Exam 4

A nurse is caring for a client who is at risk for aspiration. Which of the following actions should the nurse take to prevent aspiration during meals? (select all that apply) A) Cut food, such as meals, in half for easier chewing B) Allow extra time for the client to chew and swallow each bite of food C) Sit the client up at 90 (45 and higher) degrees prior to providing meal D) Turn on the TV to provide entertainment for the client E) Encourage the client to lie flat for 1 hour after eating to promote digestion

-Allow extra time for the client to chew and swallow each bite of food -Sit the client up at 90 (45 and higher) degrees prior to providing meal

What are the lab values for BUN and creatine?

-BUN: 5-20 (25) -Creatine: 0.7-1.3 mg/dL

A nurse is caring for a client who states, "I only eat a diet high in protein and carbohydrates." Which of the following responses should the nurse make? A) "Make sure to get enough servings of red meat in your diet daily." B) "Your diet is varied but should also be high in calorie intake." C) "A varied diet should be high in protein and carbohydrate consumption." D) "A nutritious diet should include carbohydrates, protein, fiber, and healthy fats." MY ANSWER

"A nutritious diet should include carbohydrates, protein, fiber, and healthy fats." -The nurse should instruct the client to consume a balanced diet from a variety of different food groups, such as dairy, grains, fruits, vegetables, and proteins.

A nurse is discussing dietary needs with a client. The client states, "I usually eat one or two meals per day from a drive-through restaurant. I know it's not the best diet, but I take a vitamin every day." Which of the following responses should the nurse make? A) "Make sure not to skip your daily vitamin, and you should be okay." B) "Try to eat at least one more meal per day." C) "A vitamin won't replace poor eating habits. Let's find way's to improve your overall diet." D) "Sounds like you have a good nutritional plan."

"A vitamin won't replace poor eating habits. Let's find way's to improve your overall diet."

A nurse is reinforcing teaching with a client who reports taking bisacodyl daily. Which of the following information should the nurse include? A) "Daily bowel movements are necessary for good intestinal health." B) "Excessive laxative use can cause an electrolyte imbalance." C) "Chronic use of laxatives can lead to a tear in the rectal mucosa." D) "Decrease your intake of high-fiber foods."

"Excessive laxative use can cause an electrolyte imbalance." -Chronic use of laxatives can lead to fluid and electrolyte imbalance.

A nurse is reinforcing teaching with a client who has a new colostomy. Which of the following information should the nurse include in the teaching? A) "You can expect fecal output within 24 hours." B) "You may experience a small amount of bleeding around the stoma." C) "You will need to increase your dietary intake of raw vegetables." D) "You can expect the stoma to be purplish in color for the first week."

"You may experience a small amount of bleeding around the stoma." -A small amount of bleeding around the stoma and its stem can occur; however, an increase in bleeding should be reported to the surgeon.

A nurse is caring for a client who is scheduled for a colonoscopy. The client asks the nurse if there will be a lot of pain during the procedure. Which of the following responses should the nurse make? A) "You shouldn't feel any pain since the local area is anesthetized." B) "Most clients report more discomfort from the preparation than from the procedure itself." C) "You may feel some cramping during the procedure." D) "Don't worry; you won't remember anything about the procedure due to the effects of the medication."

"You may feel some cramping during the procedure." -The nurse should reinforce the use of breathing exercises to decrease the effects of cramping during the procedure. This response by the nurse is therapeutic because it appropriately addresses the client's concerns.

What are high sources of protein?

1) 4 oz of beef 2) Chicken fryer (1/2 breast) 3) Chicken (hen) stewed-(1/2 breast) 4) Veal leg 5) Turkey

Filters

1) A 0.22 u filter is sufficient for administering solutions without lipid additives 2) Lipids are administered through separate tubing attached below the filter of the main IV administration because particles in the fat emulsion are too large to pass through filters 3) If the nutritional solution has lipids added to it, a 1.2 u filter or a larger filter should be used

What is Mendelsohn maneuver?

1) A form of the supraglottic swallow 2) Client swallows, holds the swallow for 2-3 seconds, completes the swallow and then relaxes

Fluids

1) A minimum of 6 to 8 ounce glasses of fluid per day 2) Inadequate fluid intake or dehydration slows peristalsis and leads to hard, dry stools 3) Excessive milk can lead to constipation 4) Warm liquids tend to soften stools and stimulate peristalsis 5) Cold liquids tend to slow peristalsis

What does decompression of the stomach with the removal of fluids and gas promote?

1) Abdominal comfort 2) Decreases the risk of aspiration 3) Allows surgical anastomoses to heal without distention -when used for decompression, the tube is usually attached to low intermittent suction to facilitate the removal of secretions

Children defecation

1) Ability to control defecation develops at about age 2 to 3 years 2) Neural muscular control and conscious effort 3) Must be aware of urge, control sphincter while getting to toilet and be able to remove clothing 4) Children may become engrossed in play, ignore the urge and end up soiling 5) Older children may delay urge until they get home rather than go at school

What is a protein restricted diet for?

1) Acute renal failure and chronic renal disease 2) Cirrhosis of the liver 3) Hepatic coma

What is continuous tube feeding?

1) Administered continually for 24 hours 2) An infusion pump regulates the flow

What is cyclical tube feeding?

1) Administered either in the daytime or night time for 8 to 16 hours 2) An infusion pump regulates the flow 3) Feedings at night allow for more freedom during the day

Peripheral parenteral nutrition (PPN)

1) Administered through a peripheral vein 2) Used for short periods (5 to 7 days) and when the patient needs only small concentrations of carbohydrates, fats, and proteins 3) Used to deliver isotonic or mildly hypertonic solutions; the delivery of highly hypertonic solutions into the peripheral veins can cause sclerosis, phlebitis, or swelling

What can tube feeding be used for?

1) Administration of medication 2) May be used as a temporary feeding tube 3) Irrigate the stomach 4) Remove toxic substances, such as poisoning

How do you pouch an ostomy?

1) After skin barrier and pouch removal, assess the skin around the stoma 2) Position client in seated position or supine 3) Place towel or disposable waterproof barrier under the client 4) Remove pouch and skin barrier gently by pushing the skin away from barrier 5) Cleanse peristomal area with water using gauze pad or washcloth 6) Measure the stoma for the correct size 7) Apply skin barrier, pouch, and use paste to fill in and let dry for 1-2 minutes 8) May apply non-allergic paper tape around the wafer if needed

when is Intubation of the stomach with a flexible tube passed through the client's nares, nasopharynx, and esophagus and into the stomach is performed?

1) After surgical procedures 2) Trauma 3) Conditions affecting the GI tract when normal peristalsis temporarily becomes altered 4) When peristalsis is slowed or absent and the client cannot eat or drink without causing abdominal distention

Potassium-sparing diuretics

1) Amiloride 2) Triamterene 3) Spironolactone eplerenone

What are fats

1) An essential nutrient that helps the body absorb vitamins while providing energy 2) Monounsaturated fats are healthy fats

Lipids (fat emulsion)

1) An isotonic solution administered through a peripheral vein 2) Prevent or correct fatty acid deficiency 3) Commercial lipid emulsions are formulations of safflower oil, soybean oil, with glycerol added for tonicity and egg phospholipid added as an emulsifying agent

What medications and other dietary supplements can slow gastric motility and cause constipation?

1) Antacids 2) Anticholinergics and antispasmodics (treat muscle spasms) 3) Antiseizure medications 4) Calcium channel blockers (treat elevated blood pressure) 5) Diuretics (increase urine production) 6) Iron supplements (anemia) 7) Anti-Parkinson disease medications 8) Narcotic pain medications (treat pain) 9) Antidepressants 10) Antibiotics (bacterial infection)

How do you assess residual volume?

1) Aspirate all stomach contents (residual) and measure amount 2) Re-instill residual feedings to prevent excessive fluid and electrolyte losses up to 100mL of residual volume. Discard residual volume over 100 mL - Check residual volumes every 4 hours, before each feeding, and before giving medications

What are the nutritional concerns for infancy?

1) Avoid cow milk in the first year because of the deficiency in essential fatty acids, iron, zinc, vitamin E and Vitamin C 2) Do not give milk or juice to go to bed to avoid nursing bottle syndrome and dental caries 3) Introduce one food at a time to detect allergies 4) Solid/semisolid foods at 4-6 months 5) Strained food around 8 months and finger foods at age one 6) Avoid round foods such as grapes, peanuts, popcorn, and hotdogs

What foods increase flatus?

1) Beef 2) Carbonated beverages 3) Dried beans 4) Milk or milk products 5) Onions 6) Broccoli, cabbage, brussel sprouts 7) Cucumbers 8) Corn 9) Spicy foods 10) Turnips

What does Spironolactone (Potassium-Sparing Diuretics) do?

1) Blocks aldosterone (excrete Na, H2O, and retains K) 2) Often used in combination with other diuretics 3) May cause gynecomastia and hyperkalemia

What are signs of hypoglycemia?

1) Blood glucose level less than 70 mg/dL 2) Shakiness 3) Weakness 4) Anxiety 5) Diaphoresis 6) Hunger

What are the types of GI tube feedings?

1) Bolus 2) Continuous 3) Cyclical

What are signs of fluid overload?

1) Bounding pulse 2) Jugular vein distension 3) Headache 4) Increased blood pressure 5) Crackles on lung auscultation 6) Weight gain greater than desired

Ileostomy

1) Brings a portion of the ileum through a surgical opening in the abdominal wall, bypassing the large intestine entirely 2) Drainage is liquid and continuous so patient needs an appliance at all times 3) Effluent has a large amount of nutrients, electrolytes, amylase, and lipase (this causes problems with fluid volume deficit, malnutrition, weight loss, electrolyte imbalances, and peristomal skin breakdown)

Nutrition food and fiber

1) Bulky foods and fiber absorb water and increase stool mass, stretching bowel wall, stimulating peristalsis and defecation 2) Five servings of high fiber foods each day: fresh fruits and vegetables (especially raw), whole grains, flaxseed, popcorn, dried peas, beans, and legumes 3) Recommended 25 to 30 grams fiber 4) Low fiber foods like pasta or refined processed foods, simple carbs (sugars), and lean meat slow peristalsis 5) Beans, broccoli, onions, and spicy cause flatus 6) Yogurt contributes to normal bowel flora (important in infections and antibiotic use)

Digital stimulation

1) Can cause stimulation of the vagus nerve, a branch of which enervates the heart 2) Vagal stimulation causes the heart rate to slow down 3) Excessive stimulation can cause bradycardia, decreased cardiac output, drop in blood pressure and syncope 5) Stop the procedure and place patient supine 6) Assess the patient 7) Leave supine and allow to recover 8) Monitor heart rate and blood pressure 9) Straining at stool can also cause this (patients should be encouraged not to)

Impaction

1) Caused by hardened stool wedged in the rectum 2) Encopresis 3) Urge to defecate without effect (pain, cramping, nausea, vomiting, anorexia) 4) Firm mass of stool in rectum on digital rectal exam

What are signs of pneumothorax?

1) Chest or shoulder pain 2) Sudden shortness of breath 3) Tachycardia 4) Absence of breath sounds on affected side

What are signs of an adverse reaction to lipids?

1) Chills, fever, flushing 2) Diaphoresis 3) Dyspnea 4) Cyanosis 5) Chest and back pain 6) Nausea and vomiting 7) Headache, pressure over the eyes 8) Vertigo 9) SLeepiness 10) Thrombophlebitis

Thiazide diuretics

1) Chlorthalidone 2) Hydrochlorothiazide 3) Metolazone 4) Indapamide

What is Promethazine (Anti-Emetics) and what does it do?

1) Classified as an antidopaminergic (reduces dopamine in the gut which reduces nausea) 2) IV/IM/PO 3) IV formulation is caustic (burns) to veins! (should be diluted)

What is Diphenoxylate with atropine/loperamide (Anti-Diarrheals) and what does it do?

1) Classified as an opiate 2) Inhibits GI motility, reducing diarrhea 3) Atropine is added to prevent abuse in large amounts 4) Avoid in patients with toxigenic bacteria or pseudomembranous colitis

Dietary modifications

1) Clear liquids, broth, gelatin, and electrolyte replacement drinks 2) Sips and chips, popsicles 3) Low fiber 4) Avoid milk products 5) Assess medications-change may be needed 6) Resume regular diet slowly 7) BRAT diet

What are some nutritional interventions for diarrhea?

1) Clear liquids, low fiber diet, avoid milk 2) BRAT diet: bananas, rice, applesauce, and toast

What is the Chin-tuck position?

1) Client holds the chin down to the chest while swallowing 2) Narrows the airway's entrance to decrease aspiration risk

What is supraglottic swallow?

1) Client swallows food/liquid while holding the breath, which protects the airway, and then coughs immediately after to remove any residual food 2) Steps include holding the breath, putting food/liquid in the mouth, swallowing up to 3 times while holding the breath until the food/liquid is mostly cleared, then coughing any residual out.

What are minerals?

1) Components of hormones, cells, tissues, and bones 2) Act as catalyst for chemical reactions and enhancers of cell functions 3) Almost all foods contain some form of minerals 4) A deficiency of minerals can occur in chronically ill clients or in clients who are hospitalized -Calcium, phosphorus, sodium, potassium

What causes diarrhea?

1) Contaminated food borne pathogens 2) Viral or bacterial infection 3) Dietary change or food allergies 4) Disease/surgery/diagnostics 5) Medication effect-especially antibiotics

What are the functions of the urinary tract?

1) Convert and move excess waste and fluid from the body in the form of urine. 2) Regulates levels of electrolytes and the production of red blood cells, produce hormones that are important for blood pressure regulation, and helps to keep bones strong.

Colostomies

1) Created at some point along the large intestine 2) The location determines the consistency of the feces, the bowel pattern, and the need to wear an appliance 3) The closer to the ascending colon, the more liquid and continuous the drainage will be 4) A colostomy in the sigmoid colon will produce solid feces 5) Colostomies near the rectum can often be controlled by diet and irrigation and the client may not need to wear an appliance

What is an aid ash diet for?

1) Decrease pH 2) Prevent renal calculi

What is Psyllium (Laxatives) used for and what does it do?

1) Defined as a bulky-forming laxative 2) Contain cellulose, drawing water into the stool (produce normal soft stool) 3) Must drink fluids 4) Avoid in bowel obstruction or fecal impaction

What is Polyethylene Gylcol (PEG) (laxative) and how does it work?

1) Defined as a hyperosmotic laxative 2) Pulls large amounts of water into the colon because of oncotic pressure 3) Usually given in small doses daily or large doses prior to GI procedures 4) Avoid in patients with ileus, bowel obstruction, or bowel perforation

What is Bisacodyl (Laxative) and what does it do?

1) Defined as a stimulant laxative 2) Causes GI tract peristalsis, evacuating the stool 3) Avoid in bowel obstruction and bowel perforation

What is Docusate Sodium (Laxative) and what is it used for?

1) Defined as an emollient laxative (stool softener) 2) Lowers surface tension of GI fluids to increase fluid and fat in the stool-act as a lubricant to more easily defecate 3)Should be used short-term 4) Avoid in patients with fecal impaction, intestinal obstruction, or N/V

What is Furosemide (Loop Diuretic) and what does it do?

1) Derivative of sulfa antibiotics 2) Stops NaCl reabsorption in the Loop of Henie 3) Causes BP and K to drop 4) Can cause ototoxicity, severe hypokalemia, and nephrotoxicity

Fecal occult blood (FOBT)

1) Detects blood in the stool not visible to the eye 2) Done in lab or at bedside, depending on facility policy and procedure 3) Patients may be given cards to take home for collection of the stool smear, then submit to lab 4) Special reagent detects the presence of peroxidase, an enzyme present in hemoglobin 5) Recommended as part of yearly screening for colon cancer in all patients age 50 to 75 years

How do you assess nutritional status?

1) Dietary records 2) 24 hour diet recall 3) Assessment of lab values 4) Anthropometric measurements - Assessment of BMI and BMR

Diagnostic tests

1) Direct visualization-lighted tube tests-invasive - EGD - Colonoscopy - Sigmoidoscopy 2) Indirect visualization-radiography - Flat plate - Barium enema (BE) - Computed tomography (CT) - Magnetic resonance imaging (MRI) - Ultrasonography

Infants

1) Do not concentrate urine well. 2) Do not have voluntary control of voiding due to immature nervous system.

What are some precautions to GI tube feedings?

1) Do not hang more solution than will be required for a 4-hour period to prevent bacterial growth 2) Check the expiration date on the formula prior to administering 3) Shake the formula well prior to inserting into container

What does Insulin do?

1) Doses that are too large might cause insulin shock 2) Doses that are too small might result in a diabetic coma 3) Available in prefilled insulin pens

Salem sump (NG)

1) Double-lumen nasogastric tube with an air vent 2) Used for decompression with continuous suction 3) Air vent is not to be clamped and is to be kept above the level of the stomach 4) If leakage occurs through the air vent, instill 30 mL of air into the air vent and irrigate the main lumen with normal saline (NS)

Chronic constipation

1) Dysfunctional intestinal motility 2) Habitual laxative use inhibits natural reflexes and can thus worsen constipation. Require larger and larger doses to attain effect and eventually do not work 3) Can lead to complications: - Impaction - Fissures and hemorrhoids - Volvulus or obstruction - Seepage - Rectal ulceration

Dietary guidelines for ostomy

1) Eat a diet high in protein, calories, and vitamins 2) Avoid foods that irritate intestines and require excessive intestinal activity such as milk or milk products, spicy food and high residue diets (raw vegetables) 3) Avoid carbonated drinks and alcohol because they increase intestinal activity 4) Eat small, frequent meals 5) Drink 8-10 cups of fluids per day

Dietary guidelines

1) Eggs should be limited to two or three times a week 2) Milk: should use low fat milk or fat free milk 3) Food preparation: should be prepared with the least amount of fat

What are signs of hyperglycemia?

1) Elevated blood glucose level 2) Excessive thirst 3) Diuresis 4) Fatigue 5) Restlessness 6) Confusion 7) Weakness 8) Confusion 9) Kussmaul's respirations 10) Coma, when severe

What are common drugs measured in units?

1) Epogen 2) Fragmin 3) Heparin 4) Insulin

What are some age related considerations for digestion?

1) Esophageal contractions decrease, but the passage of food or liquid from the mouth to the stomach does not change. 2) Stomach elasticity diminishes with age, changing the amount of food that can be held in the stomach and the rate of emptying.

Adult defecation

1) Established bowel pattern usually continues assuming adequate fiber, fluid, and activity 2) With aging peristalsis, intestinal smooth muscle tone, perineal muscle tone (pelvic floor), and sphincter tone diminish 3) This can be worsened if there is inadequate dietary fiber and fluid intake 4) Decrease in activity and exercise contribute 5) Medication effects 6) These physiologic changes can contribute to constipation in elders 7) Perceived vs actual constipation

Lipids (fat emulsion) 2

1) Examine bottle for separation of emulsion into layers, fat globules, or the accumulation of froth 2) Do not put additives into the fat emulsion solution 3) Do not use an IV filter because particles in the fat emulsion are too large to pass through filters

What do vitamins do?

1) Facilitate metabolism of proteins, fats, and carbohydrates; act as a catalyst for metabolic functions; promote life and growth processes; and maintain and regulate body functions

Lab specimens

1) Fecal occult blood testing 2) Stool for O & P 2) Stool for C & S 3) Stool for fecal fat

Bowel waste

1) Feces is the waste product of food digestion. It's a mixture of insoluble fiber, undigested food, bacteria and water (water: 75%, solid: 25%) 2) Brown color is derived from the presence of bile that has been changed to brown color by action of bacteria 3) Flatus or gas is the byproduct of the digestive process of bacterial fermentation in bowel waste (ethane, methane, and nitrogen gives its odor) 4) Normal stool soft formed, semi-solid, and brown in color 5) Wide range of "normal" frequency of 1 to 3 times a day to once a week.

What do the kidneys do?

1) Filter waste, metabolic byproducts, water, and excretes them as urine. 2) Regulates blood volume, blood pressure, electrolytes, and acid base balance. 3) Produce erythropoietin and renin. 4) Activate vitamin D3 (calcitrol)

What does bowel patterns affect?

1) Fluid balance and hydration 2) Electrolyte balance 3) Nutrition, dietary intake, and appetite 4) Skin integrity 5) Comfort 6) Self-concept and self esteem

Diarrhea

1) Frequent loose, watery stools throughout the day. 2) Causes: - Medications - Antibiotics - Enteral nutrition tube feeding and re-feeding syndrome - Food allergies - Lack of fiber - Disease/surgery/diagnostic testing - Food borne pathogens - C.difficile

How does surgery affect bowel elimination?

1) General anesthesia and analgesics slow bowel motility 2) Manipulation of the bowels during surgery results in a paralytic ileus, a cessation of bowel peristalsis 3) The bowel continues to produce secretions, which remain stagnant, causing distention, discomfort, and nausea 4) Patients who undergo bowel surgery typically have a nasogastric tube to suction to remove secretions until peristalsis returns

How do you irrigate an NG tube?

1) Gently instill 30 to 50 mL of water or normal saline with an irrigation syringe 2) Pull back on the syringe plunger to withdraw the fluid to check patency; repeat if tube remains sluggish -every 4 hours to check tube patency

What is metabolic syndrome?

1) Glucose higher then 100 mg/dL 2) Waist circumference greater than 40in in men and 35in in women 3) Triglycerides greater than 150 mg/dL 4) Blood pressure greater than 130/85 5) High density lipoprotein less than 40 in men and less than 50 in women 6) Neck circumference greater than 19 in males -Increased incidence of heart disease, type 2 diabetes, and stroke

What is a carbohydrate-controlled diet for?

1) Helps maintain normal glucose levels in clients with disorders that cause blood glucose levels to rise or fall abnormally 2) Used for diabetes mellitus, hypoglycemia, lactose intolerance, galactosemia, dumping syndrome, and obesity

What is an alkaline ash diet for?

1) Increase pH 2) Prevent renal calculi

Prostate enlargement

1) Increases with age 2) Causes frequency, urgency, hesitancy, and nocturia 3) Increased risk of urinary retention and UTI 4) Men should be asked about symptoms and screened for prostate cancer.

What is a fat controlled diet?

1) Indicated for atherosclerosis, diabetes mellitus, hyperlipidemia, hypertension, MI, nephrotic syndrome, and renal failure 2) Reduces the risk of heart disease 3) Limit both the total amount of fats and cholesterol

How do you check for air embolism?

1) Instruct the patient in Valsalva maneuver for tubing/cap changes 2) Place the patient in a head-down position with the head turned in the opposite direction of insertion site (increases intrathoracic venous pressure)

Anus

1) Internal sphincter: involuntarily opens for stool passage 2) External sphincter: under voluntary control that allows stool to be expelled 3) Anus is very vascular. Chronic pressure on veins results in hemorrhoids (itching, burning, and bleeding may result).

Voiding (urination or micturation)

1) Internal urethral sphincter keeps urine out of the the urethra. 2)Distention of the bladder activates stretch receptors in the bladder. 3)Contraction of the detrusor muscle pushes urine into the urethra causing the conscious urge to void. 4) Voiding may be delayed by inhibiting the release of the external sphincter.

Enema

1) Introduction of a solution into the rectum to soften feces, distend the colon, stimulate peristalsis, and evacuation of feces 2) Some solutions can irritate the mucosa of the rectum, sigmoid colon, and assist with the forceful evacuation of stool 3) Some cramping and fullness may be experienced 4) Response is determined by the height of the enema container, speed of flow, type of solution, and resistance of rectum 5) May be cleansing, cause retention, or return flow

Barium enema

1) Invasive 2) Written consent 3) Can be uncomfortable for patient 4) Views rectum, colon, and distal small bowel for polyps, diverticula, tumors, and some obstructions 5) Prep prior with cathartic laxatives and/or enemas to clean stool and gas from bowel 6) Liquid diet with prep and NPO several hours prior 7) Barium is instilled via a rectal tube to fill the colon in a retrograde fashion 8) Patient must retain barium through several position changes while air is instilled 9) Afterwards patient will have white stools as barium is expelled 10) Retained barium becomes very hard and may require laxatives 11) Encourage oral fluids to help elimination of barium

What are some age related changes to consider with urine output?

1) Kidney function declines with the loss of kidney tissue and nephrons, and reductions in the blood supply. 2) Loss of tone of bladder may lead to urinary leakage, urinary incontinence, or urinary retention.

GI tract anatomy

1) Large intestine or colon are large in diameter (5-6 feet long) 2) Ascending, transverse, descending, and sigmoid colon 3) Colon reabsorbs most of the water that enters it 4) Normal flora aid in digestive process 5) Peristalsis propels content through ( muscular action of colon) 6) Peristalsis triggered by food entering the stomach (gastro colic reflex)

What should you document and report for NG tube?

1) Length, size, and type of gastric tube (which nostril) 2) The clients response to tube insertion, any symptoms that could indicate tube mal-position, the clients status after insertion and comfort level 3) pH reading for placement, amount and color of secretions withdrawn from the tube 4) Insertion distance

Characteristics of stool

1) Light to dark brown: normal 2) Red: bleeding lower GI tract 3) Black or tarry: bleeding upper GI tract 4) Tan or pale: biliary disorder 5) White: barium/ contrast

Colonoscopy

1) Lighted tube test of the colon to detect disease including inflammation, tumors, polyps, and bleeding 2) Invasive and required consent and sedation 3) Pre-op teaching 4) Prep includes liquid diet and cathartic laxatives, and or enemas, to clean stool and gas from colon 5) Post procedure monitor for bleeding and complications 6) Explain follow up

Esophagogastroduodenoscopy (EGD)

1) Lighted tube test of the esophagus, stomach, and duodenum 2) Invasive and requires consent 3) Explain and teach pre-op 4) Sedation and local anesthetic 5) NPO 4 to 6 hours prior to empty stomach-visualization and decrease risk of aspiration 6) Examine, biopsy, take pictures, and stop bleeding 7) Burse may assist during procedure 8) After procedure ensure patient has gag reflex before eating or drinking 9) Observe for complications: nausea, bleeding, dysphagia, and perforation

Cystoscopy

1) Lighted tube through urethra. 2) No anesthesia and consent needed. 3) NPO 4 hours

What are proteins and what are they made from?

1) Made from amino acids and are critical to all aspects of growth and development of body tissue 2) Essential amino acid (EAAs) are required in the diet because the body cannot manufacture them

MRI

1) May require contrast-consent is needed 2) Uses strong magnetic field and pulsed radio wave energy to produce detailed cross sectional images of vessels, organs and structures 3) Very sensitive and used to assess many areas for edema, bleeding, infarct, tumors, and infection 4) Contrast is given IV, if needed, and is non-ionizing 5) Patient must lie still in very narrow tube that contains a very strong magnet 6) Patients with pacemakers, stent, and certain implants cannot have this test

Anatomy of GI tract

1) Mouth 2) Moistening food bolus with saliva 3) Salivary amylase (digestive enzyme) 4) Esophagus 5) LES "valve" opens to allow food into stomach, then closes to prevent reflux 6) Stomach 7) Small intestine

What are the routes of GI tube feedings?

1) Nasogastric 2) Nasoduodenal or nasojejunal 3) Gastrostomy 4) Jejunostomy

Pregnant women

1) Nausea and vomiting of morning sickness 2) Enlarging uterus crowds and displaces bowels 3) Higher levels of progesterone 4) Slows bowel motility, resulting in constipation, decreased appetite, and irregular food intake 5) Increased pressure of uterus can put pregnant women at increased risk of hemorrhoids

Abdominal flat plate

1) Noninvasive 2) No written consent 3) May be NPO 4) No special after care 5) An anterior to posterior x-ray is taken of the abdomen 6) Can detect gallstones, kidney stones, size and outline of kidneys and bladder, fecal impaction, distended bowel with air and fluids, and position of tubes 7) Sometimes called a KUB (kidneys-ureters-bladder) 8) Sometimes a 2 view x-ray is done: one anterior to posterior and one from the side laterally across the abdomen

CT scan

1) Noninvasive 2) Prep-NPO and may need oral contrast prior 3) Requires consent for administration of contrast-oral and/or IV, depending on test 4) Patient must lie very still 5) If in a closed scanner, claustrophobia may be a problem 6) Examines body section using a series of narrow beam x-rays to produce a three dimensional view 7) Examines many different body areas 8) Contrast may be injurious to renal function 9) Monitor intake and output, BUN, Cr for renal function

Ultra sound

1) Noninvasive and non-painful 2) No contrast 3) No written consent required 4) May require that patient have a full bladder 5) An ultrasound transducer is passed over the abdomen to pass sound waves through the structures. Based on density, the waves are reflected back, and the waves are transformed into images on the computer screen. 6) Evaluate masses, cysts, edema, stones liver, kidneys, gallbladder, and pancreas

Diverticulitis treatment

1) Patients with diverticulosis follow a high fiber diet and maintain a regular bowel habit without constipation 2) Avoid foods with seeds, nuts, and popcorn 3) Patients with diverticulitis may have abdominal pain, usually in the LLQ, altered bowel pattern, nausea, and fever 4) Treated with bowel rest-clear liquids and oral antibiotics 5) Severe cases can require surgery to resect the affected area of bowel 6) Abscess and perforation can cause life-threatening infection-peritonitis and sepsis

What are the 3 methods used to insert G-tubes?

1) Percutaneous endoscopic gastrostomy (PEG) 2) Laparoscopic technique 3) Open surgery technique

NG tube insertion

1) Place the client in high-Fowler's position 2) Measure from the tip of the nose, to the earlobe, to the xiphoid process 3) Lubricate tube about 3 inches with a water-soluble jelly to prevent the development of pneumonia if the tube accidently slips into the bronchus 4) Instruct the client to bend their head forward, which closes the epiglottis and opens the esophagus

What should you do if an air embolism is suspected?

1) Place the patient in a left side-lying position with the head lower than the feet (to trap air in right side of the heart) 2) Notify the physician 3) Administer oxygen as prescribed

What are complications of TPN?

1) Pneumothorax 2) Air embolism 3) Infection 4) Fluid overload 5) Hyperglycemia 6) Hypoglycemia

What foods obstruct flatus?

1) Popcorn 2) Chinese vegetables 3) Raw apples 4) Celery 5) Nuts 6) Coconuts 7) Fruits with seeds

How do you remove an NG tube?

1) Position the client at 45 degrees. Irrigate the tube with 10 mL air (or saline) to clear contents that could be aspirated. Release the tape and securement device. 2) Ask the client to take a deep breath and hold it. Pinch or clamp the tube. 3) Remove the tube slowly and evenly over the course of 3 to 6 seconds.

Retention with overflow

1) Pressure in the bladder builds, so the external urethral sphincter is unable to hold back urine. 2) 25-60mL of urine escapes, after which the bladder pressure falls enough to allow the sphincter to close. 3) May void 2 or 3 times an hour with no relief of distention or discomfort.

What do fats do?

1) Provide a concentrated source and a stored form of energy 2) Protect internal organs and maintain body temperature 3) Essential body nutrient, serving important body needs as a back up storage fuel secondary to carbohydrate-for energy

What is enteral nutrition for?

1) Provides liquefied foods into the GI tract via a tube 2) When the GI tract is functional but oral intake is not feasible 3) Used for clients with swallowing problems, burns, major trauma, or severe malnutrition

Defecation patterns

1) Rapid peristalsis results in less water being absorbed and softer stool, or diarrhea 2) Slower peristalsis results in more water being absorbed with constipation, or passage of hard, dry stools that are harder to pass

How are the different types of insulin distinguished?

1) Rapid-acting: 15 minutes 2) Regular or short acting: 30 minutes 3) Intermediate-acting: 1 to 4 hours 4) Long-acting: several hours

Indications to catheterize

1) Relieve urinary retention 2) Measure residual volume 3) Need sterile specimen 4) Incontinence with stage IV pressure injury 5) Empty bladder before, during, or after surgery (urinary or gynecologic surgery)

Irrigating a colostomy

1) Remove appliance and cleanse skin as normally done in changing 2) Apply irrigation sleeve and roll up so that bottom just touches water in toilet 3) Fill graduated container with required solution and hang on IV pole so that bottom of container is level with patient's shoulder 4) Fill graduated container with required solution (usually saline or water that is tepid) 5) Attach cone to irrigating tube 6) Apply lubricant to irrigating tube 7) Apply lubricant to irrigating sleeve 8) Begin flow of solution and readjust position as necessary. Adjust flow by raising and lowering irrigating containers 9) When solution runs in, clamp the tubing and remove at once 10) Clamp tip of sleeve 11) When most of the solution has returned remove the sleeve and empty it 12) Rinse the sleeve with soap and water

Adult

1) Renal size and function begin to decrease by age 50. 2) By age 80, only 2/3 of nephrons function. 3) Risk for fluid, electrolyte, and acid-base balance problems. 4) Loss of bladder tone-nocturia, frequency incontinence, and retention.

What are signs of air embolism?

1) Respiratory distress 2) Apprehension 3) Chest pain 4) Dyspnea 5) Hypotension 6) Rapid and weak pulse 7) Churning heart murmur

What are the risk of diarrhea?

1) Risk for fluid volume deficit and dehydration 2) Electrolyte loss, especially potassium 3) Infants, young children, and frail elderly highest risk 4) May require hospitalization and fluid replacement

What is Ondansetron (Anti-Emetics) and what does it do?

1) Serotonin blocker (lower nausea) 2) Often used in combination with chemotherapy 3) DOES NOT cause drowsiness 4) IV/PO

What is a clear liquid diet?

1) Serves as a primary function of providing fluids and electrolytes to prevent dehydration 2) Initial feeding after complete bowel rest 3) Used initially to feed a malnourished person or a person that has not had any oral intake for some time 4) Bowel preparation for surgery or tests 5) Post surgical diet 6) Diarrhea

Nasogastric (NG) tubes

1) Short tubes used to intubate the stomach 2) Inserted from the nose to the stomach 3) Typically a larger diameter (12-18 French)

Levin tube (NG)

1) Single-lumen nasogastric tube 2) Used to remove gastric contents via intermittent suction or to provide tube feedings

What are the medications that should not be crushed?

1) Slow release 2) Late activating 3) Extended length 4) Extended release

Infant deification

1) Small stomach capacity 2) Less secretion of digestive enzymes 3) More rapid peristalsis 4) Stools frequently, especially after meals 5) Meconium black, odorless (first feces) 6) Golden yellow (breast fed) 7) Tan (formula)

What should a nurse monitor for diarrhea?

1) Stool 2) Electrolytes 3) Fluid balance 4) Skin integrity

Defecation

1) Stool in the rectum activates stretch receptors and start contraction of sigmoid and rectal muscles 2) Internal and external sphincter relax 3) CNS is signaled to produce a conscious urge to defecate 4) Contraction of diaphragm and abdominal muscles 5) These muscles contractions and straining with a closed airway is the Valsalva maneuver (not safe for people with heart disease, HTN, glaucoma, ICP, and abdominal wounds)

What is a low-residual/low-fiber diet?

1) Supplies foods that are least likely to form an obstruction when the intestinal tract is narrowed by inflammation or scarring, or when GI motility is slowed 2) Used for inflammatory bowel disease, ileostomy, colostomy, partial obstructions of the intestinal tract, enteritis, or diarrhea

Total Parenteral Nutrition (TPN)

1) Supplies necessary nutrients via veins 2) Supplies carbohydrates in the form of dextrose, fats in special emulsified form, proteins in the form of amino acids, vitamins, minerals, and water 3) Prevents subcutaneous fat and muscle protein from being catabolized by the body for energy

What are alternatives to urinary catheterization?

1) Suprapubic catheter: urinary drainage tube inserted surgically into the bladder through the abdominal wall above the symphysis pubis. 2) Condom catheter 3) A nurse can scan at the bedside of a patient to assess for retention or residual bladder

Bowel Diversion

1) Surgically created opening for elimination of fecal waste products 2) Conditions: - Cancer - Ulceration (Crohn's or ulcerative colitis) - Diverticulosis-diverticulitis - Trauma - Ischemia (inadequate blood supply)

Urinary retention

1) The inability to partially or completely empty the bladder. 2) Feelings of pressure, discomfort, tenderness over the symphysis pubis, restlessness, and diaphoresis. 3) Absence of urinary output and a distended bladder palpated above symphysis pubis. 4) Straight or indwelling catheter or ultrasound. Monitor voiding (input and output).

What are carbohydrates?

1) The preferred source of energy 2) Promote normal fat metabolism, spares protein, and enhance lower gastrointestinal (GI) function 3) Major food source include: milk, grains, fruits, and vegetables 4) Inadequate carbohydrate intake affects metabolism

Who is a high-protein diet for?

1) Tissue building, burns, liver disease, and maternity clients 2) High-protein diets correct protein loss or assist with tissue repair by increasing the intake of protein food sources -The client may need protein supplements

Who is a low calcium diet for?

1) To prevent renal calculi 2) Avoid whole grains, milk and dairy products, and green leafy vegetables

Children

1) Toilet training requires nervous system maturity. 2) Widely influenced by culture. 3) Full control usually by age 3 to 5. 4) Enuresis: wetting the bed.

Loop diuretics

1) Torsemide (Demadex) 2) Furosemide (Lasix) 3) Bumetanide

Carbohydrates

1) Turned into sugar to provide the body's cells, organs, and tissue with the energy they need to function 2) Should make up 45% to 65% of total daily calories and are the body's primary fuel source -Vegetables, fruits, milk, nuts, grains, legumes, and seeds

What should the nurse document and report for a stoma?

1) Type of pouch and skin barrier 2) Record amount, appearance of stool, texture, condition of peristomal skin, and sutures 3) Abnormal appearance of stoma, suture line, peristomal skin, character of stool, and absence of bowel sounds 4) No flatus in last 24-48 hours 5) Document abdominal distention and excessive tenderness 6) Record the patient's level of participation and need for teaching

How does urine travel through the urinary system?

1) Urine is transported from the kidneys to the bladder by ureters. 2) Next, urine reaches the bladder. It begins to fill and stretch to accommodate the urine. 3) Once the bladder reaches capacity, receptors inside the bladder send signals to the brain to let the client know it is time to empty the reservoir. 4) Once the bladder has filled, the body releases the urine through the urethra and out of the body.

Lipids (fat emulsion) 3

1) Use vented IV tubing because the solution is supplied in a glass container for administration 2) Infuse solution initially at 1.0 mL/min, monitor vital signs every 10 minutes, and observe for adverse reactions for the first 30 minutes of the infusion; if signs of an adverse reaction occur, stop the infusion and notify the physician

What is a soft diet?

1) Used for clients with dental problems, clients with poorly fitting dentures, and clients who have difficulty chewing or swallowing 2) Used for ulceration of the mouth or gums, oral surgery, broken jaw, plastic surgery of the head or neck, dysphasia, or for the stroke client 3) Therapeutic for clients with impaired digestion and/or absorption due to condition such as ulcerative colitis and Crohn's disease

How is Insulin administered?

1) Via injection into the fatty tissue under the skin so that it reaches the blood

Supplements

1) Vitamin C softens stool and can lead to diarrhea (bleeding in GI tract in rare cases) 2) Magnesium causes loose stool 3) Iron causes dark stools (green or black) and constipation 4) Calcium causes constipation

When is powder reconstitution required?

1) When medication is unstable over long periods of time in its liquid form 2) Must be performed before administration using a sterile diluent

How does hydrochlorothiazide work?

1) Works in the distal tubule to block reabsorption of NaCl 2) Can be used for HTN and CHF 3) Causes BP and K to drop 4) Can cause nephrotoxicity (check BUN and Creatine) - Take in the morning

What does Mannitol (Osmotic Diuretics) do?

1) Works to increase oncotic pressure in the glomerular filtrate, increasing water excretion 2) May cause excessive drop in BP, pulmonary congestion, acute heart failure and convulsions 3) Does not cause much electrolyte imbalance 4) Must be administered via filter tubing

How can you determine tube placement?

1) x-ray or pH (5.5 or less) -Assess placement every 4 hours and before administering feedings or medications

If the fat emulsion has been added to the parenteral nutrition solution, what size filter should be used to allow the fat emulsion to pass through?

1.2 micron (u) or larger filter

How large should the stoma opening be?

1/16 to 1/8 inches larger than the stoma

How long do foods remain in the stomach?

2 to 8 hours

How long should you monitor the serum lipids after discontinuing the infusion?

4 hours after -Monitor liver function tests for evidence of impaired liver function indicating the liver's inability to metabolize the lipids

Which types of infection can results if a urinary tract infection is left untreated? What are the manifestations of this common urinary system infection? How is it commonly treated? Who is more likely to develop this infection?

A UTI can result in a kidney infection or pyelonephritis. Symptoms of a UTI include burning or painful urination and frequent urgency or need to urinate, despite not having a lot of urine to excrete. UTIs are commonly treated with antibiotics. Females are more likely to develop UTIs.

What is hypoglycemia?

A blood glucose lower than 70 mg/dL

What is cystostomy?

A catheter is inserted directly into the bladder and attached to a drainage bag outside the client's abdomen. It is more invasive than a urinary catherization.

What is ulcerative colitis (UC)?

A chronic disease that causes inflammation and ulcerations of the large intestine or colon.

What is crohn's disease?

A chronic disease that causes inflammation in the GI tract, but it also commonly affects the small intestine.

A nurse is reinforcing teaching with a newly licensed nurse about urinary retention. Which of the following clients should the nurse include as having an increased risk for this condition? A) A client who has an enlarged uterus B) A client who experiences frequent urinary tract infections C) A client who has an enlarged prostate D) A client who has chronic hypertension

A client who has an enlarged prostate -A client who has an enlarged prostate is more likely to experience urinary retention.

A nurse is caring for four clients. The nurse should observe which of the following clients for a risk of vitamin B6 deficiency? A) A client who has cystic fibrosis B) A client who has chronic alcohol use disorder C) A client who takes phenytoin for a seizure disorder D) A client who is prescribed rifampin for tuberculosis

A client who has chronic alcohol use disorder -Clients who have chronic alcohol use disorder are at risk for vitamin B6 deficiency because alcohol destroys and excretes vitamin B6.

What is dietary fiber in most of its forms?

A complex carbohydrate that is not digestible

What is diverticulosis?

A condition in which small sacs or pouches form in the colon. These sacs increase a client's risk for diverticulitis.

Diverticulosis

A condition that occurs when a person has problems from small pouches, or sacs, that have formed and pushed outward through weak spots in the colon wall. Each pouch is called a diverticulum. Multiple pouches are called diverticula.

what is a Kock pouch?

A continent ileostomy system. Using the ileum, the surgeon forms an internal pouch with a valve, so that intestinal contents do not escape the ileostomy. To empty the pouch, a catheter is placed through the ileostomy stoma, and the contents are drained.

Koch pouch

A continent urinary diversion (use a catheter to drain urine every 4 to 6 hours).

Marasmus

A disease of severe protein-calorie malnutrition during early infancy, in which growth stops, body tissues waste away, and the infant eventually dies.

What does all ostomy appliances have?

A faceplate or disk that attaches to the abdomen and a pouch to collect the effluent.

What is cholesterol?

A fat-related substance, synthesized only by animals -When consumed in excessive amounts, contributes to health risk

What is a colostomy?

A fecal diversion in which part of the colon is used to form a stoma through the abdominal wall, allowing for the passage of body waste.

What is Pre-Albumin?

A more sensitive indicator of nutritional status because of its shorter half life and because they respond to short-term changes in protein stores

Ureterostomy

A permanent incontinent urinary diversion created by transplanting the ureters into a closed-off part of the intestinal ileum and bringing the other end out onto the abdominal wall forming a stoma.

What is a continent cutaneous reservoir?

A reservoir surgically created from a piece of bowel and placed in the abdomen rather than the pelvis.

What is a neobladder?

A reservoir surgically created from a piece of bowel; it is used to store urine before it is expelled from the body.

Urinary urgency

A strong desire to urinate, to changes in the flow of the urinary system, to urinary retention.

Urge incontinence

A strong need or urge to urinate, but leaking occurs before the client gets to the toilet.

What is urostomy (ileal conduit)?

A surgically created diversion that uses part of the small intestine.

What is ileostomy?

A temporary or permanent fecal diversion that uses the terminal end of the small intestine (ileum). Created when the entire colon, including the rectum and anus, must be removed or bypassed.

What is irritable bowel syndrome (IBS)?

A term used to describe abdominal pain and changes to bowel elimination patterns that can include diarrhea, constipation, or a mixture of both.

What is a nasogastric (NG) tube?

A thin plastic tube that is inserted into the nostril and down the esophagus, with the end placed in the stomach. It is primarily used to provide nutrition and medication to a client, but can also be used to remove contents from the stomach in the event of a client ingesting a harmful substance, poison, or to much medication.

What is nasojejunal (NJ) tube?

A thin, soft tube that is inserted through the nostril and stomach, ending in the jejnum of the small intestine. NJ tubes are used for clients who are unable to consume nutrition, cannot tolerate foods, and liquids in their stomach, or have delayed gastric emptying.

What is the Bristol Stool Chart?

A tool that can be used to describe the different consistencies of stool. 1) Type 1 and 2 is constipation 2) Type 3 and 4 is expected or ideal stools 3) Type 5 and 7 is diarrhea

How is a nephrostomy created?

A tube is surgically inserted through the skin on the back and into the kidney. This procedure is usually performed following the removal of kidney stones.

What is a gastrostomy tube (G-tube)?

A tube that delivers nutrition directly into the stomach. It is inserted though the abdomen and is indicated for clients who are unable to consume enough nutrition on their own

What is nephrostomy?

A tube that drains urine directly from the kidneys into an external pouch.

What is urinary catheterization?

A urinary catheter placed into the bladder to allow urine to drain. The flexible tube can be placed into the bladder through urethra or through a surgically created opening in the lower abdomen.

A nurse is caring for a client who is prescribed a low glycemic index diet. The client states, "I don't understand what this means." Which of the following responses should the nurse make? (Select all that apply.) A) "The glycemic index of a food relates to its ability to increase the blood glucose level." B) "You should eat foods such as whole grains, fruits, and vegetables." C) "Consuming white bread will increase your blood glucose level slowly." D) "Try to limit or avoid potatoes due to their high glycemic index." E) "Foods with a high glycemic index will cause your blood glucose to increase rapidly."

A) "The glycemic index of a food relates to its ability to increase the blood glucose level" B) "You should eat foods such as whole grains, fruits, and vegetables" D) "Try to limit or avoid potatoes due to their high glycemic index" E) "Foods with a high glycemic index will cause your blood glucose to increase rapidly"

A nurse is caring for a client whose provider prescribed a heart-healthy diet. Which of the following information should the nurse include for the client regarding heart-healthy diets? (Select all that apply.) A) "You should limit saturated fats in your diet" B) "You should increase sodium intake to your taste" C) "Eat foods with whole grains in your new diet" D) "It's important to eat larger portions of fruits and vegetables" E) "Limiting high-calorie food intake will promote adherence to your new diet" F) "Continue to avoid skim milk and lean meats"

A) "You should limit saturated fats in your diet" C) "Eat foods with whole grains in your new diet" D) "It's important to eat larger portions of fruits and vegetables" E) "Limiting high-calorie food intake will promote adherence to your new diet"

A nurse is reinforcing teaching with a client has reports constipation. Which of the following should the nurse discuss as causes of constipation? (Select all that apply.) A) Excessive laxative use B) Ignoring the urge to defecate C) Inadequate fluid intake D) ​Increased fiber in the diet E) Increased activity

A) Excessive laxative use -Chronic use of laxatives causes the large intestine to lose muscle tone and become less responsive to stimulation by laxatives. B) Ignoring the urge to defecate -Anything that prevents the client from responding to the urge to defecate and disrupts regular habits can cause possible alterations in bowel habits, such as constipation. C) Inadequate fluid intake -Reduced fluid intake slows the passage of food through the intestine and can result in hardening of stool

A nurse is caring for client who reports having daily constipation. Which of the following information should the nurse provide to the client regarding fiber intake? (Select all that apply.) A) Increasing daily fiber intake can help alleviate the issue of constipation. B) Eating more whole grains can promote regular bowel movements. C) Consume 10 g of fiber per day. D) Foods such as white rice increase fiber intake. E) Decreasing daily fiber intake can help alleviate digestive discomfort.

A) Increasing daily fiber intake can help alleviate the issue of constipation -An adequate amount of daily fiber intake helps relieve constipation by promoting bowel movements. B) Eating more whole grains can promote regular bowel movements -Whole grains contain fiber, which helps to regulate bowel movements.

What are food sources of vitamin B1, B2, B6, and B12?

B1 (thiamine): pork, nuts, whole-grain, cereals, and legumes B2 (riboflavin): milk, lean meats, fish, and grains B6 (pyridoxine): yeast, corn, meat, poultry, and fish B12 (cobalamin): meat and liver

Bacteriuria

Bacteria in the urine.

A nurse is caring for a client who has renal disease and must limit potassium intake. Which of the following foods should the nurse instruct the client to avoid because they are high in potassium? (Select all that apply). A) Potatoes B) Bananas C) Dried beans D) Spinach E) Tomatoes

Bananas, dried beans, spinach, and tomatoes

A nurse is assisting with menu selections for a client who has recovered from the acute phase of diverticulitis. Which of the following foods should the nurse recommend? A) A poached egg with sliced tomatoes B) Ham sandwich on white bread C) Roast chicken with white rice D) Bean soup with steamed broccoli

Bean soup with steamed broccoli -A client who has diverticulitis should follow a high-fiber, high-residue diet and should avoid foods that have small seeds or husks. Chicken and broccoli are good sources of fiber.

A nurse is reinforcing dietary teaching with a client who has a burn injury and adheres to a strict vegan diet. Which of the following food choices should the nurse recommend? A) Tuna salad B) Fresh fruit C) Vegetables D) Beans

Beans -An increase in protein is needed to aid in the promotion of tissue healing following a burn injury. Vegan diets may be lower in protein. Nuts and legumes will increase the amount of protein in the diet, which will aid in tissue repair.

What are some healthcare devices for defecation?

Bedside commode and bedpan

What should you do if a patient has a 24 hour urine specimen order? A) Collect a normal bladder volume - 600mL of urine and send to the lab. B) Insert a urinary catheter stat and begin collection for exactly 24 hours. C) Give a fleet's enema and start the collection and continue for 24 hours. D) Begin after discarding first specimen, continue 24 hours, end by having the patient void just prior to end of collection.

Begin after discarding first specimen, continue 24 hours, end by having the patient void just prior to end of collection.

Mouth

Beginning of digestion with mastication (chewing).

What are risk factors for developing crohn's disease?

Being between the ages of 20 and 29, a family history, autoimmune disorder, consumption of a high-fat-diet, and tobacco use

Duodenum

Bile duct from liver and pancreatic duct from pancreas enter here.

Which laxative has the greatest incidence for dependence?

Bisacodyl

Acute renal failure

Blockage, toxins, or sudden loss of blood flow causes a change in the filtering function of the kidneys.

What do proteins do?

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

What are diets that limit sodium intake?

Cardiovascular diet or heart-healthy diet

A nurse is contributing to the plan of care for a client prescribed continuous enteral feedings. Which of the following actions should the nurse plan to take? A) Flush the tube with sterile sodium chloride solution every 2 hr. B) Change the feeding bag every 24 hr. C) Check the gastric residual every 8 hr. D) Position the head of the client's bed at 15°.

Change the feeding bag every 24 hr. -The nurse should change the feeding bag every 24 hr to minimize the potential for bacterial colonization.

What should the nurse do prior to irrigating a NG tube?

Check placement of the NG tube

A nurse is administering an enteral feeding through a client's NG tube. Which of the following actions should the nurse take? A) Keep the formula cold until instillation. B) Withhold the feeding if the residual volume is 150 mL. C) Cleanse the top of the can of formula with an alcohol wipe. D) Flush the tube with 30 mL of sterile water before the feeding.

Cleanse the top of the can of formula with an alcohol wipe. -Surface bacteria and dust can contaminate the top of formula cans, so the nurse should disinfect them before opening them and introducing contaminants into the formula. They should air-dry before opening to avoid introducing alcohol into the formula.

What is tilting of the head to the strong side?

Client tilts the head to the strong side to push food down that side

What is rotation of the head to the affected side?

Client turns the head to the affected side, which directs the food to the strong side

Nocturnal enuresis

Common in children but may occur in adults who have consumed to much alcohol, who consume caffeine at night, or who take certain medications.

What is a regular diet?

Consists of healthy foods coming from all of the food groups, such as fruits, vegetables, grains, protein, and dairy sources

Anxiolytics and sedatives

Constipating

A nurse is caring for a client who has a history of irritable bowel syndrome and reports that their last bowel movement was 5 days ago. The nurse should identify this as which of the following types of altered elimination pattern? A) Encopresis B) Diarrhea C) Fecal incontinence D) Constipation

Constipation -Constipation is a condition that slows the production of stool. It can result in dry, hard-to-pass bowel movements and gives a sensation of incomplete emptying or passing of stool.

A nurse is reinforcing teaching with a client about nutrition. The client has hypertension and is taking a potassium-wasting diuretic. Which of the following dietary instructions should the nurse include in the teaching? A) Increase consumption of canned tuna and salmon. B) Limit intake of dried fruits. C) Avoid cow's milk. D) Consume oranges and bananas

Consume oranges and bananas -Clients taking a potassium-wasting diuretic are at risk for hypokalemia. Therefore, the nurse should encourage the client to consume products high in potassium, such as oranges and bananas.

A nurse is caring for a client who reports occasionally having dark, tea-colored urine at home. The nurse identifies that which of the following activities can contribute to this finding? A) Attending a yoga class B) Consuming alcohol C) Drinking 2,000 mL of fluid in a day D) Consuming fish for dinner

Consuming alcohol -Dark urine is a sign of urine concentration and can be a sign of dehydration. Certain beverages, however, can increase urine production. Alcohol and caffeinated beverages such as cola, coffee, and tea all increase urine production and can be dehydrating if not balanced with water consumption.

Total incontinence

Continuous and unpredictable loss of urine, resulting from surgery, trauma, or physical malformation.

What is peristalsis>

Contractions that occur throughout the digestive system that move food along a pathway to be digested.

Stress incontinence

Coughing, sneezing, laughing, or physical activity that increases pressure on the bladder, resulting in urine leakage

A nurse is reinforcing teaching with a client about diagnostic urinary testing. Which of the following should the nurse recognize is consistent with cystometric testing? A) Cystometric testing measures bladder capacity, pressure, and final capacity when the urge to urinate begins. B) Cystometric testing measures urine speed and volume. C) Cystometric testing measures bladder pressure when urinary leakage occurs. D) Cystometric testing measures electrical activity of the muscles and nerves of the bladder and sphincters.

Cystometric testing measures bladder capacity, pressure, and final capacity when the urge to urinate begins. -Cystometric testing involves measuring bladder capacity, the pressure of the bladder during filling, and the final capacity when the urge to urinate begins.

Antacids

Calcium and aluminum based may lead to constipation. Magnesium may cause diarrhea.

What is a high calcium diet for?

Calcium is needed during bone growth and in adulthood to prevent osteoporosis

What is electromyography?

Calculates electrical impulses of the nerves and muscles of the bladder and sphincter.

Where does the primary source of energy for most of the world's population come from?

Carbohydrate foods -grains, legumes, vegetables, and fruits

A nurse is reinforcing discharge teaching about nutrition with a client who has a new diagnosis of diabetes mellitus. Which of the following statements should be included in the teaching? A) Carbohydrate intake should be limited to 110 g per day. B) Protein intake has the greatest effect on after-meal blood glucose levels. C) Carbohydrates should comprise 45 to 65% of daily caloric intake. D) Proteins should comprise 10% of daily caloric intake.

Carbohydrates should comprise 45 to 65% of daily caloric intake. -The nurse should instruct clients who have diabetes mellitus to consume 45 to 65% of their daily calories from carbohydrates in order to obtain balanced amounts of protein, fats, and fiber.

A nurse is reinforcing teaching with a client about how to reduce the risk of giving birth to a newborn who has a neural tube defect. Which of the following instructions should the nurse include in the teaching? A) Avoid consumption of alcohol. B) Increase intake of iron. C) Eat foods fortified with folic acid. D) Avoid the use of aspirin.

Eat foods fortified with folic acid. -An increased consumption of folic acid in the 3 months prior to pregnancy, as well as throughout the pregnancy, is associated with a decreased risk of the development of neural tube defects.

A nurse is reinforcing dietary teaching with a client about complete protein in the diet. Which of the following foods should the nurse recommend as a source of complete protein? A) ​Yams B) Oatmeal C) Eggs D) ​Peanuts

Eggs -The nurse should recommend the client eat eggs, which are a good source of complete protein, which contain all nine essential amino acids.

What allergies should you assess a patient for before lipid (fat emulsion)?

Eggs or any components of the lipids emulsion solution

What is bowel incontinence referred to as in children?

Encopresis

A nurse is caring for a client who is receiving chemotherapy for treatment of ovarian cancer and experiencing nausea. Which of the following actions should the nurse take? A) Advise the client to lie down after meals. B) Instruct the client to restrict food intake prior to treatment. C) Provide the client with an antiemetic 2 hr prior to the chemotherapy. D) Encourage the client to drink a carbonated beverage 1 hr before meals.

Encourage the client to drink a carbonated beverage 1 hr before meals. -The nurse should instruct the client to drink a carbonated beverage 1 hr before or after meals to reduce the risk for nausea.

A nurse is planning care for a client who reports blood in their stool. Which of the following tests should the nurse anticipate the provider ordering? A) Fecal occult blood test B) Stool culture C) Flexible sigmoidoscopy D) Endoscopic retrograde cholangiopancreatography (ERCP)

Fecal occult blood test -A fecal occult blood test (FOBT) is a test used to check stool for blood, which is often not visible.

What are manifestations with constipation that require medical attention?

Fever, bleeding from the GI tract, abdominal pain, vomiting, low back pain, and weight loss

How should you check for pneumothorax?

Following insertion of the catheter, obtain a portable chest x-ray to confirm placement and to detect the presence of pneumothorax

What can we use Hydrochlorothiazide for?

Hypotension and Congestive heart failure (CHF)

A nurse is caring for a client who is receiving total parenteral nutrition (TPN) via an infusion pump. When collecting data about the client receiving this therapy, which of the following factors should the nurse monitor? A) IV insertion site B) Height of the IV pole C) The client's oral intake D) Manifestations of hypoglycemia

IV insertion site -It is essential that the nurse monitor the IV insertion site, generally for a central venous access device for TPN, for signs of infection regardless of the fluid delivery system.

What are the types of fecal diversions?

Ileostomy, colostomy, J-pouch, and kock pouch

A nurse is caring for a client who has a percutaneous endoscopic gastronomy (PEG) tube, and the enteral feeding has completed infusion. Which of the following actions should the nurse take? A) Flush the tubing with 30mL of water B) Lower the head of the bed to 15 degrees C) Check the pH of the gastric contents

Flush the tubing with 30mL of water -All enteral tubes must be flushed at the end of the feeding (bolus or infusion). This is to be sure the enteral feeding formula does not remain in the tube. Enteral feeding formula that remains in the tube may harden or congeal to the tubing and cause clogging or occlusion of the tube for administration of additional feedings or medications. In addition, the water is used to maintain the clients fluid and electrolyte balance.

What is a heart-healthy diet?

Focuses on controlling portions, consuming more fruits and vegetables, increasing whole grains, limiting unhealthy fats, eating low-fat protein sources, and decreasing sodium intake

What does inadequate fat intake lead to?

Inadequate fat intake leads to clinical manifestations of sensitivity to cold, skin lesions, increased risk of infection, and amenorrhea in women

If the nurse observes a dry, pale membrane of the eye, it could indicate what?

Inadequate intake of iron

What does spongy gums indicate?

Inadequate vitamin C intake

What does abnormal redness in gingival or red raw fissured tongue indicate?

Inadequate vitamin C, as well as folate, niacin, riboflavin, iron, B6 and B12

Overflow incontinence

Incomplete bladder emptying that results in the bladder overfilling when full, leading to urine leakage.

A nurse assisting with a staff in-service is discussing aspiration. Which of the following descriptions should the nurse include in the teaching as a manifestation dysphagia? A) Inconsistent vocal ability after swallowing B) Highly sensitive gag reflex C) Swallowing liquid immediately after taking a sip of a beverage D) Swallowing more than once after taking a bite of food

Inconsistent vocal ability after swallowing -The nurse should include that some clients who have difficulty swallowing might have silent aspiration where there is no coughing when food is aspirated.

A nurse is reinforcing teaching with a client who has Crohn's Disease and is experiencing frequent cramping and diarrhea. Which of the following statements should the nurse include in the teaching? A) "Increase your caloric intake by eating foods high in protein." B) "Include fresh fruits and vegetables at each meal." C) "Maintain your weight by eating high fat foods." D) "Drink whole milk to ensure adequate calcium intake."

Increase your caloric intake by eating foods high in protein." -Clients who have Crohn's disease are at risk for malnutrition; therefore, they should eat a diet high in protein to help maintain their weight and promote healing and recovery.

What are interventions for irritable bowel syndrome (IBS)?

Increased consumption of fiber, probiotics, and avoiding irritants such as gluten

Diuresis

Increased rate of formation and excretion or urine.

What are conditions that increase the risk of developing kidney stones?

Inflammatory conditions, cystic kidney disease, gout, hypercalciuria (excessive calcium in the urine), hyperparathyroidism (excessive calcium in the blood), obesity, and frequent UTIs

A nurse is planning to reinforce teaching with a client who has hemorrhoids. Which of the following information should the nurse plan to include in the instructions? A) Use a stimulant laxative to prevent constipation. B) Follow a high-fiber diet to establish bowel regularity. C) Clean the anal area after bowel movements with alcohol-based wipes. D) Limit the intake of fruit to prevent loose stools.

Follow a high-fiber diet to establish bowel regularity. -Hemorrhoids are swollen veins in the anus and rectum, often resulting from straining during bowel movements due to constipation. The nurse should encourage clients who have hemorrhoids to follow a high-fiber diet to help promote regular, soft stools. High-fiber food choices include bran and complex carbohydrates.

Effluent

The output of fecal material.

A nurse is caring for a client who has constipation and requires an enema. Which of the following actions should the nurse take when administering the enema solution? A) Instruct the client to lie on their right side with their left leg pulled up to their chest. B) Instruct the client to lie on their left side with their right leg pulled up to their chest. C) Instruct the client to lie on their left side with both legs pulled up to their chest. D) Instruct the client to lie on their right side with both legs pulled up to their chest.

Instruct the client to lie on their left side with their right leg pulled up to their chest. -For enema use, clients are instructed to lie on their left side and place their right leg up to their chest. The enema is inserted through the anus and into the rectum and sigmoid colon. The plastic container is then squeezed until all of its contents have been emptied.

What can be added to control blood glucose levels that occur because of high concentration of glucose concentration of glucose solution in the TPN?

Insulin

A nurse is reinforcing teaching with a client who has paraplegia about urinary catheter use. Which of the following catheter types should the nurse identify will help facilitate urinary elimination for this client? A) Suprapubic catheter B) Indwelling catheter C) Condom catheter D) Intermittent catheter

Intermittent catheter -Clients who have paraplegia will often utilize intermittent catheters in conjunction with bladder training to avoid urinary accidents due to the lack of bladder sensation from paralysis.

Continent urostomy

Internal reservoir (pouch) constructed from a segment of intestine that diverts urine through an opening (stoma) that is brought through the abdominal wall.

What can crohn's disease cause?

Intestinal obstruction, fistulas, abscesses, fissures or tears in the anus, ulcers within the GI tract, malnutrition, or inflammatory processes located elsewhere in the body

Why do we not do honey in children?

It can cause infant botulism

How long is the urethra in males?

It is 20cm long from the bladder to the meatus at the distal end of the penis.

How long is the urethra in females and what does it do?

It is 3 to 4 cm long and transports urine from the bladder to the body exterior (prone to UTIs because of the short urethra).

What is benign prostatic hyperplasia (BPH)?

It is a type of prostate enlargement that affects males as they age. It is a noncancerous condition that causes constriction to the urethra, increasing urinary retention.

How is a continent cutaneous reservoir attached?

It is attached to the ureters at one end and the client's stoma on the other end. A valve is utilized so the urine cannot flow out on its on but instead needs to wait until a catheter is placed.

Why should you avoid using soap when cleansing a stome?

It leaves a residue on the skin that interferes with pouch adhesion to the skin

Where does the male urethra pass through?

It passes through the surrounding prostate gland as it leaves the bladder (enlargement of the prostate gland either benign or cancerous is a common cause of urinary symptoms in men).

What is the bladder and how many cups of urine can it hold?

It's a hollow, balloon-shaped muscle that holds up to 2 cups of urine.

What is the epiglottis and what does it do?

It's a small flap of cartilage that prevents food and liquids from entering the airway.

How is TPN administered?

It's administered through a central venous access when the patient requires a larger concentration of carbohydrates (greater than 10% glucose).

What is a food's glycemic index?

Its ability to raise the blood glucose level (foods with a high glycemic index) -Potatoes, white bread, and processed snack foods

Ileum

Joins large and small intestine in RLQ of abdomen and absorbs fats, bile salts, vitamins, and minerals.

A nurse is caring for a client who is receiving tube feedings via PEG. Which of the following actions should the nurse implement in order to help prevent the client from aspirating? A) Keep the client's head elevated to at least 30° for a minimum of 1 hr after a feeding. B) Verify the initial tube placement with an x-ray after the first feeding. C) Check the client's tube feeding tolerance every 12 hr. D) Check the pH of the gastric contents each day.

Keep the client's head elevated to at least 30° for a minimum of 1 hr after a feeding. -The nurse should keep the client's head elevated to at least 30° for a minimum of 1 hr after the feeding because this gives the client time to digest the feeding and helps prevent aspiration.

End stage renal disease (ESRD)

Kidney disease in which there is little or no remaining kidney function, requiring the patient to undergo dialysis or kidney transplant for survival

What is the amount of urine produced determined by?

Kidney function

What does the urinary tract consist of?

Kidneys, ureters, bladder, and urethra

What are the urinary tract organs?

Kidneys, ureters, bladder, urethra

Urinary incontinence causes

Lack of voluntary control over urination. 1) Women more than men and half of nursing home residents. 2) It is not a normal response to aging. 3) Men: prostatic hypertrophy-BPH, prostatectomy, and obesity. 4) Women: childbirth, perimenopausal status, high body mass index-obesity, diabetes, and cigarette smoking

What are complex carbohydrates?

Large complex molecules of carbohydrates composed of many sugar units (polysaccharides). Complex carbs contain dietary forms of starch, which is digestible and provide a major source of energy, and fiber placing bulk in the diet.

Passive bowel incontinence

Leakage of feces occurs without the person being aware

What position should you place a patient in during impaction?

Left lateral position

What is the expected reference range for a fasting blood glucose level for a client who does not have diabetes?

Less than 100mg/dL

What does Glomerular damage or inflammation do?

Lets large molecules such as blood cells and protein abnormally filter across the walls

A nurse is caring for an older adult client who is experiencing urinary leakage. Which of the following is an expected age-related change that can contribute to this occurrence? A) Reduced blood supply B) Loss of kidney tissue C) Loss of nephrons D) Loss of bladder tone

Loss of bladder tone -With advancing age there is a loss of bladder tone, which can lead to issues such as urinary leakage, incontinence, or retention.

A nurse is administering a tap-water enema to a client. The client reports cramping as the nurse instills the irrigating solution. Which of the following actions should the nurse take to relieve the client's discomfort? A) Lower the height of the solution container. B) Encourage the client to bear down. C) Allow the client to expel some fluid before continuing. D) Stop the enema and document that the client did not tolerate the procedure.

Lower the height of the solution container. -If nausea or cramping occurs, the nurse should slow the flow of water, leaving the tube in place. The nurse should then raise the solution container when the cramping has passed.

A nurse is contributing to the plan of care for a client who has an intestinal obstruction and is receiving continuous gastrointestinal decompression using a nasogastric tube. Which of the following interventions should the nurse include in the plan of care? A) Measure abdominal girth daily. B) Use sterile water to irrigate the nasogastric tube. C) Maintain the client in Fowler's position. D) Moisten the client's lips with lemon-glycerin swabs.

Maintain the client in Fowler's position. -The nurse should place the client in Fowler's position to reduce pressure on the diaphragm and to promote function of the nasogastric tube.

What does vitamin A do?

Maintains eyesight and epithelial linings -Liver, egg yolk, whole milk, green or orange vegetables, and fruits

What gender is more likely to develop urinary retention?

Males (enlarged prostate)

What is the normal range for triglycerides?

Males: 40-160mg/dL Females: 35-135mg/dL

A nurse is reinforcing teaching with the mother of a 14-month-old child about safe food choices. Which of the following food choices should the nurse recommend? A)Mashed potatoes B) Raw carrots C) Popcorn D) Watermelon with seeds

Mashed potatoes -Mashed potatoes is a safe food choice for the nurse to recommend because it is soft and has a low risk of choking.

What is a full liquid diet?

May be used as a second diet after clear liquids following surgery or for the client who is unable to chew or swallow

ASA and NSAIDs

May cause irritation, ulceration, and bleeding.

A nurse collecting data from a client who has manifestations of appendicitis. Where should the nurse palpate to monitor for pain at McBurney's point? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)

McBurney's point is found between the navel and the anterior iliac crest.

A charge nurse planning care for a group of clients is delegating tasks to an assistive personnel (AP). Which of the following tasks should the nurse delegate to the AP? A) Measure the output from a client's indwelling urinary catheter. B) Evaluate a client's pain level 30 min after receiving an oral analgesic. C) Reinforce foot care to a client who has a new diagnosis of diabetes mellitus. D) Administer an enteral feeding to a client who has a new gastrostomy tube.

Measure the output from a client's indwelling urinary catheter. -Measuring the output from a client's indwelling urinary catheter does not require use of the nursing process, but does require knowledge and skill that is within the scope of practice of the AP.

What is uroflowmetry?

Measure urine speed and volume.

What is cystometric test?

Measures bladder capacity, or the amount of fluid or pressure inside the bladder as it is filling, and its final capacity when the urge to urinate begins.

What is leak point pressure measurement?

Measures bladder pressure when the bladder begins to leak.

What is postvoid residual measurement?

Measures the amount of urine left in the bladder after vomiting.

What are food sources of Niacin?

Meats, poultry, fish, beans, peanuts, and gains

What are vitamins?

Micronutrients that promote health and ward off disease while supporting the functions of the body. They aid in promoting healthy vision, bones, and skin.

What is the order in which food or liquid contents are transported through the gastrointestinal tract

Mouth, esophagus, stomach, small intestine, large intestine, anus

A nurse is caring for a client who is schedules for an upcoming procedure with sedation. Which of the following diets should the nurse expect the provider to prescribe? A) Full liquid diet B) Renal diet C) NPO D) Heart-healthy diet

NPO

A nurse is reviewing a client's list of medications and supplements. Which of the following medication classifications increases the risk of constipation? A) Magnesium-containing antacids B) Antibiotics C) Narcotic pain medications D) Beta blockers

Narcotic pain medications -Medications used to treat pain, such as narcotics, can slow gastric motility and increase the risk of constipation.

Iron

Nausea, vomiting, constipation, and dark stool

What are the 2 forms of continent urinary diversion?

Neobladder and continent cutaneous reservoir

Bladder scanning

Noninvasive technique (ultrasound device) used to measure residual volume.

What do diets high in fat lead to?

Obesity and increase the risk of cardiac disease and some cancers

Diverticulitis

Occurs when the diverticula become blocked and inflamed, or irritated and swollen, and infected. Diverticular bleeding occurs when a small blood vessel within the wall of a diverticulum bursts.

How is a urostomy (ileal conduit) created?

Once a section of the small intestine is removed from the GI tract, it is repositioned with one end attached to the ureters, and the other attached to the wall of the abdomen, where a stoma is created to allow urine to pass into a pouch attached to the abdominal wall.

What are micronutrients?

Only small amounts of these nutrients are required in the diet -Vitamins and minerals

Encopresis

Oozing of diarrhea stool, liquid stool seeping around the blockage.

Pain medications

Opioids (narcotics) slow peristalsis and are associated with a high incidence of constipation.

A nurse is reinforcing teaching with a client about foods that can irritate the bladder. Which of the following foods should the nurse identify as being a bladder irritant? A) Milk B) Oranges C) Nuts D) Bananas

Oranges -Bladder irritants such as alcohol, acidic fruits, chocolate, soda, and spicy foods should be avoided.

What helps protect the skin during urinary incontinences?

Pads, incontinence briefs, waterproof undergarments, cleansing products, and barrier creams

Anal sphincter surgery

Pain and fear or uncontrolled drainage after surgery.

What is dysuria?

Pain or discomfort with urination often due to infection or injury.

A nurse is caring for a nondiabetic client who has a new prescription for a fasting blood glucose check. The nurse checks the client's blood glucose and it is 67 mg/dL. Which of the following actions should the nurse take next? A) Document the client's blood glucose level. B) Report the client's blood glucose level to the provider. C) Provide the client with a 15-g carbohydrate snack. D) Recheck the blood sugar in 15 min.

Provide the client with a 15-g carbohydrate snack. -According to evidence-based practice, the nurse should first provide the client with a 15-g carbohydrate snack to help bring up their blood glucose level to the expected reference range. The client's glucose level is low, less than 70 mg/dL, which means the client is hypoglycemic.

What are the only laxatives recommended for long term use?

Psyllium (Laxatives)

Pyuria

Pus in the urine.

What is Bolus tube feeding?

Resembles normal meal feeding patterns. It can be administered via a syringe or via an intermittent feeding. With an intermittent feeding, approximately 300 to 400 mL of formula is administered over a 30 to 60 minute period every 3 to 6 hours.

A nurse is contributing to the plan of care of a client who is in a long-term care facility. To improve the client's nutritional status, which of the following nursing interventions should the nurse recommend adding to the plan? A) Minimize the use of seasoning. B) Provide soft foods. C) Serve small, frequent meals. D) Limit finger foods.

Serve small, frequent meals. -Because small, frequent meals are more easily tolerated by older adults than three large meals, this intervention can improve the client's nutritional status.

Who uses a high-calorie diet?

Sever stress, burns, cancer, human immunodeficiency virus (HIV) infections, acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), respiratory failure, or any other type of debilitating disease -Must be high in protein because the purpose of the diet is to build or maintain lean body mass

Anticholinergics

Slow peristalsis and cause constipation.

Esophagus

Smooth muscular tube moves food through by peristalsis from upper esophageal sphincter to lower esophageal sphincter.

Where can a distended bladder be palpated?

Suprapubic region

Perineal surgery

Surgery in perineal area may result in pain or fear of tearing or popping sutures that may impede bowel movements.

Stoma or ostomy

Surgically created opening in the abdominal wall.

Why is susceptibility testing so important for the proper treatment of a UTI?

Susceptibility testing is used to determine which specific antibiotic can eradicate the infectious organism causing the UTI. This also prevents antibiotic resistance by ensuring the right treatment for the right organism.

A nurse is collecting data from a client who is receiving chemotherapy and is showing manifestations of malnutrition. Which of the following indicates a Vitamin C deficiency? A) Dry, red conjunctiva B) Swollen, bleeding gums C) Inflammation of the tongue D) Pale, brittle nails

Swollen, bleeding gums -The client who is malnourished can have swollen, bleeding gums from a vitamin C deficiency.

What is a diet for diverticular disease?

Symptomatic diverticulitis 1) Fiber is avoided because high-fiber is irritating to the bowel Asymptomatic diverticular disease 1) A high-fiber diet is consumed to prevent constipation

A nurse is reinforcing teaching with a client who has a prescription for simvastatin. Which of the following instructions should the nurse provide? A) Follow each tablet with an antacid tablet. B) Swallow the tablet with a glass of grapefruit juice. C) Take the medication in the evening hours. D) Have a meal or a snack when taking the medication.

Take the medication in the evening hours. -Statins are most effective if taken at bedtime or with the evening meal because this is when the peak production of cholesterol takes place.

What is video urodynamic test?

Takes pictures and video of the bladder while it is filling and emptying.

A nurse is assisting in monitoring a client who is receiving a tube feeding. Which of the following findings should the nurse identify as the priority? A) Temperature 100.8° F B) Respiratory rate 12/min C) Hematocrit 45% D) Urine specific gravity 1.015

Temperature 38.2° C (100.8° F) -A fever can indicate an infection. Therefore, the priority finding to report is the client's temperature.

Urinary incontinence (UI)

The inability to control urination, resulting in the involuntary passage of urine.

What is dysphagia?

The inability to safely swallow food

How is a j-pouch connected?

The internal reservoir connects to the anus after removal of the rectum and colon. Body waste collects in the reservoir. Then, instead of passing through the colon and rectum, it directly passed through the anus during a bowel movement.

A nurse is caring for a client who has a prescription for a vitamin K injection. The nurse should identify that vitamin K is naturally produced in which of the following locations in the body? A) The small intestine B) The large intestine C) The esophagus D) The stomach

The large intestine -Bacteria within the large intestine produce Vitamin K, a nutrient important for blood clotting and strong bones.

Peritoneal dialysis

The lining of the peritoneal cavity acts as the filter to remove waste from the blood

What does the gastrointestinal system consist of?

The liver, pancreas, gallbladder, mouth, esophagus, stomach, small and large intestines, and the anus.

what is kidney failure?

The loss of 15% of expected kidney function. The kidneys filter the blood and remove excess minerals, fluid, and waste from the body.

What is protein?

The major building block of the body, as it provides amino acids that the body needs to build and repair muscle. -Beans, soy, nuts, meats, eggs, and fish

Peristalsis (motility)

The movement of contents through the gastrointestinal tract.

What is calorie density?

The number of calories a food contains related to its volume or weight

Not every drug that is nephrotoxic is ototoxic, but every drug that is ototoxic is also nephrotoxic True or False

True

What are fistulas?

Tunnels that pass from the wall of the intestine to another organ.

A nurse is caring for a client who has a stone in the right ureter that is obstructing the flow of urine. Which of the following urinary diversions should the nurse anticipate the client will need? A) Urostomy B) Continent cutaneous reservoir C) Ureteral stent D) Neobladder

Ureteral stent -Ureteral stent placement allows the passage of urine when a ureter is blocked from either a stone, mass, scar tissue, inflammation, or infection.

What are the different types of bowel incontinence?

Urge and passive

What is the most common type of bowel incontinence?

Urge incontinence

What are the types of urinary diversion?

Urinary catheterization, ureteral stent, urostomy, nephrostomy, continent urinary diversion, cystostomy

Ileal conduit

Urinary diversion in which the ureters are connected to the ileum with a stoma created on the abdominal wall,

What is the difference between urinary incontinence and urinary retention?

Urinary incontinence affects the retention, holding, and releasing of urine. Where as, urinary retention effects the bladders ability to fully empty.

Reflex incontinence

Urinary leakage as a result of nerve damage between C1 and S2.

Nocturia

Urination during the night, disrupts sleep and the sleep cycle. - Common causes: excess intake of fluids, bladder outlet obstruction, medications, cardiovascular disease, and urinary tract infection

A nurse is planning care for a client who has an order for urinalysis. Which of the following tests should the nurse anticipate being ordered if the presence of white blood cells is detected on urinalysis? A) Urine culture B) Bladder scan C) 24-hour urine D) Stool culture

Urine culture -A urine culture is used to evaluate urine for the presence of bacteria and yeast. The test is commonly ordered in addition to a urinalysis to confirm the presence of bacteria in urine revealed on the urine dipstick.

Urinary diversion

Urine drains through an artificial opening on the abdominal wall.

A nurse is collecting data from a client who has stress incontinence. Which of the following findings should the nurse expect with this client? A) Urine leakage prior to reaching the toilet B) Urine leakage following coughing C) Urine leakage as a result of nerve damage D) Urine leakage due to not reaching the toilet in time from a physical impairment

Urine leakage following coughing - Stress incontinence is a leakage of urine when the client engages in coughing, sneezing, laughing, or physical activity due to increased pressure on the bladder.

Residual urine (residual volume)

Urine that remains in the bladder after urination.

What can you do if constipation advances to impaction?

Use a warm mineral oil enema to loosen stool and allow for its manual removal.

What type of meat should you use?

Use only lean cuts of all meats, and use more poultry and seafood (except shrimp) which is very high in cholesterol. Remove the skin from poultry and trim fat

What is Furosemide (Loop Diuretic) used for?

Used for HTN and edema in congestive heart failure (CHF), Renal disease, and Cirrhosis

What does Fragmin do?

Used in the prevention of deep vein thrombosis after surgery and unstable angina/non-Q wave myocardial infarction

What is a high iron diet for?

Used to treat anemia

Laxatives

Used to treat constipation.

Anti-motility drugs (diphenoxylate (lomotil) and immodium)

Used to treat diarrhea by slowing peristalsis.

What is a low purine diet for?

Used to treat gout

Subclavian or internal jugular veins

Used when TPN is a short-term intervention (less than 4 weeks). For an extended period (greater than 4 weeks), a more permanent catheter such as a peripherally inserted central catheter (PICC) line, a tunneled catheter, or an implanted vascular access device is used.

What is ureteroscopy?

Uses an optical instrument to view the lining of the ureters and kidneys.

What is cystoscopy?

Uses an optical instrument to view the lining of the urethra and bladder.

A nurse is caring for a client who is postoperative and has a prescription for a clear liquid diet. The nurse enters the client's room to find he has just received a dietary tray. Which of the following items on the tray should the nurse remove? A) Orange gelatin B) Beef broth C) Vanilla pudding D) Cranberry juice

Vanilla pudding -A clear liquid diet includes only foods that are clear at room or body temperature. Pudding contains milk and should not be on a clear liquid diet tray.

When should a patient seek their primary HCP about decal matters?

When any of the following symptoms last longer than 3 weeks 1) Blood in stool 2) Severe stomach pain 3) Abdominal distention 4) Change in bowel habit 5) Change in stool character 6) Constipation or diarrhea 7) Unintended weight loss 8) Constipation unrelieved after trying fiber, fluids, and exercise

A nurse is caring for a client who is postoperative and has an NG tube that has drained 2,500 mL in the past 6 hr. The nurse should monitor the client for which of the following electrolyte imbalances? A) ​Elevated sodium level B) ​Decreased potassium level C) ​Elevated magnesium level D) ​Decreased calcium level

​Decreased potassium level -Loss of gastric fluid is a common cause of potassium depletion.

A nurse is teaching a new mother about signs of effective breastfeeding of her newborn. Which of the following information should the nurse include in the teaching? A) Expect your baby to have less than 5 wet diapers per day after the fourth day of life. B) Your baby can lose 5% of body weight during the first 3 days of life. C) Your baby should gain 0.25 oz (7 grams) per day after the fourth day of life. D) Expect your baby to feed constantly the first week of life.

Your baby can lose 5% of body weight during the first 3 days of life. -The nurse should instruct the mother that the baby can have a weight loss between 5% and 6% of their birth weight during the first 3 days of life. Breastfed infants usually regain birth weight by their second or third week of life.

calculi

kidney stones

What is a cutaneous ureterostomy?

The ureters are attached directly to the stoma.

What are the 3 sets of muscles that work together to prevent accidental urination?

The urethra, internal sphincter, and the pelvic floor muscles along with the external sphincter

Where are the kidneys located and how much blood can they filter daily?

They are located below the ribcage, each adjacent to the spine. They can filter 120 to 150 quarts of blood daily.

If a patient has renal failure, will their BUN and creatine be up or down?

They will be up

What do diuretics do?

They work to rid the body of excess fluid and salt, primarily to reduce blood pressure, but also to treat conditions such as heart failure and edema.

What are the 3 categories of diuretics widely used?

Thiazide, loop, and potassium-sparing

What are ureters?

Thin tubes of muscle

How must CPN and PPN be administered?

Through tubing with an in-line filter to remove crystals from the solution.

A nurse is collecting data from a client who has hypocalcemia. Which of the following findings should the nurse expect? A) Decreased deep-tendon reflexes B) Skeletal muscle weakness C) Hypoactive bowel sounds D) Tingling of the lips

Tingling of the lips -Tingling and twitching in the extremities and face (lips, nose, and ears) are consistent with hypocalcemia, a deficiency in the serum calcium level. Intervention is required to prevent tetany, a life-threatening event.

A nurse is caring for an older adult client who is Chinese and is recovering from a bowel obstruction. The client is prescribed a clear-liquid diet and asks the nurse for a cup of hot ginger tea. The nurse should identify that this request is for which of the following purposes? A) To regulate blood pressure B) To promote digestion C) To enhance the immune system D) To reduce inflammation

To promote digestion -According to traditional Chinese medicine, disease interrupts the flow of qi, the body's vital energy. Herbal remedies can act on specific body parts or functions to restore qi. Ginger aids with digestion and relieves nausea.

Temporary bowel diversion

After adequate healing has occurred, surgical re-anastomosis (reconnection) is performed and the patient again has bowel movements from the rectum.

Where are fat-soluble vitamins stored?

After consumption, in the liver and fatty tissues for later use. Most abundant in high-fat foods, which allow them to be better absorbed.

Who is constipation common for?

After pregnancy, older adults, clients who consume little to no fiber, clients who take certain medications, and clients who have GI disorders

How many glasses of fluid per day is required?

6 to 8 ounces

What is normal blood glucose?

81-110

NG tube insertion 3

9) Advance until taped mark is reached; tape in place when correct placement is confirmed 10) If feedings are prescribed, x-ray confirmation should be done prior to initiating feedings 11) When GI tubes are attached to suction, suction may be continuous or intermittent, with a pressure in mmHg prescribed by the physician

What is a food frequency questionnaire?

Aims to determine the client's typical food consumption based on a list of foods

What are some foods and beverages that increase the risk of diarrhea?

Alcohol, caffeinated beverages and food, dairy, high fat or greasy foods, beverages that contain fructose, spicy foods, apples, peaches, pears, and products that contain sweeteners

What is a ureteral stent?

Allow passage of urine when a ureter is blocked. This can happen because of obstruction from a stone or mass, postoperative scar tissue, or inflammation and swelling from an infection.

Antibiotics

Alter normal flora of bowel leading to diarrhea. Probiotics or yogurt can maintain bacterial populations.

A nurse is caring for a client who is 2 days postoperative from abdominal surgery. The client reports discomfort from abdominal distension and flatus. Which of the following suggestions should the nurse include? A) Drink cold liquids. B) Use a straw. C) Ambulate several times a day. D) Assume position with legs and rectum lower than the stomach.

Ambulate several times a day. -The nurse should encourage the client to ambulate, which promotes the passage of flatus.

Why is age a primary risk factor for developing benign prostatic hyperplasia (BPH)?

As males age, their levels of testosterone decrease and the proportion of estrogen increases. Another factor is elevated levels of a male hormone called dihydrotestosterone (DHT).

What is endoscopic retrograde cholangiopancreatography (ERCP)?

Diagnoses problems associated with pancreatic and bile ducts such as gallstones, infections, pancreatitis, and pancreatic masses.

What is the most common side affect of Bisacodyl (Laxatives)?

Diarrhea is the most common side effect 1) Watch for dehydration 2) Watch for electrolyte imbalances (K, Mg)

What is the most common side effect of Polyethylene Gylcol (Laxatives)?

Diarrhea is the most common side effect 1) Watch for dehydration 2) Watch for electrolyte imbalances (K,Mg)

What are manifestations of Ulcerative colitis (UC)?

Diarrhea with blood or pus, abdominal discomfort, fatigue, nausea, fever, and anemia

Oliguria

Diminished urinary output in relation to fluid intake. - Common causes: fluid and electrolyte imbalances, kidney dysfunction or failure, increased secretion of antidiuretic hormone, urinary tract obstruction

Hemorrhoids

Distended blood vessels.

Stomach

Distensible sac that stores food while it churns it to chyme. Hydrochloric acid, pepsin, and gastric lipase are digestive enzymes. The chyme leaves the stomach in an average of 4 hours.

What group of medications affect urine production?

Diuretics increase urination by increasing urine production in the kidneys.

What are the most common conditions affecting bowel elimination?

Diverticulitis, irritable bowel syndrome, ulcerative colitis, crohn's disease

What should a dietary cholesterol be limited to?

300 mg/day

What should you do if you observe separation of emulsion into layers, fat globules, or the accumulation of froth in a lipid (fat emulsion)?

Do not use and return the solution to the pharmacy

What are risk factors for ulcerative colitis (UC)?

Family history, being of Jewish descent, environment, and an overactive intestinal immune system

What are risk factors for irritable bowel syndrome (IBS)?

Family history, female gender, stressful events, infection within the GI tract, digestive disorders, anxiety, depression, and fibromyalgia

A nurse is reinforcing discharge teaching with a client who is receiving intermittent enteral feedings through a gastrostomy tube. Which of the following client statements requires further teaching by the nurse? A) "I can crush and mix my medication with my formula." B) "I will return all aspirated gastric residual volume before each bolus feeding." C) "I need to flush the tube with 15 to 30 mL of water before and after each bolus feeding." D) "I should make sure the formula is at room temperature before instilling down my tube."

"I can crush and mix my medication with my formula." -The client should crush the medication or obtain a liquid form of the medication and administer after or before intermittent feedings. Administering medication mixed with an enteral feeding can lead to clogging of the tube.

A nurse is providing information to a client about what may happen if their urinary tract infection (UTI) is not treated. Which of the following statements by the client indicates an understanding of the information? A) "I can develop a kidney infection called pyelonephritis." B) "I might have urinary retention." C) "I might become incontinent." D) "I can develop functional incontinence."

"I can develop a kidney infection called pyelonephritis." -If left untreated, UTIs can result in a more serious kidney infection called pyelonephritis. Clients may present with severe lower back pain, fevers, nausea, vomiting, or blood in their urine.

A nurse is instructing a client how to collect a fecal occult blood test. Which of the following responses by the client indicates understanding? A) "I will make sure to hold my vitamins." B) "I will collect a sample that has little blood." C) "I will smear the stool with a cotton swab." D) "I will collect three samples and then call the nurse."

"I will make sure to hold my vitamins C supplements."

A nurse is caring for a 20-year-old college student who has a 2-year history of bulimia nervosa. She tells the nurse, "I know my eating binges and vomiting are not normal, but I cannot do anything about them." Which of the following is a therapeutic response by the nurse? A) "It seems like you are feeling helpless about this behavior." B) "Do you have any idea why you do this?" C) "I'm proud of you for recognizing that this behavior is not normal." D) "You should stop because you need to. You are destroying your health."

"It seems like you are feeling helpless about this behavior." -The nurse is responding to the feelings the client has expressed. Clarifying feelings begins the process of exploring how to deal with them more effectively.

A nurse is reinforcing teaching about a high-fiber diet with a client who has constipation. Which of the following statements indicates the client understands the best choice for a high-fiber diet? A) "One medium apple would be a good snack option." B) "I will select a ½ cup of sweet potatoes for my starch." C) "My breakfast choice is ½ cup of bran cereal." D) "I should choose 1 ounce of almonds when I am hungry midday."

"My breakfast choice is ½ cup of bran cereal." -The client who selects ½ cup of bran cereal is selecting the best source of fiber. A ½ cup of bran cereal contains 8.8 g per serving of fiber; therefore, it is the best food choice for the client.

A client asks a nurse why a fecal occult blood test is necessary when they have not experienced any bleeding when they have a bowel movement. Which of the following responses from the nurse best answers the client? A) "I will need to check your chart again." B) "This is a test we do on all clients your age." C) "The physician ordered it based on your recent blood work." D) "Sometimes we can't see blood in stool."

"Sometimes we can't see blood in stool."

A nurse is reinforcing instructions for a client who had kidney stone removal and placement of a nephrostomy tube. Which of the following statements should the nurse identify is true regarding a nephrostomy tube? A) "The tube will keep the client's ureter open in case of another kidney stone." B) "The tube will remain permanently because the client cannot empty their bladder." C) "The tube goes directly into the client's bladder." D) "The tube is temporary."

"The tube is temporary" -This type of diversion is usually temporary and is removed once the kidney has healed.

A nurse is caring for a client who has a high phosphorus level. Which of the following instructions regarding food should the nurse provide? A) "You should eat white bread." B) "You can drink 2 cups of milk per day." C) "You should limit broccoli to 3 cups per week." D) "You can have four servings of oatmeal per week."

"You should eat white bread." -The nurse should instruct the client to eat white bread instead whole-grain bread. Whole grains are high in phosphorus.

Who is a sodium restricted diet for?

Hypertension, CHF, kidney disease, cardiac disease, and cirrhosis of the liver

How many grams of fiber are recommended?

25 to 30 grams

What are lab values for K?

3.5-5.0

What is the angle at which the bed should be elevated for tube feedings?

30 to 45 degrees

NG tube insertion 2

5) Insert into nostril, advance backwards and through the nasopharynx 6) Have the client take a sip of water and advance tube as the client swallows 7) Do not force the tube 8) If the client experiences any respiratory distress (coughing or choking) during insertion, pull back on the tube until the distress subsides

A nurse is assisting in the plan of care for a client who had surgery for a bowel obstruction. The client has a nasogastric tube in place. Which of the following actions should the nurse include in the client's plan of care? (Select all that apply.) A) Perform leg exercises every 2 hr. B) Encourage hourly use of an incentive spirometer while awake. C) Document the color, consistency, and amount of nasogastric drainage. D) Irrigate the nasogastric tube every 4 to 8 hr. E) Maintain bed rest for 48 hr following surgery.

A) Perform leg exercises every 2 hr -Postoperative clients should frequently perform leg exercises, independently or with assistance, to prevent skin breakdown. B) Encourage hourly use of an incentive spirometer while awake C) Document the color, consistency, and amount of nasogastric drainage -Documenting the color, consistency, and amount of nasogastric drainage is appropriate to include in the client's plan of care.

What fat-soluble vitamins can be stored in the body?

A, D, E, and K -An excess can cause toxicity

What is parenteral nutrition?

Dietary intake that is administered intravenously (IV). Prevents malnutrition in clients or, if the client is already malnourished, can help correct it. This type of feeding provides liquid nutrients such as proteins, fats, carbohydrates, minerals, electrolytes, and vitamins.

Small intestine

About 20 foot long tube consisting of 1) Duodenum 2) Jejunum 3) Ileum 4) Villi and and microvilli for absorption of nutrients

Jejunum

Absorbs carbohydrates and protein.

What does Vitamin K do?

Acts as a catalyst for facilitating blood-clotting factors, especially prothrombin -Green leafy vegetables, cauliflower, and cabbage

What is a fluid restriction diet for?

Acute renal failure-oliguric phase, chronic renal disease, cirrhosis of the liver, CHF, hepatic coma, and MI

What are added sugars?

Added to foods during processing, packaged as sweeteners, sugars from concentrate, and syrups or honey -Included in total sugar count (listed below total sugars)

Hemodialysis

An artificial kidney machine removes waste products from the blood.

A nurse is reinforcing teaching for client who has an ileostomy. The nurse should identify that which of the following is true regarding an ileostomy? A) An ileostomy has an internal reservoir that collects waste. B) An ileostomy can allow the colon time to heal from surgery. C) An ileostomy must be accessed with a catheter to drain the waste. D) An ileostomy is designed to be a permanent solution.

An ileostomy can allow the colon time to heal from surgery. -Ileostomies can be reversed once the colon has had time to heal.

Urgency

An immediate and strong desire to void that is not easily deferred. - Common causes: full bladder, urinary tract infection, inflammation or irritation of the bladder, and overactive bladder

What is diverticulitis?

An inflamed pouch or sac forms as a result of stool becoming trapped.

What is a j-pouch?

An internal pouch formed with the ileum.

What is Albumin?

An overall indicator of nutritional status because of long half life; body stores and maintains normal level until chronic malnutrition occurs

What is prescribed once diverticulitis occurs?

Antibiotics and a liquid or soft diet

What is urodynamic testing?

Any procedure that evaluates how the bladder, sphincters, and urethra are holding and releasing urine.

A nurse is contributing to the plan of care for a client who has frequent diarrheal stools. Which of the following interventions should the nurse include in the plan? A) Provide the client with a high fiber diet. B) Administer a soap-suds enema to cleanse the colon. C) Allow the perineal area to air dry after each stool. D) Apply an alcohol-free barrier to the perineal area after each stool.

Apply an alcohol-free barrier to the perineal area after each stool. -The nurse should apply an alcohol-free barrier to the perineal area after each stool to provide protection and prevent skin breakdown.

A nurse is reinforcing teaching with a client who is postoperative after having an ileostomy established. Which of the following instructions should the nurse include in the teaching? A) Empty the pouch immediately after meals. B) Change the entire appliance once a day. C) Limit fluid intake. D) Avoid medications in capsule or enteric form.

Avoid medications in capsule or enteric form. -The client should not take medications in capsule or enteric form because the medication may enter the pouch undigested.

What is enteral nutrition?

Dietary intake via a medical device such as a feeding tube

Kwashiorkor

Diets lacking protein or essential amino acids-happens when children stop breast-feeding... bloated stomach and physical disabilities.

A nurse is preparing to collect a urine sample for urinalysis using a reagent strip. The nurse should identify that the reagent strip can detect substances that are consistent with which of the following conditions? A) Diabetes B) Colon cancer C) Pancreatitis D) Pregnancy

Diabetes -Urine concentration, protein, glucose, ketones, bilirubin, leukocytes, nitrites, and blood can also be tested with a urinalysis.

What are risk factors for kidney failure?

Diabetes, hypertension, cardiac disease, and a family history of kidney problems

What us celiac disease testing?

Diagnoses celiac disease.

What are food sources of vitamin D and E?

D: fortified milk, fish oils, and cereals E: Vegetable oils, green leafy vegetables, cereals, apricots, apples, and peaches

Constipation

Decrease in the frequency of bowel, movements; prolonged or difficult passage of dry, hard stools.

What does St. Johns wort do?

Decrease the effectiveness of medications including birth control, cardiac medications, and antidepressants

Diuretics

Decrease the water content of stool, leading to constipation.

Hesitancy

Delay in start of urinary stream when voiding. - Common causes: anxiety and bladder outlet obstruction

A nurse is collecting data for a client who has malnutrition resulting from a chronic illness. Which of the following manifestations should the nurse expect to find? A) Non-palpable spleen B) Slightly moist skin C) Presence of surface papillae on tongue D) Depigmented hair

Depigmented hair -The client who is malnourished due to chronic disease is most likely to have depigmented hair. Other indications of malnutrition include hair that is stringy, dull, brittle, dry, thin, sparse, and easily plucked.

What is a serving size?

Described using units such as cups or pieces. It represents the amount of the food or drink that people usually consume, it is not a recommendation of how much people should consume.

Urge bowel incontinence

Desire to defecate but inability to reach the toilet in time.

A nurse is preparing to insert a nasogastric tube into a client for decompression. Which of the following actions should the nurse perform first? A) Measure the tube from the client's ear to the xiphoid. B) Insert the tube while the client takes sips of water. C) Connect the nasogastric tube to suction. D) Ensure the client is in a sitting position.

Ensure the client is in a sitting position. -When inserting a nasogastric tube, the nurse should first encourage the client to sit up to reduce the chance of vomiting and aspiration.

What is lower GI series?

Evaluates for bleeding, changes in bowel habits, chronic diarrhea, unexplained weight loss, abdominal pain, cancer, diverticula, fistulas, polyps, or ulcers.

What is upper GI series?

Evaluates for nausea and vomiting, abdominal pain, difficulties with swallowing, unexplained weight loss, cancerous growths, and injuries to the esophagus, reflux, hernias, scarring, or ulcers.

What is upper GI endoscopy?

Evaluates the esophagus, stomach, and upper intestine after unexpected findings such as persistent heartburn, bleeding, nausea, and vomiting, pain, issues with swallowing, unexplained weight loss, ulcers, cancer, precancerous conditions, celiac disease, narrowing of the esophagus, or blockages.

What is flexible sigmoidoscopy?

Evaluates tissue that may be swollen or irritated for ulcers, polyps, or cancer.

When should you change the TPN solution?

Every 12 to 24 hours -dressing every 48 hours

When should you change the feeding container and tubing?

Every 24 hours

How many times should you change the stoma pouch?

Every 3-7 days unless leakage occurs

How often should the placement of a feeding tube be checked?

Every 4 hours

How many times should you empty an catheter drainage bag?

Every 8 hours

Anuria

Failure of the kidneys to produce urine.

Vasovagal response

Fainting because the body overreacts to certain triggers (the sight of blood, extreme emotional distress).

A nurse is reinforcing instructions with the parent of a toddler about foods that are included on a clear liquid diet. Which of the following foods suggested by the parent indicates understanding of the instructions? A) Yogurt B) Pureed fruit C) Gelatin D) Strained soup

Gelatin -Clear liquid diets include liquids that can be seen-through, and do not contain solid food particles or creams. The nurse should identify gelatin as an appropriate choice that indicates understanding of the instructions.

What are food sources of folic acid?

Green leafy vegetables, liver, beef, fish, legumes, grapefruit, and oranges

Kidney stones (renal calculi, nephrolithiasis, or urolithiasis)

Hard formations of minerals that collect in the kidneys.

What does Epogen do?

Helps combat effects of anemia caused by chemotherapy or chronic renal failure

What does the pelvic floor muscles, along with the external sphincter do?

Helps to support the urethra.

What can be added to reduce the build-up of fibrinous clot at the catheter tip in LPN?

Heparin

A nurse is planning care for a client who has a new colostomy. Which of the following complications should the nurse plan to monitor for? A) Hernia B) Gastroesophageal reflux disease C) Crohn's disease D) Ulcerative colitis

Hernia -Complications of fecal diversions include hernia, electrolyte imbalance, blockage, prolapse, diarrhea, and infection.

What are interventions to treat constipation?

High-fiber diet, staying well hydrated, exercise, bowel training, and medications to soften stools

A nurse is reviewing the medical record of a client who has persistent diarrhea. Which of the following findings should the nurse identify as risk factors? (Select all that apply.) A) History of frequent respiratory infections B) A shortened urethra C) Cardiovascular disease D) Consumes large amounts of dairy in their diet E) Currently taking cephalexin for pneumonia

History of frequent respiratory infections -A client who experiences frequent infection is at an increased risk for developing persistent diarrhea. Consumes large amounts of dairy in their diet -A client who consumes large amounts of dairy in their diet is at an increased risk for developing persistent diarrhea. Currently taking cephalexin for pneumonia -A client who takes certain medications, such as antibiotics, is at an increased risk for developing diarrhea.

What does the internal sphincter do?

Holds urine inside the bladder.

Dysuria

Painful urination resulting from bacterial infection of the bladder and obstructive conditions of the urethra. - Common causes: urinary tract infection, inflammation of the prostate, urethritis, trauma to the lower urinary tract, urinary tract tumors

A nurse is collecting data from a client who has an indwelling urinary catheter and determines that the catheter is in place and functioning properly. The nurse should expect which of the following findings? A) Dark yellow, cloudy urine B) Pale yellow, clear urine C) Urine with a strong odor D) Urine with a slight red tint

Pale yellow, clear urine. - In a healthy person, urine is light yellow, clear, and without cloudiness.

A nurse is assisting an adolescent client in the selection of complementary protein sources on the lunch menu. The client is a vegetarian who eats milk products but does not like beans. Which of the following food items should the nurse recommend? A) Peanut butter and jelly with enriched bread B) Baked potato with sour cream C) Bagel with cream cheese D) Fruit salad and carrot sticks

Peanut butter and jelly with enriched bread -The client who does not substitute protein-rich beans for meat protein should select a peanut butter sandwich, which is an excellent source of protein. A peanut butter and jelly sandwich, if prepared on protein-enriched bread, can provide almost 20 g of protein, called a complementary protein. A complementary protein is when two incomplete proteins are the equivalent of a complete protein and provides all the essential amino acids.

A nurse is reinforcing teaching with an older adult client who is on bed rest about foods high in dietary fiber. Which of the following food items should the nurse indicate is the best source of fiber? A) Pears with skin B) Mashed potatoes C) Celery D) Canned pineapple

Pears with skin -The nurse should encourage a client who is on bed rest to eat pears with skin because they are an excellent source of dietary fiber. An older adult client on bed rest has a high risk of constipation and increasing dietary fiber through the addition of high-fiber foods, such as pears with skin, promotes bowel regularity.

A nurse is caring for a client who has a colostomy and does not wear a colostomy pouch. Which of the following actions should the nurse anticipate performing on this client to maintain expected bowel function? A) Administer an enema B) Administer a laxative C) Perform colostomy irrigation D) Insert a rectal tube

Perform colostomy irrigation -Colostomy irrigation acts as a type of bowel training to help prevent passage of stool at other times and reduces the client's need to wear a colostomy pouch.

Permanent bowel diversion

Performed if the bowel is necrotic (dead) or is so damaged it cannot be salvaged.

What is a 24-hour recall?

Performed to see what the client has consumed in the last 24 hours, including different foods and portion sizes

What is it called when the colon can perforate or tear, causing an infection in the abdomen?

Peritonitis

what can B12 deficiency lead to?

Pernicious Anemia

Functional incontinence

Physical inability to reach the toilet in time. This may be due to a physical impairment such as being wheelchair bound or having arthritis of the hands, which can hinder the fine motor skills needed to unbottom clothing.

How should a stoma appear?

Pink or red in color, which indicated adequate blood supply. - A pale stoma indicates compromised blood flow and enzymes in the effluent can quickly cause excoriation.

Decreased mobility

Post operatively patients experience pain or discomfort that affects mobility that slows bowel motility and increases risk of complication.

What do you lose when you urinate?

Potassium (K)

Hematuria

Presence of blood in urine. - Common causes: tumors, infection, urinary tract calculi, trauma to the urinary tract

What are Mannitol (Osmotic Diuretics) used for?

Primarily used to reduce cerebral edema -Have to have good kidney functions before use (not nephrotoxic)

What does vitamin C do?

Produce collagen, a vital component in wound healing -(ascorbic acid): citrus fruits, tomatoes, broccoli, and cabbage

What is the most common side effect of Ondansetron (Anti-Emetics)?

Prolonged QT interval (EKG change-dysrhythmia) is the most common side effect

What does water do?

Promotes brain function, hydrates and flushes out wastes from the body, regulates body temperature, and acts as a lubricant in the body

What can inadequate protein cause?

Protein energy malnutrition and severe wasting of fat and muscle tissue -The nurse should check the client's total protein and albumin (plasma protein)

What are macronutrients?

Provide the body with the energy it needs to function and are the primary building blocks of any diet. -Protein, carbohydrates, and fat, and are eaten in large amounts.

A nurse is contributing to the plan of care for a client who has a pressure ulcer on his heel. Which of the following information should the nurse include in the plan? A) Keep the ulcer bed dry. B) Clean the wound bed with hydrogen peroxide. C) Provide the client a diet high in vitamin C. D) Reposition the client at least every 4 hr.

Provide the client a diet high in vitamin C. -Vitamin C is essential for wound healing to promote formation of new capillaries, synthesis of new tissue and development of collagen.

A nurse is caring for a client who is scheduled to receive a bolus feeding via the nasogastric (NG) tube. The nurse checks the pH of the gastric contents and the result is a 6.5. Which of the following actions should the nurse take? A) Recheck the pH of the gastric contents B) Replace the NG tube C) Begin the feeding D) Flush the NG tube with 30mL of water

Recheck the pH of the gastric contents -Gastric pH is a reliable method to verify the placement of the NG tube. A result of 6.0 pH or above may indicate that the NG tube is not in the stomach. To reduce the risk of aspiration to the client, the nurse should hold the feeding and recheck the gastric pH. If the pH is higher than 6.5 again, the feeding should ne held, the provider notified, and an X-ray done to confirm NG placement.

How long does the rectum and anus last?

Rectum: 6 inches of intestine Anus: 1 inch of colon

What does antioxidant supplements, including vitamin C and E do?

Reduce the effectiveness of chemotherapy

A nurse is assisting with teaching a newly licensed nurse about parenteral nutrition (PN). Which of the following information should the nurse include in the teaching? A) Remove solution from refrigerator 2 hr before infusion. B) Reduce the rate of the solution gradually to discontinue. C) Weigh the client weekly. D) Shake the solution before hanging if there is a layer of fat present on the top.

Reduce the rate of the solution gradually to discontinue. -The nurse should slowly taper the flow rate of the PN solution to reduce the risk for hypoglycemia.

What can kidney failure cause?

Reduced urine production, joint pain, increased blood pressure, anemia, and itching

What does vitamin k do?

Reduces the effectiveness of warfarin, an anticoagulant, which can increase the risk of blood clots

Bladder irrigation

Removes mucus, blood clots, and other tissue from the bladders. It also introduces medication into the bladder.

A nurse is caring for a client who is postoperative and has a prescription for a full liquid diet. The nurse enters the client's room to find he has just received a dietary tray. Which of the following items on the tray should the nurse remove? A) Cream of rice cereal B) Scrambled eggs C) Vanilla yogurt D) Apple juice

Scrambled eggs -A full liquid diet includes foods that are liquid at room or body temperature. Scrambled eggs do not liquefy at room temperature. They are a component of a soft diet.

What is colonoscopy?

Screening procedure for colon or rectal cancer, can also be used to evaluate for causes of GI bleeding, changes in bowel habits, abdominal pain, and unexplained weight loss.

What is the most common side effect of Promethazine (Anti-Emetics)?

Sedation is the most common side effect - Also has antihistamine properties

What are the thickened liquid stages?

Stage 1: Nectar like: fluid runs freely off the spoon but leaves a mild coating on the spoon Stage 2: Honey-like: fluid slowly drips in dollops off the end of the spoon Stage 3: Spoon-thick: fluid sits on the spoon and does not flow off it

How do you irrigate a colostomy?

Sterile water is inserted into the colon via the stoma site.

What are the different types of urinary incontinence?

Stress, urge, reflex, overflow, functional, nocturnal

Glycosuria

Sugar in urine

What are total sugars?

Sugars that naturally occur in food

What are simple carbs?

Sugars with a simple structure of one or two single sugars

Enuresis-involuntary urination

Wetting the bed at night without waking from sleep.

What are net carbs?

The amount of carbohydrates in a product minus either the fiber or the sugar alcohols and fiber. -Fiber and sugar alcohols essentially cancel out carbohydrates

A nurse is caring for a client who is receiving antibiotic treatment for a urinary tract infection and is experiencing diarrhea. Which of the following should the nurse identify as a potential cause of the diarrhea? A) The antibiotic dose is not correct, and the provider should be alerted. B) The antibiotic interferes with the client's ability to absorb nutrients. C) The antibiotic eliminates the healthy gastrointestinal bacteria, allowing harmful bacteria to grow. D) The antibiotic decreases a client's immunity level, resulting in diarrhea.

The antibiotic eliminates the healthy gastrointestinal bacteria, allowing harmful bacteria to grow. -The GI tract contains bacteria that live naturally within the body to promote health. When antibiotics are needed to treat bacterial infections, a side effect may be the loss of healthy bacteria within the GI tract. This loss allows other bacteria to multiply, causing diarrhea.

What does the urethra connect?

The bladder at the bladder neck.

A nurse is collecting data for a client who has brittle hair. Which of the following should the nurse determine about the client's nutritional intake? A) The client is not getting enough vitamin A. B) The client has insufficient protein in their diet. C) The client needs more vitamin D from sun exposure. D)The client needs to eat five servings of fruits and vegetables daily.

The client has insufficient protein in their diet. -Protein helps promote healthy hair and prevents brittle hair and hair loss. Therefore, the nurse should identify that this client might have inadequate protein intake.

What are calories?

The energy that is stored in food; they are used to support processes of the body such as walking, breathing, and running. -Fresh fruits, vegetables, legumes, whole grains, and lean proteins

How does food travel through the digestive system?

The esophagus is a tube that extends from the mouth to the stomach; muscles in this structure propel food from the mouth to stomach. The stomach holds and digests food, with food remaining in the stomach for 2 to 8 hours. The liver produces bike, which the gallbladder stores and releases. The pancreas produces insulin, a hormone that helps metabolize sugars. The small intestine is responsible for absorbing most of the nutrients from food, while the large intestine helps turn the rest to feces. The feces are then temporarily stored in the rectum until removed from the body as waste via the anus.

What are nephrons?

The filters in the kidney.

What is the percent daily value?

The percentage of recommended daily value for each individual nutrient in a single serving of the food, it provides a reference to help individuals avoid exceeding these daily values

Defecation (bowel elimination)

The process by which the bowel eliminates waste.

Urosepsis

The spread of the organism to the blood stream

How is an ileostomy directed?

The surgeon redirects the ileum through a surgically created opening (stoma or ostomy) in the abdominal wall to allow for the drainage of stool. If the ileostomy is temporary, once the colon has healed, the stoma can be reversed by removing the ileum from the abdominal wall and reattaching it to the colon so bowel contents can continue to pass through the colon.

Which vitamins are water soluble, not stored in the body, and can be excreted in the urine?

Vitamin B and C

A nurse is reinforcing teaching about pernicious anemia with a client following a total gastrectomy. Which of the following dietary supplements should the nurse include in the teaching as the treatment for pernicious anemia? A) Vitamin B12 B) Vitamin C C) Iron D) Folate

Vitamin B12 -The nurse should recommend a lifelong intake of vitamin B12 to prevent pernicious anemia. A total gastrectomy brings a complete halt to the production of intrinsic factor, the gastric secretion that is required for the absorption of vitamin B12 from the gastrointestinal tract.

What vitamins are water soluble?

Vitamin C and vitamin B complex -Carried to the tissue of the body, but not stored in the body

What is rickets?

Vitamin D deficiency in children

Polyuria

Voiding excessive amounts of urine. Common causes: high volumes of fluid intake, uncontrolled diabetes mellitus, diabetes insipidus, diuretic therapy

Frequency

Voiding more than 8 times during waking hours and/or at decreased intervals, such as less than every 2 hours. - Common causes: high volumes of fluid intake, bladder irritants, urinary tract infection, increased pressure on bladder, bladder outlet obstruction, and overactive bladder

Under the control of ADH, what is reabsorbed?

Water and sodium