Catheter -Radial Artery -Brachial Vein -Carotid Artery

Radial Artery

What might the nurse notice if the patient if experiencing impaired digestion and nutrition as a result of a stomach disorder?

Reports epigastric pain or indigestion before/after a meal. Reports inability to tolerate certain foods. NV with or without blood. Melena or frank blood in stools.

If the client has a condition that causes an obstruction of the airway or depresses the respiratory system, monitor the client for

Respiratory Acidosis

The accumulation of CO2 in the blood, predisposes a patient t which acid-base imbalance?

Respiratory Acidosis

Which acid-base imbalance is a patient who is hyperventilating prone to?

Respiratory Alkalosis

Since the client with hepatitis is not eating very well and is in the preicteric phase, explain the signs/symptoms the nurse would expect the client to exhibit during this phase of the disease.

Same as the prodromal phase: see some jaundice, but more so flu like sx such as N/V malaise, fatigue-first few weeks

Describe 3 cardinal signs to help diagnose pancreatitis and what do they cause?

Sever abdominal pain in the epigastric area, jaundice, decreased BS, sever tenderness/rigidity of the abdomen, nausea and vomiting. amylase and lipase labs elevated, Tripson lab elevated

The nurse designs a health teaching program specifically for a patient who had a gastrectomy. What should this plan include?

Small meals, Vit B12 injections for life, educate on dumping syndrome.

Before a cholecystectomy the physician orders vitamin k. Why is this administered?

To help with the clotting factors after surgery, it is also a fat soluble vitamin and not well absorbed in the stomach

Bluish discoloration of the flanks

Turner's Sign

Prior to drawing arterial blood gases in the radial artery, the adequacy of circulation through the _____ artery should be checked

Ulnar

The nurse understands that a client may develop pernicious anemia following a gastrectomy because why?

Vitamin B12 is now deficient because stomach produces intrinsic factor to absorb B12 and when part of stomach is removed then they do not have this intrinsic factor to absorb B12

What is the rationale for low-fat diet with cholelithiasis?

Will help reduce discomfort and nausea, want to promote rest of the gallbladder and the bile duct

Compare and contrast acute and chronic pancreatitis including signs & symptoms.

•Acute: ◦Cause: blockage of biliary obstruction ◦Most r/t heavy alcohol intake or biliary obstruction ◦Steady/severe, worse when laying or supine or with walking, made better by curling up, stretching out makes it worse ◦Turner's sign- bruising on the flank area ◦Cullen's sign-bruising around umbilicus ◦Abd distention, decrease BS, rigid abd, severe pain ◦Activated pancreatic enzymes begin auto digestion ◦50-60 y/o ◦Abdominal trauma ◦Meds ◦Blockage somewhere r/t gallstones •Chronic: ◦Irreversible process of gradual destruction of pancreatic tissue ◦Anorexia, N/V, weight loss, tender abd, attack lasts hours to weeks, may se e bulky, fatty stools ◦50-80% attributed to chronic alcohol use ◦Seen more with (cystic fibrosis, obesity, DM: other causes)

The nurse is preparing a teaching plan for a client with a history of cholelithiasis. The nurse should include in the plan that the client will experience discomfort after ingesting fatty foods because why?

•Fatty foods are harder to digest; Pathophysiology of gallstone formation is not clearly understood •Cholelithiasis causes a blockage (stone) so the bile isn't able to be excreted

A client is discharged home after a cholecystectomy. Name 5 interventions that would be appropriate for home care.

•Keep dressings in place for 4 weeks •Report bile-colored drainage from any of the incisions •Expect dark, tarry stools after surgery •Be aware that no dietary changes will be necessary •Pain management

What should you teach the client who has inadequate digestion and nutrition as a result of chronic esophageal problems?

◦Avoid spicy, fatty, or irritating foods & caffeine ◦Smoking & alcohol ◦Avoid eating within 3 hours of going to bed ◦Small meals ◦Eat slower and chew well ◦Elevate head of bed ◦Avoid smoking ◦Weight reduction if overweight ◦Avoid restrictive clothing ◦Sleep on right side to promote digestion

Women have health considerations when it comes to cholecystitis. Describe these risk factors.

◦Women between 20-60 yrs old are twice as likely to develop gallstones as are men. -Obesity is a major risk factor for gallstone formation -Pregnancy and drugs such as hormone replacements and birth control pills alter hormone levels and delay muscular contraction of the gallbladder which decreases the rate of bile emptying -Multiple Pregnancies -Four F's- Female, Forty, Fat, Fertile