Exam 4

What are nursing interventions for a patient who has undergone a radical neck dissection?

*Maintain airway*, pain control, wound care, graft assessment, communicate via previously agreed upon method, Fowler's position

What are risk factors for pancreatic cancer?

*Tobacco*, obesity, chronic pancreatitis, genetics

What is the ideal Hgb for a CKD patient? What if it is too high?

11-12 Hgb > 13 increases risk of death

How often will someone with Barrett's esophagus have to undergo an EGD?

2-3 times each year

What labs should the nurse monitor for a patient with liver disease?

AST, ALT, LDH (marker for hemolysis), serum protein, bilirubin, ammonia, clotting factors, and lipids

What are the cardinal signs of a bowel obstruction?

Abd pain, cramping, and distention

The nurse irrigates a client's colostomy. If the client has abdominal cramping after receiving about 150 mL of solution during the colostomy irrigation, the nurse should:

Abdominal cramping that may occur during a colostomy irrigation results from colon stimulation by the irrigating solution. The best course of action is to *temporarily stop the flow of solution* until cramping subsides.

Which patients are priority for liver transplants?

Acute liver failure patients

What are risk factors for GI cancers?

Alcohol, tobacco, diet high in smoked, salted, and pickled foods

What is Barrett's esophagus?

Alteration of the esophageal mucosa resulting in frequent heartburn, dyspepsia, and regurgitation. Pre-cancerous lesions.

What meds will a patient with chronic pancreatitis be on?

Analgesic, enzyme replacement, bile salts, antacids, and PPIs

What meds would a patient with gastritis be on?

Analgesics, antacids, abx, PPIs, H2 recpetor antagonists, IVF

What are hematologic s/s of uremia?

Anemia, bleeding, infection

What are s/s of acute hepatitis?

Anorexia, weight loss, n/v, lethargy, fatigue, RUQ tenderness, distaste for cigs, decreased sense of smell, low-grade fever, skin rashes, myalgias, arthralgias, dark urine, clay stool, hepatomegaly, lymphadenopathy, splenomegaly

How is Hepatitis C managed?

Antiviral medication, treatment of side effects of med, and medication compliance education.

What should the nurse include in education for a patient with GERD?

Avoid caffeine, tobacco, beer, milk, carbonated beverages, trigger foods, and eating 2-3hr before bed. Maintain a normal BMI, elevate HOB, and meds (antacids, PPIs, H2 receptor antagonists).

A client with cirrhosis should be encouraged to follow which diet?

Balanced, low-sodium diet

What should the nurse include in education for a patient with chronic pancreatitis?

Bland low-fat diet, small frequent meals, take enzyme replacement with all meals and snacks, observe stool for steatorrhea, monitor glucose, antacids ACHS, no alcohol

What are complications of an AV fistula or graft?

Bleeding, erosion, stenosis, thrombosis, infection, pseudoaneurysm/aneurysm, steal syndrome

What are complications of liver transplant?

Bleeding, rejection, infection, graft nonfunction (most severe)

WHat should the nurse monitor after an upper GI series?

Bowel function

What is gastritis?

Breakdown of normal gastric mucosa barrier due to irritating foods, NSAID overuse, increased alcohol intake, radiation, and bile reflux.

What are musculoskeletal s/s of uremia?

CKD mineral and bone disorder (CKD-MBD): osteomalacia (demineralization), osteo fibrosa (decalcification), tissue damage r/t vascular calcification Muscle cramps, decreased strength, bone pain, bone fractures

What are foods high in sodium?

Canned and processed foods, lunch meat, soup, hot dogs, hamburgers, cheese

A client requires hemodialysis. Which type of drug should be withheld before this procedure?

Cardiac glycosides (digoxin)

What is required for the preparation of a colonoscopy?

Cleansing the bowel with laxatives, liquid diet 24 hours prior to procedure, and NPO status the night before procedure

What are s/s of a peritoneal infection?

Cloudy drainage, fever, hyperactive bowel sounds, and abdominal pain

What should the nurse include in education for a patient with Hepatitis B?

Condom use, don't share razors, keep sores covered, 10:1 bleach solution to clean any blood spills, and increased risk for chronic hepatitis, cirrhosis, and hepatic cancer.

What are neuro s/s of uremia?

Decreased LOC, lethargy, apathy, decreased ability to concentrate, irritability, h/a, peripheral neuropathy

What are s/s peritonitis?

Diffuse pain that progresses to constant local pain aggravated w activity, tenderness, distention, rebound tenderness, paralytic ileus, n/v, fever 100-101

What meds would a CKD patient be on?

Diuretic, antihypertensive, increased vitamins and minerals, iron supplement (possibly epoetin), statins

A client has a temperature of 98.6° F (37° C) prior to dialysis and 100° F (37.7° C) post dialysis. What is the appropriate nursing action?

Document the expected finding

What instructions should the nurse give a patient scheduled to undergo an upper GI series?

Don't eat or drink 8 hours before the test You can expect white stools for about 48 hours after the test

The nurse warms the dialysis solution before use in peritoneal dialysis. What is the expected outcome of warming the solution?

Encourages the removal of serum urea by dilating vessels

What should never be done for a patient with appendicitis or potential for perforation?

Enemas and laxatives

A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl (70mmol/L). What would the nurse administer?

Epoetin alfa

When should the nurse measure the NG tube length?

Every use

What should the nurse include in the diet education for a CKD patient?

Fluid restriction of 500-800ml + total output of the last 24hr Decreased sodium, potassium, phosphorous, and protein Takes phosphorous binders with food

What are urinary s/s of uremia?

Fluid retention, anuria with dialysis

What is the difference between gastric and duodenal ulcers?

Gastric- >50yo, less common, normal/hyposecretion, weight loss, pain 30min-1hr after eating, vomiting relieves pain, hemorrhage w hematemesis Duodenal- 30-60yo, males, more common, hypersecretion, weight gain, pain 2-3hr after eating, may wake up at night, eating relieves pain, hemorrhage w melena, more likely to perforate

What is the priority nursing intervention for a patient with fulminant hepatic failure?

Getting the patient as healthy as possible to receive a liver trasnplant

What causes PUD?

H. pylori, alcohol, smoking, cirrhosis, stress, gastritis, NSAIDs

What are cardiac s/s of uremia?

HTN and HF r/t fluid overload, CAD, dysrhythmias

What are the main causes of CKD?

HTN and diabetes

What are s/s of a hiatal hernia?

Heartburn, regurgitation, dysphagia, may be asymptomatic

What are risk factors for gallbladder disease?

High estrogen meds, fatty diet, 5 F's (female, 40, fertile, fat, family hx), previous gallbladder problems

What meds will a patient with acute pancreatitis be on?

IV morphine antispasmodics, antacids, and PPIs

How is peritonitis managed?

IVF and electrolytes, pain and n/v control, abx, surgery if severe

What causes GERD?

Incompetent lower esophageal sphincter, pyloric stenosis, motility disorder

What are electrolyte changes with uremia?

Increased K, Na, Ph, Ca, Mg Metabolic acidosis

What are metabolic s/s of uremia?

Increased waste products, altered carb metabolism, increased triglycerides

What are reproductive changes r/t uremia?

Infertility, decreased libido, high risk pregnancy for mother and baby

What are s/s of decompensated cirrhosis?

Jaundice, ascites, pedal edema, gastroesophageal varices, hepatic encephalopathy

What are respiratory s/s of uremia?

Kussmaul's breaths, dyspnea, pulmonary edema that may lead to pleural effusion

What is the difference between a laparascopic and open cholecystectomy?

Lap- 1-4 puncture sites, shorter recovery and less pain Open- R subcostal incision, T tube insertion, no heavy lifting for 6 weeks

What is dumping syndrome and how does it manifest?

Large amounts of solids and liquids rapidly dumping into the duodenum, resulting in a feeling of fullness, nausea, cramping, and sudden diarrhea 20min-2hr after eating (causes malabsorption).

What is fulminant hepatic failure?

Life-threatening, sudden, severe impairment of the liver r/t Hep A or B, acetaminophen overdose, or various other causes

What are pre-op interventions for a patient getting an ostomy?

Listen to fears and educate what to anticipate

What diet restrictions would a dialysis patient have?

Low protein, low sodium, low potassium, low phosphorous, low fluids, high carbohydrates

What are GI s/s of uremia?

Metallic taste, uremic fetor (breath odor), weight loss, malnutrition, gastritis, GI bleed, constipation, anorexia, n/v

What are priority nursing interventions for a patient with pancreatitis?

Monitor BP, pain control, NPO status, correct fluid/electrolyte imbalances

A patient comes in with suspected appendicitis. What are the nurse's next actions?

NPO status, stat CT scan, IVF, alleviate pain with positioning, abx

What diet would a patient with gastritis be on?

No food until s/s subside; after that- bland, small, frequent meals. No alcohol.

What should the nurse include in education for the patient with cirrhosis?

Obtain adequate rest, increase protein if no ascites or edema and decrease protein if neuro changes, eat small frequent meals, sodium restriction, keep fingernails trimmed, educate s/s bleeding and encephalopathy, no alcohol, infection control

What are s/s of GI cancer?

Painless sores/mass that won't heal, dysphagia, lymph nodes

What are s/s of a major complication of peritoneal dialysis?

Peritonitis: fever, severe abd pain, cloudy effluent, rebound tenderness

What should the nurse do for a patient with esophageal varices?

Prevent bleeding, neuro checks, maintain nutrition. Pt may be intubated, have IV access, and be on vasoconstrictors.

What are treatment options for a patient with hepatocellular carcinoma?

Resection, chemo, transplant

A client is receiving peritoneal dialysis. What should the nurse assess while the dialysis solution is dwelling in the client's abdomen?

Respiratory status r/t pressure on the diaphragm

What is the most effective way to prevent Hep B?

Safe sex practices

What are foods high in potassium?

Salt substitutes, citrus, melons, tomato, potato, bananas, spinach, avocado

What labs should the nurse monitor for a patient with pancreatitis?

Serum amylase, lipase, and urine amylase. Additionally, glucose, calcium, and triglycerides

During dialysis, the client has disequilibrium syndrome. What should the nurse do first?

Slow the rate of dialysis, then assess neuro status

What are the differences between small bowel and large bowel obstruction s/s?

Small- Vomiting, may pass blood and mucus but no feces or flatulence, s/s dehydration Large- Weakness, decreased weight, anorexia, severe distention, perforation

A patient with a GFR of 47 would be in what stage of CKD?

Stage 3a. Begin treatment.

What are post-op interventions for a patient getting an ostomy?

Stoma assessment, skin assessment, educate that there may be edema around site for up to 6 weeks, educate pouch care and frequent emptying, monitor GI motility, monitor drainage, maintain nutrition and hydration

How is cholelithiasis treated?

Stones are passed, ESWL shocks and breaks stones, ERCP physically removes stones

What are s/s of acute pancreatitis?

Sudden *abd pain* in the LUQ radiating to the back that gets worse from lying down, eating, and alcohol and is not relieved with vomiting. Systemically- pleural effusion, atelectasis, pneumonia, *hypotension*, arrhythmias, tetany r/t *hypocalcemia* (Convulsions, Arrhythmias, Tetany, Spasms), *low grade fever*, flushing and diaphoresis, n/v, *tachycardia*, *hypoactive bowel sounds*, ileus, *Cullen's sign and Grey Turner's sign*, sepsis, shock

What should the nurse monitor for in a patient receiving hemodialysis?

Sudden drop in BP

How is pancreatic cancer treated?

Surgical removal ("whipple") of pancreatic head, duodenum, part of jejunum, common bile duct, and gallbladder; chemo; radiation; palliative measures

What is the role of the kidneys in metabolic acidosis?

The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance.

How is Hepatitis A prevented?

Vaccination, hand hygiene, and proper food prep

When should the CKD patient call the doctor?

Weight gain of 4lb in 24hr, increased BP, SOB or edema, and increased fatigue, weakness, or confusion

How is NG tube placement confirmed?

X-ray, pH test, and auscultation (30ml air pushed in)

What are risk factors for appendicitis?

Young, winter, fam hx, male, cystic fibrosis

What are s/s of gastritis?

abd pain, h/a, n/v, anorexia, and hiccups

A nurse is assessing a client who has a history of a bleeding peptic ulcer. What assessment findings should the nurse report immediately?

abdominal distension cool, clammy skin weak, thready pulse

What is the client with hepatitis C at increased risk for?

chronic liver disease and hepatic cancer

What are foods high in phosphorous?

dairy, peas, beans, nuts, dark soda, chocolate, pizza

What are s/s of hepatic encephalopathy?

increased ammonia, change in mental status, motor changes, asterixis (clonus-like hand movement), constructional apraxia (decreased ability to draw r/t decreased neuro/motor function), and fetor hepaticus (sweet, shitty breath)

What is the prognosis for gallbladder or pancreatic cancer?

poor- give supportive cares

What are s/s of ascites?

portal HTN, increased abd girth, 1-2lb weight gain, pedal edema, dyspnea r/t pressure on the diaphragm

What are skin changes r/t uremia?

pruritus, dry flaky skin, uremic frost

What are s/s of cholecystitis?

sudden indigestion, RUQ pain, biliary colic (with stones), eructation, flatulence, nausea, anorexia, fever, jaundice, dark urine, steatorrhea, clay stool

How are hernias managed?

surgery if severe, small frequent meals, sit upright 1hr after eating

What are s/s of appendicitis?

vague RUQ pain, low grade fever, n/v, loss of appetite, rebound tenderness, McBurney's point, constipation or diarrhea