EXAM 2 study guide/ practice exam

what are the common s/sx of appendicits

-abdominal pain -N/V -rebound tenderness -fever -pain with right leg extension & movement of hip

Stomach acid

A mixture of bile and secretions made to digest food

Barium Swallow Test

A patient drinks a solution and then have x-rays performed to assess for hiatal hernias, strictures, and other structural or anatomic esophageal problems.

Chemo Brain

A term commonly used to describe thinking and memory problems, 'brain fog', that a cancer patient may have before, during, or after cancer treatment

The nurse is caring for a patient experiencing an upper GI bleed. What is the priority action for the patient's care?

ABC's

Which disorders and labs are related in those with alterations in the GI system? (SATA)

Alanine aminotransferase and ammonia are related to the liver. Amylase and lipase are related to the pancreas. Urobilinogen evaluates both hepatic and biliary function.

A patient has dumping syndrome. What menu selections indicates understanding of correct diet for this condition? (SATA)

Apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, and low- to moderate-carbohydratediet. Coffee cake, other sweet treats, sweet drinks, and gas-forming foods need to be avoided.

A nurse cares for a patient who is recovering from a colonoscopy. Which actions would the nurse take? (SATA)

Assess the client for rectal bleeding and severe pain Obtain vital signs every 15 to 30 minutes until alert Confirm the client has a ride home and plans to rest

what are some complications a patient might encounter following an EGD

Bleeding infection pain

3 diagnostic tests that may be used to rule out the diagnosis of GERD.

Esophagogastroduodenoscopy (EGD) Barium Swallow Test pH Monitoring Examination

A nurse assesses a patient who has ulcerative colitis and severe diarrhea. Which assessment would the nurse do first?

Heart rate & rhythm The patient would have electrolyte levels monitored, and electrolyte replacement may be necessary. Oral mucosa inspection, dietary intake, and abdominal percussion are important parts of physical assessment but are lower priority for this patient.

what is a risk following paracentesis? Assessments?

Hypovolemia due to decrease in abdominal pressure so the patient will have s/sx of hypotension & low uop

when DC a patient what is a priority assessment the RN should include

ID what support the patient may need

the nurse prepares to administer albumin to a client with ascites. which effect would the nurse anticipate

Intravascular fluid volume will increase

what is happening in cirrhosis of the liver

It is a progressive, irreversible scaring of the liver. remember scar tissue cells do not function like regular cells so liver function is lost

What activities of lifestyle factors would most likely worsen cirrhosis? What would be the dietary recommendations for him?

Limit sodium intake (1 to 2mg/day). Vitamin supplements (Thiamin) Avoid alcohol, smoking.

Second-look

Not frequently done, but used to check on the status of the cancer

Why is pain control such an important component of management of acute pancreatitis?

Pain control is important in managing acute pancreatitis to decrease the amount of inflammation in the pancreas. Inflammation can cause more damage to the pancreas and progress the disease. Reducing anxiety can help reduce pain, distraction, fetal position, and NPO are all non pharmacological interventions that can help reduce pain along with opioids. Respiratory status should be monitored every 4-8 hours as pleural effusions and other respiratory distress may occur and increase the patient's discomfort.

Describe what acute and chronic pancreatitis is

Pancreatitis is the infection and associated inflammatory symptoms of the pancreas and hepatic bile duct. The major symptoms are caused by the backup of digestive enzymes becoming activated in the pancreas causing severe pain and GI distress and dysfunction. Acute pancreatitis either new, or an exacerbation of chronic pancreatitis due to history of complications.

SBRT Nsg considerations:

Patient must be in same position for all radiation delivery. Skin breakdown and burns will only occur in the path of the radiation beam.

leukemia RN priorities

Risk for infection is highest priority

Alopecia

Sudden hair loss occurs when the immune system attacks the hair follicles. Can be a result from CHEMOTHERAPY treatment for cancer patients.

what system is used to classify cancer

TNM system - T is tumor - N is node M is metastasis

What is important teaching when patient's are prescribed medications

Take the meds as directed & for the length of time directed. consult the HCP before stopping or adding another medication

What is a priority assessment following any procedure before providing PO intake to a patient

The gag reflex and patients mental status should be assessed before allowing anything by mouth

Progression

The tumor gegins making substances that trigger nearby capillaries to grow new branches into the tumor, making it's own blood supply ensuring nourishment and growth)

pH Monitoring Examination

This involves placing a small catheter through the nose into the distal esophagus or temporarily attaching a small capsule to the wall of the esophagus during an upper endoscopy.

diet to prevent dumping syndrome

eat small meals with low carbs and moderate fat content

cirrhosis diet

low fat, low sodium

why does pancreatic cancer have such a high mortality rate

the organ is hidden by other organs and needs to be visualized with a CT (contrast preferred) The s/sx are vague until the disease is progressed. There is not specific screening

the nurse observes the student nurse caring for the skin of a client who recently underwent radiation therapy. which actions by the student nurse needs correcting

-using a washcloth for cleaning the radiated site -drying the irradiated area with rubbing motions -removing the ink marks that identify the location of the focused beam of radiation

the shortening of the DNA following cell division allows the cell to respond to what process

APOPTOSIS This is programmed cell death. As cells divide, their telomeric DNA shortens and once gone, the cell can respond to the signals for APOPTOSIS

a client receiving cisplatin therapy developed tumor lysis syndrome (TLS) which med would the nurse anticipate administering to this client for treatment of the TLS

Allopurinol- promotes purine excretion (cisplatin is a nephrotoxic agent that is used in clients with cancer

Esophagogastroduodenoscopy (EGD)

An EGD involves insertion of an endoscope down the throat, which allows the healthcare provider to see the esophagus and look for abnormalities.

A patient is recovering from an EGD and requests something to drink. What action by the nurse is appropriate?

Assess the client's gag reflex

List factors that predispose adults to decreased lower esophageal sphincter pressure and lead to reflux.

Caffeinated beverages, such as tea, coffee, and soda Chocolate Citrus fruits Tomatoes/tomato products Smoking and use of other tobacco products Calcium channel blockers Nitrates Peppermint, spearmint Alcohol Anticholinergic drugs High levels of estrogen and progesterone Nasogastric tube placement

Define Barrett's epithelium

Columnar epithelium that the body may substitute during the healing process when a patient has GERD. It is more resistant to acid and supports esophageal healing. It's considered premalignant and is associated with an increased risk for cancer in patients with prolonged GERD. The fibrosis and scarring that accompany the healing process can produce esophageal stricture which leads to progressive difficulty swallowing

What is the treatment plan for H. Pylori?

Common treatment for H. Pylori includes two antibiotics at once to prevent bacteria from becoming resistant to one. Other medications include Proton pump inhibitors, which inhibit gastric secretion H2 or histamine blockers which block gastric secretions Antacids Sucralfate/Carafate, mucosal barrier fortifier that helps the lining of the stomach Repeat testing for H. pylori is recommended at least 4 weeks after treatment. Common blood tests and screenings are done to detect H. pylori

WHat should you teach a patient that has been diagnosed with peptic ulcer disease?

Emphasize the importance of follow up care with labs. Advise the patient to not NSAIDs and aspirin. The importance of taking prescribed medications even if feeling better. Avoid or limit caffeine, including coffee, tea and colas. Teach the patient about stress management and weight loss program. Seek medical attention if blood in vomit, blood in the stool or tarry or black stools, severe abdominal pain, pain in one or both shoulders.

A patient had an open traditional Whipple procedure this morning. For what priority complication would the nurse assess?

Fluid and electrolyte imbalances

Which assessment finding would the nurse expect in a patient admitted for a Crohn's disease exacerbation?

High-pitched, rushing bowel sounds in the right lower quadrant

List and describe the factors that contribute to the development of GERD in infants

Neurological impairments (cerebral palsy, Down syndrome, head injury) Delayed gastric emptying of a liquid meal Partial/incomplete swallowing dysfunction Medications (theophylline, caffeine) Increased intraabdominal pressure from straining, crying, coughing, or slumping Obesity Hiatal hernias

Explain how chronic alcohol abuse causes cirrhosis of the liver

One of the liver's main functions is metabolizing. This includes metabolizing toxins like alcohol. Alcohol causes the liver to become swollen and inflamed. Overtime, the liver becomes overworked with chronic alcoholism and starts to develop binds of fibrotic/ scar tissue. This changes the makeup of the liver and causes it to lose normal function.

The nurse is caring for a patient who has been diagnosed with PUD. For which complication would the nurse monitor?

Peptic ulcer disease (PUD) can cause gastric mucosal damage or perforation, which causes upper GI bleeding. Dyspepsia is a symptom of PUD, gastritis, and gastric cancer. PUD affects the stomach and/or duodenum, not the colon.

Following an EGD with midazolam, the patient has a RR of 8 BPM. What action by the nurse is most appropriate?

Provide physical stimulation ***For an EGD, patients are given mild sedation. For shallow or slow respirations after the sedation is given, the nurse's most appropriate action is to provide a physical stimulation such as a sternal rub and directions to breathe deeply.

1 day after a colonoscopy/biopsy, a spot of bright red blood is present after wiping. How should the nurse respond?

Remind the client that a small amount of bleeding is possible The nurse would remind the patient of this and instruct them to go to the emergency department for large amounts of bleeding, severe pain, or dizziness.

A patient has dumping syndrome after a partial gastrectomy. Which action by the nurse would be most appropriate?

The patient with dumping syndrome after a gastrectomy has multiple dietary needs. A referral to the registered dietitian nutritionist will be extremely helpful. Food and fluid intake is complicated and needs planning. The patient should not be NPO.

SBRT (Stereotactic body radiotherapy)

Uses 3-dimensional imaging to identify tumor location, therefore providing accurate delivery of higher doses for radiation.

List the manifestations of GERD in infants

Vomiting/spitting up after a meal Hiccuping Recurrent otitis media r/t pooled secretions in nasopharynx Weight loss Failure to thrive Irritability Discomfort/abdominal pain Coughing, choking, asthma, wheezing, pneumonia, apnea, and bradycardia

what diet is recommended for ascites related to cirrhosis

a low sodium diet

When making a patient assignments what are top considerations that should be included

acuity of patients skill level of RN safety issues for both patient and nurse

which action is likely to reduce the pancreatic & gastric secretions of a client with pancreatitis

administer prescribed anticholinergic medication. (block the neural impulses that stimulate the pancreatic/gastric secretions)

the nurse administers 2 units of salt-poor albumin to a client with portal hypertension & ascites. which information would the nurse share with the client regarding the purpose of the albumin

albumin pulls fluid into the circulation

a patient has a suspected DVT, what is the priority assessment the nurse should complete

ask the patient about pain, look at skin color & measure & compare the extremities

a patient has a drain post op that previously had no OP but now has Frank, red blood noted. what should be done

assess VS - look for s/sx of hypovolemia) notify HCP

a client was admitted to the hospital with blunt trauma to the abdomen. during the recovery period, the nurse would monitor the client for which indications of peritonitis

boardlike abdomen abdominal tenderness decreased bowel sounds

for which clinical indicators would the RN monitor when caring for a client with cholelithiasis & obstructive jaundice

dark urine yellow skin clay colored stool

The nurse is caring for a patient with a long history of PUD. What assessment findings would the nurse expect? (SATA)

decreased UOP & BP Dizziness Hematemesis The HR increases and becomes weaker.

Rapid/continuous cell division

do not respond to calls for apoptosis

what 2 functions does the pancreas serve

endocrine & exocrine

a patient suffering from any disorder that includes diarrhea is at risk for what type of imbalances

fluid & electrolyte

when receiving a patient immediately following a sedation procedure, what is an important assessment the nurse should perform

frequent VS. Depending upon the patient & the procedure VS may need to be done every few minutes.

what is the most important teaching topic for patient & family with obesity

healthy behaviors

What is H. Pylori

helicobacter pylori is a gram negative bacteria that infects the stomach and duodenum. It penetrates the mucosal gel lining of the gastric epithelium, which decreases the protective defenses of the mucosal lining (the epithelium is no longer protected from acid and pepsin) and can open sores called peptic ulcers. - H. Pylori is most commonly abstained through contaminated food or water, stool, vomit, saliva, and excessive NSAID use.

what are almost all patients undergoing chemo at risk for?

infection due to immunosuppression

famotidine is prescribed for a client with PUD, what is the MOA

inhibits gastric acid secretion

how does drinking relate to acute pancreatitis

it increases enzyme secretion & pancreatic duct pressure that causes backflow of enzymes into the pancreas

The nurse is caring for a client who has late-stage (advanced) cirrhosis. What are expected assessment findings? (SATA) Select one or more answers!

jaundice/icterus petechiae dark urine

Abdominal cramping, bloating, and diarrhea after drinking milk or ingesting other dairy products would most likely be?

lactose intolerance

a client with cancer of the cervix has an intracavity radioactive sealed implanted in place. which precaution would the nurse take to protect against excessive exposure to radiation

leaving used linens in the room until cleared by the radiation safety team

To promote comfort and the passage of flatus after a colonoscopy, in what position does the nurse place the patient?

left lateral

A patient with prolonged prothrombin time values (not related to medication) probably has dysfunction in which organ?

liver

The nurse is caring for a patient who has cirrhosis. What nursing action is appropriate to help control ascites?

low sodium

the nurse is caring for a client with ascites secondary to liver failure. which interventions are appropriate to include in the client's care

low sodium diet daily abdominal girth measurements daily weights

which clinical findings would the nurse anticipate when assessing a child with acute lymphoblastic leukemia

pallor fatigue multiple bruises

encopresis

passing feces either voluntary or involuntarily into inappropriate places

in general if a patient has an absorption problem what general teaching should be included

patient may need to take supplements

What teaching should be included following any procedure with sedation

patient should not drive or use mechanical equipment

TLS (tumor lysis syndrome)

precipitation of metabolites (purine & potassium) of cell breakdown

how can the nurse best manage side effects of chemo

provide oral hygiene

what are priority actions the RN should take when DC a patient with a new ostomy

provide psychosocial support understand how to order supplies referral to a support group

what are 2 considerations for those with obesity

psychosocial support and safety (bigger equipment)

what is a common intervention for children that are mildly dehydrated

rehydrate with oral solutions. typically least invasive

what is an example of primary cancer prevention

removal of at risk tissue such as a colon polyp, moles or breasts. & vaccinations

what is encopresis & what will you see in the patient

repeated constipation that leads to impaction & the involuntary loss of stool

a client diagnosed with invasive cancer of the bladder has brachytherapy scheduled. which successful therapy outcome would the nurse expect with this client

shrinkage of the tumor when scanned

what is a common complication of radiation teletherapy

skin damage and irritation. **teach the patient that good skin care is important. - DO NOT use harsh cleansers or have clothing rubbing on the site (increases irritation)

a client with ascites is scheduled to receive albumin. To have the greatest therapeutic effect, the nurse expects which infusion rate & which oral fluid intake

slow IV rate & restricted fluid intake

what are typical s/sx of an acute bleed

sudden onset of severe epigastric or abdominal pain board-like abdomen vomiting or coffee ground emesis ** EMEGENCY

why would a patient have a decrease serum albumin level with worsening cirrhosis

the liver has a decrease ability to synthesize protein & the fluid shift happens

Define GERD

the regurgitation of gastric/stomach contents into the esophagus. GERD is considered a more severe and chronic form of gastroesophageal reflux (GER) that is a normal response