NSG 502 exam 4

hypertrophic pyloric stenosis

- Circular muscle around pylorus thickens & elongates leading to constriction & gastric obstruction - Eventual high-grade obstruction leads to compensatory dilation, further hypertrophy, & hyperperistalsis

open cholecystectomy considerations

- Conversion due to poor visibility (obesity), prior abdominal surgeries (adhesions), bleeding T tube (placed in common bile duct) management for several weeks - Sleep on opposite side - Secure tube to clothing or skin - Cover with plastic bag when showering - May need to flush with 10 ml saline twice daily or empty drainage bag - Change dressing daily

constipation nursing interventions

- Diet - hydration - activity - timing - positioning - stress level

where can ulcers develop d/t peptic ulcer disease

- Lower esophagus - Stomach - Duodenum - Margin of gastrojejunal anastomosis after surgical procedures

fracture

- complete or partial break of the bone

fracture complications

- fat embolism - compartment syndrome - pulmonary embolism

types of traction

- manual - skin - skeletal

cast assessment

- pain or point tenderness - pallor - pulse - paresthesia - paralysis - temperature - cap. refill

scoliosis complications

- respiratory issues: lungs cannot fully expand - GI/GU issues - mobility limitations

idiopathic juvenile arthritis diagnosis

- similar to RA - children have negative RF in 90% of cases - leukocytosis is present during flares of systemic disease

osteoarthritis diagnosis

- x-ray (gold standard) - MRI - CT scans

How do you anticipate rehydrating this patient? - A 7-month-old infant presents to the ED with diarrhea accompanied by decreased oral intake and fever for 5 days. - Upon examination, baby is listless, mucus membranes are tacky, extremities cool and mottled, and sunken eyes. - VS are 101.5-180-28-79/35

IVF b/c patient is severely dehydrated with s/s and decreased oral intake

closed fracture

The bone is broken but the skin is intact

6. The nurse would monitor a patient with a pelvic fracture for a. changes in urine output. b. petechiae on the abdomen. c. a palpable lump in the buttock. d. sudden increase in blood pressure.

a

skeletal traction

applied directly to the skeletal structure by a pin, wire, or tongs inserted into or through the diameter of the bone, distal to the fracture site

open fracture

bone is exposed through the skin

4. The nurse suspects a neurovascular problem based on assessment of a. exaggerated strength with movement. b. increased redness and heat below the injury. c. decreased sensation distal to the fracture site. d. purulent drainage at the site of an open fracture.

c

9. The discharge teaching plan for the patient after an acute episode of upper GI bleeding includes information about the importance of (select all that apply) a. limiting alcohol intake to 1 serving per day. b. only taking aspirin with milk or bread products. c. avoiding taking aspirin and drugs containing aspirin. d. only taking drugs prescribed by the health care provider. e. taking all drugs 1 hour before mealtime to prevent further bleeding.

c, d

common adult fragility fractures

caused by fall from standing height or less - wrist - hip - pelvis - vertabral

how is GERD diagnosed?

endoscopy

surgical management of gall bladder disease

lap/open cholecystectomy

osteoarthritis clinical manifestations

- pain and stiffness - pain worse with use or in PM - early am stiffness that resolves in 30 minutes - joint swelling and inflammation - most commonly affect fingers, feet, knees, hips, spine

arthroplasty nursing care

- pain management (MMAs and around the clock management) - keep knee straight while in bed - 6 week restriction of hip flexion, adduction (crossing legs), internal or external rotation - safe patient handling (weight bearing status) - discharge planing (home vs rehab) - home help - prevent immobility complications

developmental dysplasia of the hip treatments/considerations

- pavlik harness worn 24 hr/day - only the provider may adjust the harness - may use regular car seat - check for skin breakdown where harness touches skin - sitting upright is a major milestone (<6 months), need to promote normal activities/play

fat embolism s/s

- petechia - cyanosis - tachypnea - dyspnea - tachycardia - chest pain - changes in LOC may lead to: - SIRS - ARDS - CHF

dumping syndrome

- post-operative complication of gastric surgery - rapid gastric emptying leads to issues - 20% of patients experience this post-op

Pernicious anemia

- post-operative gastric complication - May occur after removal of the lower part of the stomach due to loss of intrinsic factor, which is needed for absorption of colbalamin (Vitamin B12) and the development of RBCs. - Requires lifelong cobalamin replacement, along with folate, calcium, Vitamin D, and iron.

Bile reflux gastritis

- post-operative gastric complication - Surgery can result in reflux alkaline gastritis - Continuous epigastric distress that increases after meals - Treat by administering cholestyramine (Questran) to relieve irritation by binding with the bile salts.

juvenile idiopathic arthritis overall goals of management

- preserve joint function and ROM - minimize the effects of inflammation - minimize joint deformation - promote normal growth and development - pain management

scoliosis nursing interventions

- prevent neurological deficits (weakness and paresthesias may occur) - promote mobility - pain management - promote social interaction - promote body image positivity - skin integrity (2/2 braces) - promote optimal nutrition

compartment syndrome treatment

- prevention and early detection - dont elevate above the heart (slows arterial perfusion) - no ice (causes vasoconstriction) - bivalve (open) cast and loosen under layer - loosen surgical dressings - fasciotomy

nursing management of ostomies

- protect the stoma - protect the skin surrounding the stoma - promote patient independence

peptic ulcer disease surgical treatments

- pyroplasty - USUALLY ONLY DONE TO TREAT COMPLICATIONS LIKE RECURRENT HEMORRHAGE OR PERFORATIONTYPICALLY REQUIRED BY 20% OR FEWER OF CLIENTS

total hip arthroplasty

- remove worn cartilage - resurface the femoral head and acetabulum - can be done for hip fracture - hips don't lie - 1-2 hour procedure - home in 1-3 days (or to rehab center)

total knee arthroplasty (TKA)

- remove worn cartilage - resurface tibia, femur, and patellar surfaces - unicompartmental - 1-2 hour procedure - home in 1-3 days (or to rehab center)

what is RICE

- rest - ice - compression - elevation very common in MSK issues

scoliosis treatment/management

- serial radiographs - bracing - traction - surgical spine fusion

idiopathic juvenile arthritis clinical manifestations

- stiffness - swelling - pain/tenderness - warmth without erythema - loss of motion in affected joint - persists longer than 6 weeks ~10% may have systemic manifestations including: - fever - maculopapular rash - hepatosplenomegaly - pericarditis - lymphadenopathy

developmental dysplasia of the hip (DDH/hip dysplasia)

- subluxation or dislocation of the head of the hemur from the acetabulum - females affected more than males

types of surgeries for UC

- total colectomy and creation of ileostomy - proctocolectomy with ileal pouch/anal anastomosis

arthritis surgical management

- total or partial (hemi) joint replacements (not usually done) - arthroscopies - osteotomies

talipes equinovarus (clubfoot) therapeutic management

- treatment is started as soon as possible after birth - goal is to gently stretch the tightened ligaments and tendons - serial stretching, manipulation, and casting are performed at least weekly - caregiver may soak off cast (plaster) in AM before appointments - if not corrected within 3-6 months, surgery is usually indicated

osteoarthritis pharmacological interventions

- tylenol, NSAIDs, ASA - tramadol/narcotics (typically avoided) - topical agents (BenGay, etc) - intra-articular injections (steroids/gel, hyaluronic acid)

ulcerative colitis

- type of IBD that affects the entirity of the colon (large intestine)

crohns disease

- type of IBD that can affect any part of the GI tract from mouth to anus

general considerations for fractures

- ulna, clavicle, tibia, and femur are common fracture sites in both adults and children - manifests as site pain, immobility, deformity, edema - treated by reduction and immobilization

traction nursing considerations

- understand the purpose and function of the therapy - maintain traction (check lines, weights, ropes, bed position) - maintain alignment (check after repositioning) - assess bandages - replace straps when needed - assess pin sites - clean pin sites - note pull of traction on pin - ensure screws are tight - prevent skin breakdown - assess the 5 P's - skeletal traction is *never* released by the RN - do not lift counterweights

scoliosis clinical manifestations

- uneven fit of clothing - uneven hem length - shoulder asymmetry - prominent scapula and hip - spinous process misaligned

dumping syndrome symptoms

- weakness - sweating - palpitations - dizziness - abdominal cramps - borborygmi - urge to defecate - N/V/D - bloating - impaired nutrition - electrolyte disturbances - occurs at end of meal/15-30 minutes after - symptoms last no longer than an hour

rheumatoid arthritis diagnosis

- x-ray - blood tests (CRP/ESR, rheumatoid factor, anti-CCP) - joint fluid analysis (increased WBCs and proteins)

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? 1. Notify the health care provider (HCP). 2. Administer the prescribed pain medication. 3. Call and ask the operating room team to perform the surgery as soon as possible. 4. Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

1

The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Where should the nurse anticipate the location of the pain? 1. Right lower quadrant, radiating to the back 2. Right lower quadrant, radiating to the umbilicus 3. Right upper quadrant, radiating to the left scapula and shoulder 4. Right upper quadrant, radiating to the right scapula and shoulder

4

A patient, who has recovered from cholecystitis, is being discharged home. What meal options below are best for this patient? A. Baked chicken with steamed carrots and rice B. Broccoli and cheese casserole with gravy and mashed potatoes C. Cheeseburger with fries D. Fried chicken with a baked potato

A

A patient, diagnosed with acute cholecystitis, is extremely nauseous and reports RUQ pain 9/10 radiating to the right shoulder blade. A nasogastric tube is inserted with GI decompression. Select all the appropriate nursing interventions for the patient: A. Encourage the patient to consume clear liquids. B. Administered IV fluids per MD order. C. Provide mouth care routinely. D. Administer analgesic as ordered. E. Maintain high continuous suction to NG tube.

B, C, D

Perforation

- 15-36% of children under 5 years old perforate - Can occur within 48 hours of symptoms - Bowel contents contaminate the mesenteric bed & peritoneum leading to peritonitis - Temporary, sudden relief from pain with progressive diffuse pain, abdominal distention, high fever, acutely ill appearance - Can deteriorate quickly to septic shock

gastroesophageal reflux disease (GERD)

- Backward movement of gastric contents into esophagus - Acid comes up esophagus aeb lower esophageal sphincter not closing

Appendicitis

- Blockage of appendix lumen leads to increased pressure, impaired blood flow, & inflammation - etiology is poorly understood - Most common cause of emergency surgery in children & adolescents - Uncommon in children under 4 years - Symptoms can be vague, especially in young children

perforation diagnosis

- CBC, electrolytes, UA (UA to r/o UTI, etc) - CT: high sensitivity and specificity - US: lower cost, but lower sensitivity

GERD dietary irritants

- Chocolate - soda - coffee - dairy (high fat) - alcohol - peppermint - fried fatty foods

gall bladder disorders nursing assessment

- Cholelithiasis is typically asymptomatic until obstruction occurs With obstruction or movement of stones - Severe pain occurring after meals (especially high fat) or when patient lies down - RUQ and radiating to right scapula & shoulder - N/V - Systemic inflammation - Jaundice - Dark urine - light stool - itchy skin

peptic ulcer disease nursing assessment

- Epigastric discomfort - Timing of pain r/t meals (duodenal vs gastric) - Weight loss - n/v - Hematemesis (gastric ulcer) vs melena (duodenal ulcer)

cleft lip and palate etiologies

- Genetic and environmental factors - Failure of merging/fusion of lip/palate during gestation leads to abnormal opening in the lip, palate, & sometimes nasal cavity - Can occur together or alone

hypertrophic pyloric stenosis nursing assessment

- HALLMARK: Progressive projectile non-bilious vomiting after feeds (20-25 minutes after feed) - Usually noted by 2 to 6 weeks old - Infant presents hungry, irritable, thin, pale, failure to thrive - May palpate the hypertrophied pylorus as an olive shaped mass in the mid-epigastrum. May see peristalsis in abdomen - May have dehydration, alkalosis, & electrolyte derangements

hypertrophic pyloric stenosis diagnosis

- History and physical - Abdominal ultrasound

osteomyelitis treatment

- IV abx for at least 3-4 weeks (possibly up to 6) - immobilization (limits spread) - surgical intervention

gall badder issues collaborative/nursing management

- IV fluids if NPO - Avoid gas forming and fatty foods (what might some of these be?) - NG tube if nausea & vomiting is severe - Shock-wave lithotripsy if stones are small Medications: - Antiemetics - Analgesics - Anticholinergics - Antibiotics - Bile acids

peptic ulcer disease nursing management

- Identify patients at risk for PUD - Monitor for S/S anemia (Hgb/HCT, Fatigue) Education: - Take ulcerogenic drugs with food - Report signs and symptoms - Engage in smoking cessation programs - Adhering to prescribed medication during course of treatment

intussusception nursing assessment

- Intermittent crampy pain that progresses to constant and severe with flexed legs - Child acts normal between pain episodes - Red, currant jelly-like stools (blood/mucus) - RLQ sausage mass - Vomiting, distended abdomen - Pallor, diaphoresis, lethargy, dehydration - Shock & sepsis can develop

cleft palate surgical repair

- Lip at 3-6 months - Palate at 6-24months - Possibly combined repair at various times at tertiary centers - Important for repair to occur before 1 year of age for proper speech development - Complex defects may require revisions

laparoscopic cholecystectomy considerations

- Minimally invasive - Removal via 4 small puncture holes in the abdomen - Discharged same day or overnight Patient education: - Shoulder pain - Incision care - Typically back to light activity work in 3 to 7 days - Strenuous activity and lifting restriction for 4 to 6 weeks

hemorrhage r/t PUD

- Most common complication of peptic ulcer disease - May be insidious occult or sudden overt - Physical exam emphasis on BP, rate and character of pulse, peripheral perfusion with capillary refill, and patient respiratory status - Thorough abdominal examination

perforation r/t PUD

- Most lethal complication of peptic ulcer - Sudden, dramatic onset - Severe upper abdominal pain spreads throughout abdomen - N/V, Absent BS, ridged abdomen - Tachycardia, weak pulse; Shallow, rapid respirations - Bacterial peritonitis may occur within 6 to 12 hours

intussusception etiology

- Mostly idiopathic - may follow viral gastroenteritis or a URI (small increase within 1 week of rotavirus vaccine) - Most common obstruction in children 75% of cases before the age of 2

intussusception nursing care

- NPO - fluid resuscitation - NG - broad-spectrum antibiotics - Assess stool post reduction - Educate parents regarding serious nature of the condition & the potential for a good outcome if treated early - Fatal if not treated

idiopathic juvenile arthritis pharmacological interventions

- NSAIDs - disease modifying anti-rheumatics (DMARDs) - biologics - corticosteroids

intravenous rehydration

- Needed for hypovolemic shock/severe dehydration - Isotonic solution - 20 ml/kg - Once rehydrated move to maintenance fluids

cleft palate nursing assessment

- Observation & careful exam of palate with finger in delivery room - Sign of cleft palate may be breastmilk/formula coming from nose

appendicitis nursing assessment

- PAIN progressing in intensity & *may* localize at McBurney's point (RLQ) - *May* have rebound tenderness - Knee to chest position for comfort - Periumbilical pain - Nausea & vomiting - Diarrhea or constipation - High fever & chills - Refusal to eat or play - "favorite food test" - "jump test"

GERD medications

- PPIs - Antacids - H2 antagonists - Avoid meds that decrease gastric emptying (anticholinergics)

gastric outlet obstruction r/t PUD

- Pain that progresses to generalized upper abdominal discomfort. - Pain worsens toward end of day as stomach fills and dilates. - Relief obtained by belching or vomiting - Vomiting is common (often projectile, foul odor)

laparoscopic cholecystectomy post-operative management

- Prevent respiratory complications - Pain Control - Ambulate early

open cholecystectomy post-operative management

- Prevent respiratory complications (very important given site) - Pain control - Ambulate early - May have NG tube

Osgood-Shlatter Disease nursing interventions

- RICE - taping, bands, braces - time off sports - education r/t better shoes, etc, and you will return to normal with proper rest - educate that a bony prominence my occur in the area

intussusception complications

- Reoccurrence (most common 10-20%) - infarction - perforation - sepsis - obstruction - gangrenous bowel - death

intussusception

- Segment of bowel telescopes into segment just distal to it (often ileum into cecum) - results in Venous compression, arterial obstruction, swelling, bleeding from pressure, ischemia, perforation

dumping syndrome treatment

- Small, frequent meals, low in carbohydrates and high in fiber - Drink fluids between meals, not with meals

hypertrophic pyloric stenosis etiology

- Some evidence supports a genetic association - May be related to abnormal nerve innervation - More common in first born, full-term infants, males, and offspring of an affected parent

peptic ulcer disease diagnosis

- Urea Breath Test (not actually done) - Endoscopy, possibly with biopsy (H. pylori urease detection) - Hemoglobin and Hematocrit - Fecal occult blood (positive)

IBD nursing interventions

- Watch for hypovolemia (what would you be looking for?) - Monitor VS & labs (ESR/CRP, H&H, lytes) - Perform perineal care - Assess stools for bleeding if indicated - Promote bedrest to decrease motility & diarrhea during acute exacerbations - Monitor I&O and daily weights during acute exacerbations - Provide oral care - Frequent small frequent meals - avoid irritating foods & raw veggies. - High protein. Vitamins. Low fiber. Increased fluids - Monitor for major complications: --- UC=large bowel perforation, toxic megacolon --- CD=small bowel perforation, infection, small bowel obstructions

oral rehydration therapy

- When a person is alert, awake and not in danger oral rehydration can be attempted - Oral rehydrating solutions (ORS) - Set amount depending on severity - Takes place over 4-6 hours - 50-100 ml/kg in children - 75 ml/kg in adults - 10 ml/kg for stool replacement - Can be given frequently via syringe - Inexpensive - After rehydration, can alternate with low sodium supplements (Formula, breast milk, etc.)

considerations for fractures in children

- a fracture in infant or child under 1 year is uncommon (rubber bones) - MUST be evaluated for potential abuse - children's bones have less ossification and bend more before breaking - growth plates are a common site of fracture

scoliosis

- abnormal lateral curvature of the spine - adolescent idiopathic - occurs during growth spurt - females affected more than males

types of surgeries for crohns disease

- abscess drainage - fistula repair - ileostomy - proctectomy - colectomy - resection - strictureplasty

exogenous osteomyelitis

- acquired from outside source - ex: penetrating wound or open fracture

osteomyelitis nursing interventions

- administer IV abx - pain management - immobilization/weight bearing restriction - contact isolation (if open wound) - optimize nutrition (high cal. diet) - education - distraction - facilitate development (if young) - maintain function of non-affected extremities

peptic ulcer disease complications

- all require emergency treatment - hemorrhage - perforation - gastric outlet obstruction

manual traction

- applied to body part by hand - placed distally to fracture site - typically done during cast application

skin traction

- applied to the skin surface and indirectly to skeletal structures - applied over soft foam backed traction straps to distribute the traction pull

cast nursing interventions

- assist with cast application - observe skin - reposition q2 - protect bony prominences - keep dry - nothing inside cast - assess for skin breakdown - prepare patient for cast removal - clean skin after cast removal

fat embolism r/t fracture

- associated with major trauma - usually presents w/in 3 days of trauma - typically occurs in young adults and elderly with fracture of a long bone, tibia, ribs, and pelvis - bone marrow fat globules embolize and occlude small vessels of lungs, brain, kidneys - vaso-occlusive and inflammatory cascade initiates - rare - may occur with total arthroplasties, spinal fusions, liposuction, crush injuries, bone marrow transplant

osteomyelitis

- bacterial infection of the bone that involves the cortex or marrow cavity - 2x more common in males - common between ages 5 - 14 - S. aureus - can be exogenous or hematogenous - may lead to amputation

GERD s/s

- burning sensation/heartburn - regurgitation - hypersalivation - difficulty swallowing - dyspepsia (indigestion)

myogloinuria/rhabdomyolysis r/t compartment syndrome

- causes disruption of the sarcolemma - damaged muscle cells release protein - protein travels to the kidneys where it precipitates like a gel - renal tubules become obstructed - urine turns dark reddish brown - acute renal failure may occur

constipation s/s in children

- changes in behavior - Avoidance - withholding - mostly idiopathic and functional - Painful stools=vicious cycle

disorders of the gallbladder

- cholelithiasis (gall stones) - cholecystitis (infection often results from obstruction) - cholecystectomy

common adult fractures r/t trauma

- clavicle - tibia/fibula - femur - pelvis

treatment of fractures

- closed reduction - casting and bracing - external fixation (consider pin care) - internal fixation (ORIF) - early treatment optimal for fracture and for patient

talipes equinovarus (clubfoot)

- congenital malformation of the lower extremity - foot and ankle "turns inward" - occurs in 1/1000 live births - males affected more than femals - etiology unknown - possibly related to restricted mobility in utero - deformity is apparent at birth

rheumatoid arthritis pharmacological interventions

- disease modifying anti-rheumatics (DMARDs may affect pregnancy) - biologics - corticosteroids - NSAIDs

GERD education points

- do not eat at bedtime - do not lay flat - elevate HOB - hold infant upright after feedings; small frequent meals; avoid risk factors

fiberglass cast considerations

- does not mold easily - 1 hour to dry - more expensive - water resistant, can be made water proof - heats as it dries

why do patients with a duodenal ulcer have a relief of pain after eating, while those with gastric ulcers have increased pain after eating?

- eating stimulates stomach acid production - this makes ouchie on gastric ulcers - everything is mixed (less acidic) by the time it reaches the duodenum

idiopathic juvenile arthritis risk factors

- female - < 16 years old - unknown etiology

osteoarthritis risk factors

- female - advanced age - obesity - repeated use/injury

rheumatoid arthritis risk factors

- female - genetic - infection - older age - tobacco

pathological fractures

- fractures caused by weakened bone tissue - usually r/t tumor

peptic ulcer disease causes

- h. pylori - smoking - alcohol - NSAIDs - stress (increased stomach acid) - spicy foods

osteomyelitis clinical manifestations

- history of trauma to affected bone - history of infection - elevated WBCs - elevated sedimentation rate (c-reactive protein, i.e. inflammation) - irritability - fever - local tenderness, swelling, pain - positive bone cultures

idiopathic juvenile arthritis non-pharmacological treatments

- ice, heat, rest for pain - PT/OT - night time splints to avoid flexion - optimize nutrition - prevent infection (causes exacerbations)

rheumatoid arthritis non-pharmacological interventions

- ice, heat, rest for pain - braces - adaptive equipment - assistive devices - positioning to avoid prolonged flexion - avoid repetitive grip motions

osteoarthritis non-pharmacological interventions

- ice/heat/rest for pain - weight reduction - exercise (low impact) - smoking cessation - assistive devices - physical therapy - accupuncture - tai chi - yoga - guided imagery

compartment syndrome

- increase in intracompartmental pressure - may lead to occlusion of blood vessels and nerves - compartment pressure of 30-50 mmHg considered abnormal (0-15 is normal) - ischemia can occur in 4-12 hours

inflammatory bowel disease

- inflammation of the colon and small intestine - ulcerative colitis - crohns disease

peptic ulcer disease symptoms

- loss of appetite - n/v - stomach pain - feeling sick - heart burn - bloating

osteoarthritis overall goals of management

- maintain or improve joint function - improve activity intolerance - optimize self-care and role function - pain management

talipes equinovarus (clubfoot) nursing considerations

- maintain skin integrity - assess circulation distal to the cast - pain management - parental support - facilitate normal growth and development - rare long term affects are calf muscle atrophy and small foot

fat embolism management

- maintenance of adequate oxygenation and ventilation - maintain fluid volume

rheumatoid arthritis overall goals of management

- maintenance of joint function - reduce inflammation - prevent or minimize joint deformation - maintain self-care and role function - pain management

rheumatoid arthritis clinical manifestations

- malaise - fatigue - symmetrical pain and stiffness - typically persists hours after awakening - remissions and exacerbations - chronic inflammation - joint destruction/deformities that lead to loss of function - commonly affects small joints, wrists, fingers, knees, and spine - has extraarticular manifestations

plaster cast considerations

- molds easily - heavy - cheap - 24-48 hours to dry - cannot get wet

osgood shlatter disease (OSD)

- most frequent cause of knee pain in children - most often occurs between 9-16 years, can be earlier - males and females affected equally - associated with overuse - caused by irritation of the patellar ligament at its attachment point at the tibial tuberosity

scoliosis (really all spinal fusion) post operative care

- neuro assessment (focus on below the affected spinal section) - incontinence care - pain - log rolls only for reposition - no bending, lifting, twisting (BLT) - head of bed remains flat - respiratory assessment

risk factors for gall bladder disorders

- obesity - women (pregnancy, hormonal contraceptives use, post menopausal) - sedentary lifestyle - fhx

compartment syndrome s/s

- pain (on passive stretch) - pallor - paresthesia - paralysis - puslelessness - pressure - myogloinuria/rhabdomyolysis (dark red/brown urine and acute renal failure)

considerations for gastric vs. duodenal ulcers r/t PUD

duodenal: - pain relieved by meal - pain occurs 2-3 hours after meal - most common type - causes dark, tarry (melena) stools) - less likely to cause cancer gastric: - pain increased by meal - occurs 30-60 minutes after meal - not as common - vomiting occurs - hematemesis may be present

developmental dysplasia of the hip etiologies

generally unknown, but multiple possibilities: - maternal hormone secretion - positioning (breech or tight infant swaddling) - genetics

cleft palate nursing management

intense family support: - Congratulate parents on birth at delivery and unit admission - Document parental interaction - Provide pictures of infants after repair - Role modeling and encouraging touching and holding - Pointing out positive attributes of infant aspiration precautions/nutrition management: - Head upright, cheek support - Special nipple with large opening, compressible plastic bottle - Special Needs Feeder (formerly Haberman), Pigeon bottle, Cleft Palate Nurser - Breastfeeding may remain possible - Frequent burping

cleft palate *post-operative* nursing care

lip only - upright position (prone can rub sutures) - clean suture line, possible with anti-infective ointment palate only - sit upright (prone positioning not as concerning) both - protect surgical site - elbow restraints - no objects in mouth - analgesia - optimize nutrition

cleft palate nursing diagnoses

risk for: - aspiration - impaired nutrition - impaired speech - impaired psychosocial development

hematogenous osteomyelitis

spread through blood from pre-existing infection

why are patients placed on ulcer prophylaxis after surgery or trauma?

stress increases stomach acid and thus risk for PUD

constipation causes

Disorder based: - Structural abnormalities, hypothyroidism, lead poisoning, spinal cord injury, spina bifida Medications: - Name your favorite offending drugs! antacids, diuretics, antiepileptics, antihistamines, opioids, antibiotics, and iron supplements Activity-related (especially in older adults) Diet: - Low fiber, low fluid, high calcium/iron

crohns disease treatment

Drug Therapy - 5-ASA - antimicrobials - biologic therapies (TNF) - corticosteroids - immunosuppressants (Azathioprine) Diet therapy: - Know the triggers - Avoid spicy, greasy foods, high fiber foods, nuts, seeds, coffee, alcohol may all exacerbate flare ups. - May require enteral feedings for acute exacerbations

ulcerative colitis treatment

Drug Therapy - 5-ASA - antimicrobials - biologic therapies (TNF) - corticosteroids - immunosuppressants (Azathioprine) Diet therapy: - Know the triggers - Low residue diet is better tolerated, such as white bread, white rice, cooked (peeled) veggies, lean meats/fish, eggs.

intussusception collaborative management

Early surgical consultation - 50% diagnosis based on clinical findings Diagnostics - 50% diagnosis based on abdominal radiograph, ultrasound, or contrast/air enema Contrast/air enema - 100% diagnostic success - 70% success rate in reduction of mass - Remainder require surgical repair

peptic ulcer disease (PUD)

Erosion of GI mucosa resulting from digestive action of HCl and pepsin

overall goal for IBD treatment

Induce and maintain remission

perforation laparoscopic vs open surgery

Laparoscopic - Three to four incisions (umbilicus) - Decreased anesthesia & decreased risk of infection & decreased stay Open - Wound may be left open, dressing changes - One large incision - IV antibiotics in hospital - NG to decompression - Strict NPO - Monitor bowel sounds

peptic ulcer disease nursing considerations

Location: - Gastric vs. duodenal Duration/Involvement: - Acute vs. chronic

How do you anticipate rehydrating this patient? - A 7-month-old with a history of diarrhea with no associated symptoms for 2 days. - Upon exam, baby is irritable, anterior fontanel is flat, and capillary refill is 3 seconds. - VS are 98.6-160-24-90/44

PO fluids b/c not severe or emergent

peptic ulcer disease collaborative management

Pharmacological - Histamine (H2) blockers - Proton Pump Inhibitors (PPI) - Antibiotic Therapy - Cytoprotective therapy Nutritional Therapy - Avoid foods that cause irritation (Coffee, tea, chocolate, spicy) - Smoking cessation - avoid alcohol - avoid ulcerogenic drugs Treatment of complications Surgical therapy

perforation nursing perioperative care

Preoperative Care - Immediate antibiotics (need to start w/in 1 hour) - NPO, IVF, correct acid/base disturbances - NG, analgesics, bed rest (remember positioning!), family support Postoperative Care - Advance diet & activity slowly - Monitor hydration - Incentive spirometry - Pain control - Monitor surgical incision - Drain (perforation) - NG to decompression

hypertrophic pyloric stenosis perioperative nursing care

Preoperative Care: - The infants are often SICK preoperatively! - Surgery is not emergent - Need to correct dehydration, electrolyte derangements, and acid/base imbalance before surgery (IVF) - Stomach decompression (NG to suction) Postoperative Care: - Start diet soon after surgery - These children generally do very well and get discharged in 1-2 days

GERD risk factors

Risk factors: - obesity - pregnancy - hiatal hernia - diet

perforation treatment

Surgery - Usually within 24 hours - Laparoscopy (4 smaller incisions), or one incision Medical Treatment - If improvement within 48 hours on antibiotics, may continue treatment and delay surgery

hypertrophic pyloric stenosis collaborative management

Surgical repair: - Surgery to split hypertrophied muscle - Laparoscopic approach becoming more common

1. The most appropriate therapy for a patient with acute diarrhea caused by a viral infection is to a. increase fluid intake. b. administer an antibiotic. c. administer an antimotility drug. d. quarantine the patient to prevent spread of the virus.

a

4. Which instructions would the nurse include in a teaching plan for a patient with mild gastroesophageal reflux disease (GERD)? a. "The best time to take an as-needed antacid is 1 to 3 hours after meals." b. "A glass of warm milk at bedtime will decrease your discomfort at night." c. "Do not chew gum; the excess saliva will cause you to secrete more acid." d. "Limit your intake of foods high in protein because they take longer to digest."

a

7. A patient with osteoporosis shows an understanding of appropriate self-care when they state a. "I should remove trip hazards such as throw rugs in my house to make it safer." b. "I am not using the cane my HCP recommended. I don't want to look that old!" c. "I can continue to go downhill skiing as long as I'm careful and don't ever fall." d. "I need to take up running to help strengthen my bones. Walking is just not enough."

a

7. The nurse determines a patient undergoing ileostomy surgery understands the procedure when the patient states a. "I should only have to change the pouch every 4 to 7 days." b. "The drainage in the pouch will look like my normal stools." c. "I may not need to wear a drainage pouch if I irrigate it daily." d. "Limiting my fluid intake should decrease the amount of output."

a

traction

a pull to the arm or leg muscles to bring a bone back into place when it is dislocated or fractured

2. A 35-year-old female patient is admied to the emergency department with acute abdominal pain. Which medical diagnoses should you consider as possible causes of her pain? (select all that apply) a. Gastroenteritis b. Ectopic pregnancy c. Gastrointestinal bleeding d. Irritable bowel syndrome e. Inflammatory bowel disease

a, b, c, d, e

1. A patient with acute osteomyelitis is being discharged on antibiotic therapy. What would the nurse include in the teaching plan? (select all that apply) a. It is important to finish all the antibiotics even if you feel better. b. You will need to schedule periodic through bone scans and ESR testing. c. If the infection comes back, you must contact the HCP to schedule surgery. d. Signs such as fever and night sweats may be present but are usually not severe. e. Contact the HCP if signs of infection such as pain and swelling at the site occur.

a, b, d, e

3. Assessment findings suggestive of peritonitis include (select all that apply) a. abdominal pain. b. rebound tenderness. c. a soft, distended abdomen. d. shallow respirations with bradypnea. e. observing that the patient is lying still.

a, b, e

1. M.J. calls the clinic and tells the nurse that her 85-year-old mother has been nauseated all day and has vomited twice. Before the nurse hangs up and calls the HCP, she should tell M.J. to a. administer antiemetic drugs and assess her mother's skin turgor. b. give her mother sips of water and elevate the head of her bed to prevent aspiration. c. offer her mother large quantities of Gatorade to decrease the risk for sodium depletion. d. give her mother a high-protein liquid supplement to drink to maintain her nutrition needs.

b

2. A patient with history of colon cancer is diagnosed with rib fractures, and the HCP orders a bone scan. The nurse determines the patient understands teaching about the purpose of the procedure when they state a. "The bone scan will cure my rib fractures." b. "The bone scan will see if my colon cancer may have spread." c. "My colon cancer was cured so I really don't think this is necessary." d. "The results of the bone scan will only just confirm that I have a rib fracture."

b

8. A patient with osteoarthritis is scheduled for total hip arthroplasty. The nurse explains the purpose of this procedure is to (select all that apply) a. fuse the joint. b. replace the joint. c. prevent further damage. d. improve or maintain ROM. e. decrease the amount of destruction in the joint.

b, d

3. A patient with a comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when a. the patient cannot tolerate prolonged immobilization. b. the patient cannot tolerate the surgery for a closed reduction. c. other nonsurgical methods cannot achieve adequate alignment. d. a temporary cast would be too unstable to provide normal mobility.

c

4. In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease a. often results in toxic megacolon. b. causes fewer nutrition deficiencies than ulcerative colitis. c. often recurs after surgery, while ulcerative colitis is curable with a colectomy. d. is manifested by rectal bleeding and anemia more often than is ulcerative colitis.

c

6. The nurse monitors a patient with gastritis for pernicious anemia due to a. chronic autoimmune destruction of cobalamin stores in the body. b. progressive gastric atrophy from chronic breakage in the mucosal barrier and blood loss. c. a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa. d. hyperchlorhydria from an increase in acid-secreting parietal cells and degradation of RBCs.

c

7. Which finding can indicate gallstones and gallbladder obstruction? a. Dark colored stools b. Pain in the left lower abdomen c. Referred pain to the right shoulder d. Improved symptoms with high-fat meals

c

A 12-year-old who was in an all-terrain vehicle (ATV) accident has a long leg fiberglass cast on his left leg for a tibia-fibula fracture. He requests pain medication at 2:00 AM for pain he rates as 10/10 on the numeric scale. The nurse brings the pain medication and notes that he has removed the pillows that kept his leg elevated. He complains of pain in the left foot, and she notes that there is 3+ edema in the exposed leg and foot and she has difficulty slipping a finger under the cast; no pulse is found, and the capillary refill is difficult to visualize. Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. The nurse notes that these may be signs of a ____________________. The nurse would immediately call the physician since permanent damage can occur within ____________________. The nurse would ____________________ and continue to assess for a pulse ____________________ the fracture.

compartment syndrome; hours; keep the limb at heart level; distal to

5. A patient with a stable, closed humeral fracture has a temporary splint with bulky padding applied with an elastic bandage. The nurse suspects early compartment syndrome when the patient has a. increasing edema of the limb. b. muscle spasms of the lower arm. c. bounding pulse at the fracture site. d. pain when passively extending the fingers.

d

5. When caring for a patient after lumbar spinal surgery, the nurse would immediately report which finding to the HCP? a. The patient reports mild low back pain. b. The patient has a single episode of emesis. c. The patient is nauseated and has not voided in 4 hours. d. The patient has loss of sensation to the perineum, buttocks, inner thighs, and back of the legs.

d

7. The nurse is teaching the patient and family that peptic ulcers are a. caused by a stressful lifestyle and other acid-producing factors, such as H. pylori. b. inherited within families and reinforced by bacterial spread of Staphylococcus aureus in childhood. c. promoted by factors that cause oversecretion of acid, such as excess diet fats, smoking, and alcohol use. d. promoted by a combination of factors that cause erosion of the gastric mucosa, including certain drugs and H. pylori.

d

8. Discharge teaching for the patient who underwent laparoscopic cholecystectomy should include the need to a. abstain from alcohol. b. avoid eating low-fat meals. c. obtain hepatitis A vaccine. d. call if there are changes in stool or urine color.

d