Unit 1 medsurg2

acute complications of diabetes

•DKA •HHS •Hypoglycemia

interventions for diabetes

•EDUCATION •Blood glucose control •Wound Care

1. In completing a history on a patient diagnosed with gastroenteritis caused by Salmonella, which recently ingested food does the nurse recognize as the most likely cause of this diagnosis? A. Undercooked eggs B . Undercooked pork C. Steamed shrimp D. Grilled beef

A. Undercooked eggs

. The nurse is caring for a patient admitted with severe dehydration secondary to gastroenteritis. Which item on the patient's meal tray does the nurse question? A. Apple juice B. Coffee C. Broth D. Caffeine-free soda

B. Coffee

1. The nurse is evaluating teaching provided to a patient with type 1 diabetes mellitus. Which patient observation indicates that medication teaching has been effective? A. Uses a 1 mL syringe to measure insulin dose B. Places a new injection an inch away from previous injection site C. Inserts the needle at a 25-degree angle before injecting the medication D. Provides an injection in the thigh after an abdominal injection in the morning

B. Places a new injection an inch away from previous injection site

1.a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of: A.1130 and 1330 B.1330 and 1930 C.1530 and 2130 D.1730 and 2330

B.1330 and 1930

1.Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of pre-diabetes? A.6.5-7% B.5.7-6.4% C.5-5.6% D.>5.6%

B.5.7-6.4%

4.A diabetic patient who is experiencing a reaction to alternating periods of nocturnal hypoglycemia and hyperglycemia. The patient might be manifesting which of the following? A.Uncontrolled diabetes B.Somogyi phenomenon C.Brittle diabetes D.Diabetes insipidus

B.Somogyi phenomenon

4. The nurse provides discharge instructions to a patient who is postoperative for an appendectomy. Which patient statement indicates a need for additional teaching? A. "I can go home as soon as I am able to urinate." B. "I will get up and walk around as much as I can." C. "I will take the antibiotics until I no longer have a fever." D. "I will use the incentive spirometer 10 times an hour while awake."

C. "I will take the antibiotics until I no longer have a fever."

5. The nurse monitors for which clinical manifestations of ulcerative colitis in the patient admitted for the treatment of irritable bowel disease (IBD)? Select all that apply. A. Fistulas B. Weight loss C. Hemorrhage D. Intermittent fever E. Frequent, liquid stools

C. Hemorrhage D. Intermittent fever E. Frequent, liquid stools

1.Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following, except: A.Integumentary inspection for the presence of brown spots on the lower extremities B.Observation for paleness of the lower extremities C.Observation for blanching of the feet after the legs are elevated for 60 seconds D.Palpation for increase pulse volume in the arteries of the lower extremities.

D.Palpation for increase pulse volume in the arteries of the lower extremities.

diabetics are at an increased risk for

HTN, CVD,CVA, infection

hemorrhoids

Swollen, painful rectal veins; often a result of constipation discomfort when sitting or during bowel movements

Microvascular complications

retinopathy, nephropathy, neuropathy

4. The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.) a. Delayed gastric emptying b. Eating large meals c. Hiatal hernia d. Obesity e. Viral infections

a. Delayed gastric emptying b. Eating large meals c. Hiatal hernia d. Obesity

pharmacological tx for appendicitis

antibiotics surgery-lap pain management

diet for colostomy

as Raw vegetables, Skins and peels of fruit (fruit flesh is OK), Dairy products such as milk and cheese Very high-fiber food such as wheat bran cereals and bread, Beans, peas, and lentils, Nuts and seeds, High-fat and fried food such as fried chicken, sausage, and other fatty meats

assessing diabetics

assess head to toe, important to note changes to feet, skin, bony prominences ask about toileting habits

GERD pathophysiology

backflow because of incompetent lower esophageal sphincter, pyloric stenosis, HH, or motility disorder (also obesity or pregnancy)

Colostomy/Ileostomy

brings end of colon or small intestine through abdominal wall where a pouch collects the feces related to colon not working properly/needing to be removed

appendicitis results from

obstruction of the appendiceal lumen, typically by lymphoid hyperplasia but occasionally by a fecalith, foreign body, or even worms

3. A patient has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication would the nurse anticipate teaching the patient? a. Famotidine b. Magnesium hydroxide c. Omeprazole d. Ranitidine

c. Omeprazole

2. A patient has returned to the nursing unit after an open Nissen fundoplication to repair a hiatal hernia. The patient has an indwelling urinary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. The nurse notes bright red blood in the NG tube. What action would the nurse take first? a. Document the findings in the chart. b. Notify the surgeon immediately. c. Reassess the drainage in 1 hour. d. Take a full set of vital signs.

d. Take a full set of vital signs.

islet of Langerhans

groups of pancreatic cells secreting insulin and glucagon.

pathophysiology of neuropathy

high glucose levels harms blood vessels, damage to nerves,

nutrient deficiencies in Crohn's

iron, B12, vitamin D, vitamin K, folic acid, selenium, zinc, vitamin B6, and vitamin B1

high blood pressure in daibetics contributes to

nephropathy

S/S of diabetes

polyuria, polydipsia, polyphagia fluid electrolyte imbalances

s/s kidney disease

: proteins spilling out into the urine (called proteinuria), decreased glomerular filtration rate (or GFR), increased creatinine and urea levels, anemia, and fluids and electrolyte imbalances. The earliest sign of kidney problems is albuminuria

3. Which statement by the patient scheduled for proctocolectomy with permanent ileostomy for treatment of ulcerative colitis indicates the teaching was effective? A. "My colon and rectum will be removed, and my anus will be closed." B. "My colon will be removed, and my ileum is sutured to the anal canal." C. "My colon will be removed while the distal portion of my ileum is used to create a pouch." D. "My colon and rectal mucosa will be removed and a reservoir created using a portion of my ileum."

A. "My colon and rectum will be removed, and my anus will be closed."

2. A patient is newly diagnosed with type 2 diabetes mellitus. The nurse correlates which medication classification's mechanism of action as decreasing glucose production in the liver? A.Biguanides B.Meglitinides C.Sulfonylureas D.Alpha-glucosidase inhibitors

A.Biguanides

3. The nurse correlates which clinical manifestation in a patient with type 2 diabetes mellitus (DM) with macrovascular complications? A.Chest pain B.Sight impairment C.Gingival hyperplasia D.Chronic kidney failure

A.Chest pain

● 4.A 65-year-old patient has a glomerular filtration rate of 55 mL/min. The patient has a history of uncontrolled hypertension and coronary artery disease. You're assessing the new medication orders received for this patient. Which medication ordered by the physician will help treat the patient's hypertension along with providing a protective mechanism to the kidneys? A.Lisinopril B.Metoprolol C.Amlodipine D.Verapamil

A.Lisinopril

S/S of Crohn's disease

Abdominal pain, diarrhea, weight loss

4. The nurse provides education to a patient who is diagnosed with type 1 diabetes mellitus (DM). Which patient statements indicate the need for additional teaching regarding self-monitoring of blood glucose? Select all that apply. A."I will check my blood glucose daily before meals and at bedtime." B."I will monitor my blood glucose levels more frequently when I have the flu." C."I don't need to document the results of my blood glucose if it is within the normal limits." D."Because I am using an insulin pump, I don't need to check my blood glucose as often as before." E."Because my fasting blood glucose levels are consistent with my A1c, I don't need to increase the frequency of monitoring my glucose."

C."I don't need to document the results of my blood glucose if it is within the normal limits." D."Because I am using an insulin pump, I don't need to check my blood glucose as often as before."

diabetic diet

Carb counting may be part of this diet, as the amount of carbohydrates eaten must be carefully regulated

Macrovascular complications

Cardiovascular disease Cerebrovascular disease, kidney disease, reduced immunity

S/S of ulcerative colitis

Diarrhea, Abdominal Pain and rectal bleeding, severe symptoms include multiple bloody stools usually 10-20 a day.

nursing interventions DKA

Monitor vitals, Start two large-bore Ivs, Check blood sugars and treat with insulin as ordered, Administer fluids as recommended, Check electrolytes as potassium levels will drop with insulin treatment, Monitor renal function, Assess mental status, and Look for signs of infection

insulin types

Rapid-acting (clear) , Short-acting (clear), Intermediate (cloudy), Long acting , Combinations

Barrett's esophagus

a condition that occurs when the cells in the epithelial tissue of the esophagus are damaged by chronic acid exposure precancerous

1. A nurse cares for a teenage girl with a new ileostomy. The patient states, "I cannot go to prom with an ostomy." How would the nurse respond? a. "Sure, you can. Purchase a prom dress one size larger to hide the ostomy appliance." b. "The pouch won't be as noticeable if you avoid broccoli and carbonated drinks prior to the prom." c. "Let's talk to the enterostomal therapist about options for ostomy supplies and dress styles." d."You can remove the pouch from your ostomy appliance when you are at the prom so that it is less noticeable."

c. "Let's talk to the enterostomal therapist about options for ostomy supplies and dress styles."

Peritonitis s/s:

rebound tenderness, muscular rigidity, laying still w/fast shallow breaths, distended abd, ascites, fever

peritonitis s/s

rebound tenderness, muscular rigidity, laying still w/fast shallow breaths, distended abd, ascites, fever,

hernia

weakness in abdomnila wall muscles, intestines protrude through

hiatal hernia s/s

•Age •Weight •Trauma •Heartburn/Regurgitation •Pain •Blood

s/s gerd

•Dyspepsia •Odynophagia •Regurgitation •Chronic cough •Disrupted sleep

nursing interventions for peritonitis

•Monitor Vital signs •Monitor I&O •Monitor bowel •Antiemetics/pain management •Prepare for possible surgery

pharmacology for GERD

•OTC •Antacids •H-2-receptor blockers •Proton Pump Inhibitors •Prescription •Surgical •Fundoplication •LINX •TIF

S/S of appendicitis

•Pain (mcburneys pt) •Nausea and Vomiting •WBC (high 10-18) •Low-grade fever •Ultrasound •Sudden relief of pain constipation