final theory review

Avandia (rosiglitazone)

Classification: Antidiabetic. Thiazolidinediones Therapeutic Effects: Decrease insulin resistance Adverse Reactions & side effects: Edema, anemia, wt gain, increased cholesterol Nursing Implications & teaching: Monitor for fluid retention, hypoglycemia. Check PLFTs & CBC High Alert Medication!

Colostomy Irrigations. Teaching

Colostomy irrigations may be used to stimulate emptying of the colon. Regularity is possible only when the stoma is in the distal colon. If the colon is irrigated and emptied on a regular basis, the bowel can be trained, and little or no spillage should occur between irrigations. The patient may need to wear only a pad or small pouch over the stoma. Irrigation requires manual dexterity and adequate vision. People who irrigate regularly should still have ostomy bags readily available in case they develop diarrhea from foods or illness.

EKG Heart Rate

Count QRS complexes on 6 second strip, multiply by 10.

What levels should you pay attention to if your giving Low Fractioned (LF) Heparin?

Creatinine Bc it gives you a look at the patient's renal functions. Creatinine will build up in the body Quickly when kidneys can't filter it out.

Causes of metabolic acidosis

DKA, severe diarrhea, renal failure, shock

CKD Dietary Plan

Dietary (protein, sodium, potassium, phosphate) and fluid restrictions.

symptoms of respiratory alkalosis

Dizzy, confused Tetany Hyperventilation Neuromuscular irritability

Prednisone Teaching

Do not stop medication suddenly (adrenal insufficiency could ensue- notify HCP if those types of s/s occur); Medication may mask symptoms of infection so AVOID people with contagious illnesses and report possible infections immediately to HCP (e.g. Sore throat, UTI); Ask HCP before getting a vaccine; Report Promptly if you have severe abdominal pain or Tarry stool Also report: unusual swelling, weight gain, tiredness, bone pain, bruising, non healing sores, visual disturbances or behavior changes; Get period lab tests and eye exams

Prednisone Teaching- Diet (Long term therapy)

Eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates; Avoid alcohol

symptoms of nephrotic syndrome

Edema (generalized) Hyperlipidemia lipiduria Vitamin D deficiency Proteinuria (white/foamy/frothy urine) Hypoalbuminemia thromboembolism

Ostomy teaching Effects of Food on Stoma Output: odor producing

Eggs Garlic Onions Fish Asparagus Cabbage Broccoli Alcohol

Hypokalemia S/S

Fatigue, Anorexia, N/V, Muscle weakness, Decreased GI motility, Dysrhythmias, Paresthesia, Flat T waves on ECG

Left sided stroke symptoms

Feelings of guilt Anxiety concerning the future Expressive Aphasia, difficulty understanding directions

SIADH treatment

Fluid restriction, IV hypertonic saline, conivaptan/tolvaptan, demeclocycline

what is the treatment for diabetic ketoacidosis

IV fluids IV insulin K+ (to replete intracellular stores) glucose if necessary to prevent hypoglycemia

Avandia (rosiglitazone) NSG Assessment

If patient is concurrently taking Insulin: Look for s/s of hypoglycemia! (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety) Assess for edema and s/o HF! (dyspnea, rales/crackles, peripheral edema, wt gain, JVD) Labs: Glucose, CBC with differentials (may decrease hemoglobin, hematocrit, WBC, usually in the beginning (first 4-8 wks); AST & ALT Before therapy and during- look for jaundice Monitor Renal Function

A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action should the nurse implement first? a. Infuse 1 L of normal saline per hour. b. Give sodium bicarbonate 50 mEq IV push. c. Administer regular insulin 10 U by IV push. d. Start a regular insulin infusion at 0.1 units/kg/hr.

Infuse 1 L of normal saline per hour. ANS: A The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids. The other actions can be done after the infusion of normal saline is initiated.

After CABG interventions (3): include strategies

Manage pain and prevent venous thromboembolism (e.g., early ambulation, sequential compression device) and respiratory complications (e.g., use of incentive spirometer, splinting during coughing and deep-breathing exercises). Postoperatively, patients may experience some cognitive dysfunction. This includes impairment of memory, concentration, language comprehension, and social integration. Patients may cry or become teary.

Osmotic Diuretics

Mannitol

Which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP) who are working in the diabetic clinic? a. Measure the ankle-brachial index. b. Check for changes in skin pigmentation. c. Assess for unilateral or bilateral foot drop. d. Ask the patient about symptoms of depression.

Measure the ankle-brachial index. ANS: A Checking systolic pressure at the ankle and brachial areas and calculating the ankle-brachial index is a procedure that can be done by UAP who have been trained in the procedure. The other assessments require more education and critical thinking and should be done by the registered nurse (RN).

Prednisone side effects

Muscle wasting, osteoporoses, spike in glucose levels, hyperglycemia, hypokalemia, glaucoma, insomnia, delayed wound healing

Hyperkalemia symptoms "MURDER"

Muscle weakness Urine, oliguria, anuria Respiratory distress Decreased cardiac contractility ECG changes (peaked T at 6, prolonged PR at 7, absent P and wide QRS at 8-9) Reflexes, hyperreflexia, or areflexia (flaccid)

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first? a. Infuse dextrose 50% by slow IV push. b. Administer 1 mg glucagon subcutaneously. c. Obtain a glucose reading using a finger stick. d. Have the patient drink 4 ounces of orange juice.

Obtain a glucose reading using a finger stick. ANS: C The patient's clinical manifestations are consistent with hypoglycemia, and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon or dextrose 50% might be given if the patient's symptoms become worse or if the patient is unconscious.

Illeostomy

Opening into the small intestine. Stool= liquid

Best exercise plan for someone who is overweight

Patients should exercise daily, preferably 30 minutes to an hour. -parking farther from their place of employment or taking the stairs versus an elevator. -Encourage individuals to wear a pedometer to track their activity with a goal of 10,000 steps a day. (success may be walking one third of the recommended steps with incremental increases over time) -walk, swim, and cycle (from obesity chapter) -Because consistency with exercise is important, assessment for the types of exercise that the patient finds enjoyable is the most important action by the nurse in ensuring adherence to an exercise program. -regular exercise of 30 minutes five times a week lowered the risk of developing type 2 diabetes up to 58%. *Exercise feet daily either by walking or by flexing and extending feet in suspended position. Avoid prolonged sitting, standing, and crossing of legs (from DM chapter)

A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first? a. Place the patient on a cardiac monitor. b. Administer IV potassium supplements. c. Ask the patient about home insulin doses. d. Start an insulin infusion at 0.1 units/kg/hr.

Place the patient on a cardiac monitor. ANS: A Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with electrocardiogram (ECG) monitoring. Because Insulin should not be administered without cardiac monitoring because insulin infusion will further decrease potassium levels. potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Discussion of home insulin and possible causes can wait until the patient is stabilized.

Potential complications after CABG (includes cardiac cath)

Postoperative dysrhythmias, especially atrial dysrhythmias (e.g., atrial fibrillation), are common in the first 3 days after CABG surgery. β-Blockers should be restarted as soon as possible after surgery (unless contraindicated) to reduce the incidence of AF.

Role of Registered Nurse (RN) Postprocedure (Cardiac catheterization and PCI) *Assess cath site for _________, __________, ___________ *Monitor EKG for ______________ *IV infusions are_________ &__________, why? *Discharge drugs will be ____________, ____________, _____________

Postprocedure • Perform assessment and compare to baseline: vital signs, pulse oximetry, heart and breath sounds, neurovascular assessment of extremity used for procedure, assessment of catheter insertion site for hematoma, bleeding, and bruit. • Monitor ECG for dysrhythmias or other changes (e.g., ST segment elevation). • Monitor patient for chest pain and other sources of pain or discomfort. • Monitor IV infusions of anticoagulants, antiplatelets (reduces r/o MI&stroke. • Teach patient and caregiver about discharge drugs (e.g., aspirin, clopidogrel , antianginal drugs). • Teach patient and caregiver about discharge care including signs and symptoms to report to HCP (e.g., site complications, return of chest pain).

Cardiac Catheterization what to know preprocedure

Procedure prep: IV contrast dye Allergy: premedicated with corticosteroids. Chronic kidney disease: need hydration pre- and postprocedure. Baseline serum creatinine level is obtained because the IV contrast dye can cause or worsen renal dysfunction. Monitor renal function closely after the procedure. This procedure should only be done if the patient is a candidate for percutaneous or surgical coronary revascularization.

Peptic Ulcer Disease Treatment

Proton-pump Inhibitors Antibiotics Endoscopy Surgery

symptoms of respiratory acidosis

Rapid, shallow breathing (kussamaul) , dyspnea, disorientation, muscle weakness

signs and symptoms of myocardial infarction

Remember the mnemonic: CRUSHING -Chest pain (intense, heavy) -Radiating chest pain that goes to left arm, jaw, back -Unrelieved by nitroglycerin or rest (chest pain) -Sweating (cold) -Hard to breathe (shortness of breath) -Increased heart rate, blood pressure or irregular heart rate -Nausea with vomiting -Going to be anxious and scared

Describe diverticulitis

Results from inflammation of flase diverticuli that typically form in the sigmoid colon of patients consuming low fiber diets. This condition usually presents with left lower quadrant abdominal pain and rectal bleeding

Adrenal crisis

Severe ABD pain, profound weakness, hypotension, renal failure, shock, and possibly death. May result from stress/trauma, or from abrupt discontinuation of long-term steroid medication use, ex: Prednisone.

pulmonary edema s/s

Severe dyspnea and air hunger Cough productive of frothy, blood tinged sputum Tachypnea and tachycardia Cold, clammy skin Cyanosis Extreme apprehension Confusion, stupor

Stages of CKD stage 5

Stage description: Kidney Failure GFR: 15 or less (dialysis) Clinical Action Plan: Renal replacement therapy (if uremia present and patient desires treatment)

Stages of CKD stage 2

Stage description: Kidney damage with mild ↓ GFR GFR: 60-89 Clinical Action Plan: Estimation of progression

Stages of CKD stage 1

Stage description: Kidney damage with normal or ↑ GFR GFR: GFR≥90 Clinical Action Plan: Diagnosis and treatment CVD risk reduction Slow progression

Stages of CKD stage 3b

Stage description: Moderate ↓ GFR GFR: 30-44 Clinical Action Plan: More aggressive treatment of complications

Stages of CKD stage 3a

Stage description: Moderate ↓ GFR GFR: 45-59 Clinical Action Plan: Evaluation and treatment of complications

Stages of CKD stage 4

Stage description: Severe ↓ GFR GFR: 15-29 Clinical Action Plan: Preparation for renal replacement therapy (dialysis, kidney transplant)

Tuberculosis patient teaching

TB is spread by airborn droplets - *cover your mouth/wash hands to protect others.* Take full course of medication as rx'd If taking INH, avoid food with tyramine Rifampin causes body fluids to become red-orange and may stain soft contact lenses

Avandia (rosiglitazone) Teaching

Take as directed; Medication CONTROLS hyperglycemia only. If hypoglycemia occurs: advies pt to take a glass of orange juice or 2-3 tbsps of sugar, honey or corn syrup and dissolve in water and notify HCP Report: s/o HF Carry some form of candy around ID explaining you diabetes process

Things to know: colostomy

The colostomy starts functioning when peristalsis returns about 2-4 days You wouldn't exactly "monitor" the bag for stool right after surgery bc nothin would be there... mucus and serosanguinous crud might start to show up after a day though

The nurse is interviewing a new patient with diabetes who takes rosiglitazone (Avandia). Which information would the nurse anticipate resulting in the health care provider discontinuing the medication? a. The patient's blood pressure is 154/92. b. The patient's blood glucose is 86 mg/dL. c. The patient reports a history of emphysema. d. The patient has chest pressure when walking.

The patient has chest pressure when walking. ANS: D Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health care provider and expect orders to discontinue the medication. A blood glucose level of 86 mg/dL indicates a positive effect from the medication. Hypertension and a history of emphysema do not contraindicate this medication.

A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test? a. The patient's most recent A1C was 6.5%. b. The patient's blood glucose is 128 mg/dL. c. The patient took the prescribed metformin today. d. The patient took the prescribed captopril this morning.

The patient took the prescribed metformin today. ANS: C To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary angiogram and should not be used for 48 hours after IV contrast media are administered. The other patient data will also be reported but do not indicate any need to reschedule the procedure.

diabetes insipidus treatment

Treat the underlying cause if possible; fluid intake, hormone replacement therapy (desmopressin), vasopressin medications

Patient & Caregiver Teaching Ostomy Self-Care Include the following instructions when teaching the patient and/or caregiver about self-care of an ostomy.

Two major aspects of nursing care for the patient with an ostomy are (1) emotional support as the patient copes with a radical change in body image and (2) patient and caregiver teaching about ostomy care. 1. Demonstrate and allow the patient and caregiver to practice the following activities: • Remove the old skin barrier, cleanse the skin, and correctly apply new skin barriers. Most pouching systems have an adhesive skin barrier and a pouch to collect the feces. • Apply, empty, clean, and remove the pouch. • Empty the pouch before it is one-third full to prevent leakage. 4. Irrigate the colostomy to regulate bowel elimination (optional). •5.Identify foods to avoid to reduce diarrhea or gas. Most patients with colostomies can eat anything they want. However, some choose to avoid certain foods because of possible increased gas, odor, or stoma output. Teach patients to chew their food very well to reduce the chance of blockage. • Promote fluid intake of least 3000 mL/day to prevent dehydration (unless contraindicated). • Describe symptoms of fluid and electrolyte imbalance, particularly potassium and sodium • Explain how to recognize problems (fluid and electrolyte deficits, fever, diarrhea, skin irritation, stomal problems) and how to contact the appropriate health care provider. 6. The patient can resume activities of daily living within 6 to 8 weeks but should avoid heavy lifting. 7.Swimming with an ostomy pouch intact is not a problem. The patient can bathe and shower with or without the pouching system in place because water does not harm the stoma. 8. Sexual dysfunction may be temporary and resolve in 3 to 12 months. 9. Teach the patient to empty the pouch before sexual activities. Some may apply a smaller pouch during sexual activity. 10.Ostomy rehabilitation, including teaching and ongoing support, should be available for all ostomy patients.

Avandia (rosiglitazone) Effects and Cautions

Type 2 Diabetes (w/ diet and exercise) may be used with Metformin and sulfonylureas Class: Antidiabetic. Thiazolidinediones TE: Decrease insulin resistance resulting in glycemic control without hypoglycemia aka Improves sensitivity to insulin by acting as a agonist at receptor sites involved in insulin responsiveness and subsequent glucose production CAUTION: High Alert Medication! NOT FOR DKA USE CAUTIOUSLY when using w/ insulin (can increase risk of worsening HF and fluid retention [edema]) TITRATE and decrease does in geri pts (due to decreased renal function) DO NOT GIVE to patients 80 yrs old and above

Avandia Side Effects and Adverse Effects

Use cautiously with Edema and when using w/ insulin (can increase risk of worsening HF and fluid retention [edema]) CNS: Stroke! CV: HF! GI: hepatitis, increased liver enzymes Hemat: anemia Metab: wt gain, increased cholesterol, LDL & HDL Misc: Angioedema! ; fractures (arm, hand, foot) in female pts Natural Products: some worsen blood glucose control (glucosamine) Nursing Implications & teaching: Monitor for fluid retention, hypoglycemia. Check PLFTs & CBC

Avandia (rosiglitazone) Implementation

With or without meals Pts may require insulin if exposed to stress, fever, trauma, infection, or surgery

Temporary vascular access

a double-lumen catheter placed in pts jugular or femoral vein

when removing a central line, if a patient complains of chest pain and impending doom, assume its

a pulmonary embolism

Thyroid storm

a relatively rare, life-threatening condition caused by exaggerated hyperthyroidism

Cardiopulmonary bypass (CPB) is

a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the patient's body. The CPB pump itself is often referred to as a heart-lung machine or "the pump".

ischemic stroke

a type of stroke that occurs when the flow of blood to the brain is blocked

Which nursing responsibilities are priorities when caring for a patient returning from a cardiac catheterization (select all that apply)? a. Monitoring vital signs and ECG b. Checking the catheter insertion site and distal pulses c. Assisting the patient to ambulate to the bathroom to void d. Informing the patient that he will be sleepy from the general anesthesia e. Instructing the patient about the risks of the radioactive isotope injection

a, b

What characterizes type 2 diabetes (select all that apply)? a. β-cell exhaustion b. Insulin resistance c. Genetic predisposition d. Altered production of adipokines e. Inherited defect in insulin receptors f. Inappropriate glucose production by the liver

a, b, c, d, e, f. Type 2 diabetes is characterized by β-cell exhaustion, insulin resistance, genetic predisposition, altered production of adipokines, inherited defect in insulin receptors, and inappropriate glucose production by the liver. The roles of the brain, kidneys, and gut in type 2 diabetes development are being studied.

Priority Decision: A patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient? a. Administer the usual insulin dosage. b. Hold fluid intake until the nausea subsides. c. Come to the clinic immediately for evaluation and treatment. d. Monitor the blood glucose every 1 to 2 hours and call if it rises over 150 mg/dL (8.3 mmol/L).

a. Administer the usual insulin dosage. During minor illnesses, the patient with diabetes should continue drug therapy and fluid and food intake. Insulin is important because counter regulatory hormones may increase blood glucose during the stress of illness. Food or a carbohydrate liquid substitution is important because during illness the body requires extra energy to deal with the stress of the illness. Blood glucose monitoring should be done every 4 hours, and the health care provider should be notified if the level is greater than 240 mg/dL (13.9 mmol/L) or if fever, ketonuria, or nausea and vomiting occur.

Potential complications from cardiac catheterization with PCI include

abrupt closure from coronary artery dissection, vascular injury at the artery access site (e.g., femoral, radial), acute MI, stent embolization, coronary spasm, dye allergy, renal compromise, bleeding (e.g., retroperitoneal), infection, stroke, and emergent coronary artery bypass graft (CABG) surgery. The possibility of dysrhythmias during and after the procedure is always present.

Chest Tube water seal

active or passive chest tube drainage device using a water seal that can be used to prevent and treat pneumothorax (fluid comes out but air doesn't come back in)

diabetes insipidus

antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect

Stroke S/S

aphasia, hemiplegia, hemianopsia (loss of half of visual field)

describe diverticulosis

asymptomatic diverticular disease. pouches in colon that are not inflamed, no symptoms

On examining a patient 8 hours after having surgery to create a colostomy, what should the nurse expect to find? a. Hyperactive, high-pitched bowel sounds b. A brick-red, puffy stoma that oozes blood c. A purplish stoma, shiny and moist with mucus d. A small amount of liquid fecal drainage from the stoma

b. A brick-red, puffy stoma that oozes blood A normal new colostomy stoma should appear rose to brick-red, have mild to moderate edema, and have a small amount of bleeding or oozing of blood when touched. A purplish stoma indicates inadequate blood supply and should be reported. Bowel sounds after extensive bowel surgery will be diminished or absent. The colostomy will not have any fecal drainage for 2 to 4 days, but there may be some earlier mucus or serosanguineous drainage.

To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually (select all that apply)? a. Chest x-ray b. Blood pressure c. Serum creatinine d. Urine for microalbuminuria e. Complete blood count (CBC) f. Monofilament testing of the foot

b. Blood pressure c. Serum creatinine d. Urine for microalbuminuria f. Monofilament testing of the foot ANS: B, C, D, F Blood pressure, serum creatinine, urine testing for microalbuminuria, and monofilament testing of the foot are recommended at least annually to screen for possible microvascular and macrovascular complications of diabetes. Chest x-ray and CBC might be ordered if the patient with diabetes presents with symptoms of respiratory or infectious problems but are not routinely included in screening.

Which laboratory value reported to the nurse by the unlicensed assistive personnel (UAP) indicates an urgent need for the nurse's assessment of the patient? a. Bedtime glucose of 140 mg/dL b. Noon blood glucose of 52 mg/dL c. Fasting blood glucose of 130 mg/dL d. 2-hr postprandial glucose of 220 mg/dL

b. Noon blood glucose of 52 mg/dL The nurse should assess the patient with a blood glucose level of 52 mg/dL for symptoms of hypoglycemia and give the patient a carbohydrate-containing beverage such as orange juice. The other values are within an acceptable range or not immediately dangerous for a patient with diabetes.

16. Priority Decision: Before administering a bolus of intermittent tube feeding to a patient with a percutaneous endoscopic gastrostomy (PEG), the nurse aspirates 220 mL of gastric contents. How should the nurse do next? a. Return the aspirate to the stomach and recheck the volume of aspirate in an hour. b. Return the aspirate to the stomach and continue with the tube feeding as planned. c. Discard the aspirate to prevent over-distending the stomach when the new feeding is given. d. Notify the HCP that the feedings have been scheduled too frequently to allow for stomach emptying.

b.Return the aspirate to the stomach and continue with the tube feeding as planned. With intermittent feedings, less than 250 mL residual does not require further action. With continuous feedings and a residual of 250 mL or more after a second residual check, a promotility agent should be considered. The aspirate will not be discarded as this could alter the patient's fluid, electrolyte, and pH balance.

Hemorrhagic stroke treatment

blood pressure management, ICP monitoring and management

medications for deep vein thrombosis

blood thinners (end with aban, atran, or arin) i.e. heparin, apixaban or dabigatran,

what do you assess for with fluid overload

bp, edema, intake and output, diagnostics (BNP< chest radiograph, ecG), JVD,

Priority Decision: The nurse is assessing a newly admitted patient with diabetes. Which observation should be addressed as the priority by the nurse? a. Bilateral numbness of both hands c. Rapid respirations with deep inspiration b. Stage II pressure ulcer on the right heel d. Areas of lumps and dents on the abdomen

c. Rapid respirations with deep inspiration Rapid deep respirations are symptoms of diabetic ketoacidosis (DKA), so this is the priority of care. Stage II pressure ulcers and bilateral numbness are chronic complications of diabetes. The lumps and dents on the abdomen indicate the patient has lipodystrophy and may need to learn about site rotation of insulin injections.

The nurse should observe the patient for symptoms of ketoacidosis when a. illnesses causing nausea and vomiting lead to bicarbonate loss with body fluids. b. glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss. c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy. d. the patient skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy.

c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy. When insulin is insufficient and glucose cannot be used for cellular energy, the body uses stored fats to meet energy needs. Free fatty acids from stored triglycerides are metabolized in the liver in such large quantities that ketones are formed. Ketones are acidic and alter the pH of the blood, causing acidosis. Osmotic diuresis from the elimination of both glucose and ketones in the urine causes dehydration, not ketosis. The loss of bicarbonate and skipping a meal after insulin administration do not cause keto

PEG tube care

check tube placement and residual volume Q4h

Following the teaching of foot care to a patient with diabetes, the nurse determines that additional instruction is needed when the patient makes which statement? a. "I should wash my feet daily with soap and warm water." b. "I should always wear shoes to protect my feet from injury." c. "If my feet are cold, I should wear socks instead of using a heating pad." d. "I'll know if I have sores or lesions on my feet because they will be painful."

d. "I'll know if I have sores or lesions on my feet because they will be painful." Complete or partial loss of protective sensation of the feet is common with peripheral neuropathy of diabetes, and patients with diabetes may suffer foot injury and ulceration without ever having pain. Feet must be inspected during daily care for any cuts, blisters, swelling, or reddened areas.

In report, the nurse learns that the patient has a transverse colostomy. What should the nurse expect when providing care for this patient? a. Semiliquid stools with increased fluid requirements b. Liquid stools in a pouch and increased fluid requirements c. Formed stools with a pouch, needing irrigation, but no fluid needs d. Semiformed stools in a pouch with the need to monitor fluid balance

d. Semiformed stools in a pouch with the need to monitor fluid balance The patient with a transverse colostomy has semiliquid to semiformed stools needing a pouch and needs to have fluid balance monitored. The ascending colostomy has semiliquid stools needing a pouch and increased fluid. The ileostomy has liquid to semiliquid stools needing a pouch and increased fluid. The sigmoid colostomy has formed stools, may or may not need a pouch but will need irrigation, and no changes in fluid needs.

nursing intervention for nephrotic syndrome

daily weights, monitor intake and output fluid restriction diuretics with iv albumin to help reduce extra fluid monitor edema and skin breakdown

SIADH s/s

decreased loc (cerebral edema/increased icp) seizures coma sodium less than 120

Frequent BP monitoring, cardiac catheterization, and emergent cardioversion are used for

diagnosis and/or treatment of cardiovascular disorders

A patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should a. place ice packs around the stoma. b. notify the surgeon about the stoma. c. monitor the stoma every 30 minutes. d. document stoma assessment findings.

document stoma assessment findings. ANS: D The stoma appearance indicates good circulation to the stoma. There is no indication that surgical intervention is needed or that frequent stoma monitoring is required. Swelling of the stoma is normal for 2 to 3 weeks after surgery, and an ice pack is not needed.

regular insulin duration, peak and onset

duration 6-8 hrs peak 2-4 hours onset .5-1hr

possible side effects of the prednisone and should be addressed

elevated glucose, skin change, and hypertension (Ch 46 AKI tb) Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a side effect of prednisone. (Ch 48 DM tb) Corticosteroids have the potential to cause diabetes mellitus. Corticosteroids increase appetite and lead to weight gain. Corticosteroid use is associated with an increased risk for infection, so the nurse should report the urinary tract symptoms immediately to the health care provider. (ch 64 TB)

percutaneous endoscopic gastrostomy (PEG)

feeding catheter inserted into the stomach through the skin and subcutaneous tissues of the abdomen. Most PEG tube feeding can start within 2 hours of insertion Assess for bowel sounds before feeding.

Side effects of TB meds

gastrointestinal disturbance, psychiatric disorder, hepatitis, peripheral neuropathy

Anasarca

generalized edema Seen in CHF

Long acting insulin

glargine, detemir

PPE order of removal

gloves, goggles, gown, mask

PPE order

gown, mask, goggles, gloves

peptic ulcer disease dietary management

high fiber rich in fruit, vegetables and whole grains. do not consume chocolate, coffee, spicy, alcohol, acidic foods, caffeine

Regular (rapid acting insulin) Acting Insulin names

humalin R and novolin R

What does HHS look like?

hyperosmolar hyperglycemic nonketotic syndrome Severe hyperglycemia No or slight ketosis Profound dehydratioin Hyperosomolatity

Causes of respiratory alkalosis

hyperventilation (anxiety, PE, fear), mechanical ventilation

SIADH lab findings

hyponatremia, serum osmolality <280 most/kg, and high urine osmolality

Causes of respiratory acidosis

hypoventilation

Prednisone used for

immunosuppression

Right sided stroke symptoms

impulsivity

Viagra causes

low bp

role of nurse during bronchoscopy

maintain a viable airway, closely monitor patient's respiratory status, relieve pain and anxiety by providing medication and. emotional support

role of nurse during thoracentesis

make sure patient signed consent, tell patient do not cough when needle is inserted, explain procedure reinforcing surgeon teaching, patient may have a diagnostic procedure such as x-ray, chest fluoroscopy, ultrasound, or ct scan, monitor fluid drainage look and amount -may give patient sedative before procedure -vital signs monitored before and after procedure

thoracentesis discharge instruction

may have pain after procedure -take easy for 48 hours after procedure -dont due strenuous exercise such as lifting - ou will have small bandage over puncture site, check puncture site for the signs of infection

cytotoxic drug

medication that kills or damages cells

bowel obstruction causes what acid imbalance

metabolic alkalosis

No IV contrast if pt is taking ________________ it causes:______________

metformin lactic acidosis

A 26-yr-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to a. use only the lispro insulin until the symptoms are resolved. b. limit intake of calories until the glucose is less than 120 mg/dL. c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise. d. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.

monitor blood glucose every 4 hours and notify the clinic if it continues to rise. ANS: C Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA). Decreasing carbohydrate or caloric intake is not appropriate because the patient will need more calories when ill. Glycosylated hemoglobin testing is not used to evaluate short-term alterations in blood glucose.

adrenalectomy post op

monitor for bleeding, Monitor for Adrenal Crisis Lifelong Hormone replacement

hemorrhagic stroke

occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed

Long acting insulin onset and duration

onset 1-2 hours duration 20-24 hours

diabetic angiogram

patients treated with insulin are 62% more likely to die. patients with diabetes mellitus should consider dietary intervention to treat their condition first before trying glucose lowering treatments

NPH insulin peak, onset and duration

peak 1-2 effect: 4-6 hours duration more than 12 Very small doses will have an earlier peak effect and shorter duration of action, while higher doses will have a longer time to peak effect and prolonged duration.

Many patients are malnourished before surgery. They may require placement of a

percutaneous endoscopic gastrostomy (PEG) and enteral nutrition before radiation treatment or surgery.

PEG tube

percutaneous endoscopic gastrostomy tube

When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone. The nurse will anticipate that the patient may a. need a diet higher in calories while receiving prednisone. b. develop acute hypoglycemia while taking the prednisone. c. require administration of insulin while taking prednisone. d. have rashes caused by metformin-prednisone interactions.

require administration of insulin while taking prednisone. ANS: C Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient may have an increased appetite when taking prednisone but will not need a diet that is higher in calories.

Causes of metabolic alkalosis

severe vomiting, excessive GI suctioning, diuretics, excessive NaHCO3

what do you do if a cytotoxic drug infiltrates

stop drug immediately, allow the needle to remain and aspirate as much drug as possible, consider prescription of analgesia for pain, mark area with soft pen to see if spreads, elevate limb and gently move t to maintain mobility, photograph area, place cold pack,

laryngectomy

surgical removal of the larynx

SIADH definition

syndrome of inappropriate antidiuretic hormone

Ischemic stroke treatment

tPA if within 3-4.5 hours and no hemorrhage/risk of it reduce risk: aspirin, clopidogrel, BP control, blood sugar and lipids control, treatment of conditions that inc risk (e.g. a.fib.)

Suspect PE in any patient with

tachypnea, dyspnea, and tachycardia, particularly when the patient is already receiving O2 therapy. After chest tube removal if pt suddenly has chest pain and is tachypnic Other manifestations may include agitation, chest pain, hypotension, hemoptysis, dysrhythmias, and heart failure.

Presnisone teaching

take with food one to four times a day, side effects can be high blood sugar and shifting body fat, fatigue, diarrhea, body pains, headache in morning

Drugs commonly used during PCI / After PCI are... (Cardiac Catheterization)

unfractionated heparin (UH) or low-molecular-weight heparin (LMWH eg Enoxoparin SQ)+ Direct thrombin inhibitor (e.g., bivalirudin [Angiomax]), and/or a glycoprotein IIb/IIIa inhibitor (e.g., eptifibatide [Integrilin]). After PCI, the patient is treated with dual antiplatelet drugs (e.g., aspirin [indefinitely] and clopidogrel) up to 12 months or longer, until the intimal lining grows over the stent and provides a smooth vascular surface.

Role of Nursing Personnel Registered Nurse (RN) Preprocedure (Cardiac catheterization and PCI)

• Assess for allergies, especially to contrast dye. • Perform baseline assessment, including vital signs, pulse oximetry, heart and breath sounds, neurovascular assessment of extremities (e.g., distal pulses, skin temperature, skin color, sensation). • Assess baseline laboratory values (e.g., cardiac biomarkers, creatinine). • Teach patient and caregiver about procedure and postprocedure care.

Role of Licensed Practical/Vocational Nurse (LPN/LVN) (Cardiac catheterization and PCI)

• Give drugs before and after the procedure (consider state nurse practice act and agency policy). *• Assess neurovascular status of involved extremity every 15 min for the first hour, then according to agency policy • Check for bleeding at catheter insertion site every 15 min for the first hour, then according to agency policy. • Report changes in neurovascular status of involved extremity or any bleeding to the RN.

Patient Teaching for Hemodialysis

"Let me know if you experience any nausea or headache" (disequilibrium syndrome) "If there is bleeding at site afterward, apply light pressure. Contact HCP if bleeding is more than 30mins" (no bruit/thrill, or findings of infection) *Normally, a thrill (buzzing sensation) can be felt by palpating the fistula, and a bruit (rushing sound) can be heard with a stethoscope with arterial blood moving at a high velocity through the vein. FOLATE: "Take medications/supplements with folate. Add folate to you diet with beans & green vegetables" Teach about protein- "each pass depletes you of protein so increase protein intake predialysis staying within restricted limits " "Don't lift anything heavy with access site arm, don't hold anything over it (don't compress it) or sleep on the site" "preform hand exercises for arterial fistula maturation" "Showering over bathing with AVF"

A 29-yr-old woman with systemic lupus erythematosus has been prescribed 2 weeks of high-dose prednisone therapy. Which information about the prednisone is most important for the nurse to include? a. "Weigh yourself daily to monitor for weight gain." b. "The prednisone dose should be decreased gradually." c. "A weight-bearing exercise program will help minimize risk for osteoporosis." d. "Call the health care provider if you have mood changes with the prednisone."

"The prednisone dose should be decreased gradually." ANS: B Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these are not life-threatening effects. Osteoporosis occurs when patients take corticosteroids for longer periods. (endocrine problems TB)

If your patient experiences angina, perform the following measures: What will the patient look like?

(1) position patient upright unless contraindicated and apply supplemental O2, (2) assess vital signs, (3) obtain a 12-lead ECG, (4) provide prompt pain relief first with NTG followed by an opioid analgesic if needed, and (5) assess heart and breath sounds. The patient will most likely be anxious and may have pale, cool, clammy skin. The BP and HR may be elevated. Auscultation of the heart may reveal an atrial (S4) or a ventricular (S3) gallop. A new murmur heard during an anginal attack may indicate ischemia of a papillary muscle of the mitral valve. The murmur is likely to be transient and disappear when symptoms stop. Assess for other signs of pain, such as restlessness; ECG changes; elevated HR, respiratory rate, or BP; clutching of the bed linens; or other nonverbal cues. Support and reassure the patient. Use a calm approach to help reduce the patient's anxiety during an anginal attack.

Laryngectomy Discharge Planning

- Cover trach when in shower with a waterproof bib -wear a stoma cover to keep moisture from being lost when you breath - Wear plastic collar - do not swim - cool mist Humidifier in room - Medic alert bracelet - Install smoke detectors

stroke diagnostic tests

- non-contrast ct - mri - mra (magnetic resonance angiography) - cerebral angiogram - carotid duplex - ekg - echocardiogram (TEE)

symptoms of metabolic alkalosis

-Respiration slow and shallow -Hyperactive reflexes ; tetany -Often related to depletion of electrolytes -Atrial tachycardia -Dysrhythmias

Many of the postoperative complications that develop after a CABG surgery w/ cardiopulmonary bypass (CPB) are: How to Focus Post-op Nursing Care Systemic infection can result with these complications...

-bleeding and anem (from damage to red blood cells and platelets) -fluid and electrolyte imbalances -hypothermia (as blood is cooled when passing through the CPB machine) -infections. Focus your care on assessing the patient for bleeding (e.g., chest tube drainage, incision sites), hemodynamic monitoring, checking fluid status, replacing blood and electrolytes as needed, and restoring temperature (e.g., warming blankets).

what to assess for with a carotid artery angiplasty with stent placed

-cranial nerves (hypoglossal, facial, vagus, spinal accessory) -pupillary reaction -all four extremities for equal strength, movement and sensation -airway for edema and hematomas, respiratory distress, drooling, problems swallowing -incision, -vital signs (call hcp if SBP is >180 or dBP <100 - assess for head ache (may be intracranial bleed) No lovenox notify surgeon if swelling enlarges

Fluid overload intervention

-monitor cardiovascular, respiratory, neuromuscular, renal, integumentary and gastrointestinal status. -Prevent further fluid overload and restore normal fluid balance -administer diurectics; osmotic diuretics typically are prescribed first to prevent severe electrolyte imbalances -Restrict fluid and sodium intake -monitor intake and output -monitor electrolyte values

35. Priority Decision: The patient with diabetes is brought to the emergency department by his family members, who say that he has had an infection, is not acting like himself, and he is more tired than usual. Number the nursing actions in the order of priority for this patient. a. Establish IV access. b. Check blood glucose. c. Ensure patent airway. d. Begin continuous regular insulin drip. e. Administer 0.9% NaCl solution at 1 L/hr. f. Establish time of last food and medication(s).

1. c. Ensure patent airway. 2. b. Check blood glucose. 3. a. Establish IV access 4. e. Administer 0.9% NaCl solution at 1 L/hr. 5. d. Begin continuous regular insulin drip 6. f. Establish time of last food and medication(s). a. 3; b. 2; c. 1; d. 5; e. 4; f. 6.As with all patients, first establish an airway. With a patient with diabetes and abnormal behavior, the blood glucose must then be checked to determine if the patient's symptoms are related to the diabetes. In this case, it is hyperglycemia, so an IV must be started for fluid resuscitation and insulin administration. The last food intake and times at which medications were recently taken may establish a cause for the hyperglycemia and aid in determining further treatment.

Thyroid storm treatment?

1. radioactive iodine treatment can precipitate 2. treatment: prevent T4 tranfer to T3 glucocorticoid, PTU and methimazole, beta blocker, iodine(after antithyroid drug)

Long acting insulin duration

20-24 hours

When infusing UF Heparin you want normal pTT ranges like this:

25-35 (therapeutic 2x normal)- IV

After change-of-shift report, which patient should the nurse assess first? a. A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12% b. A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL c. A 40-yr-old patient who is pregnant and whose oral glucose tolerance test is 202 mg/dL d. A 50-yr-old patient who uses exenatide (Byetta) and is complaining of acute abdominal pain

A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL ANS: B Because the brain requires glucose to function, untreated hypoglycemia can cause unconsciousness, seizures, and death. The nurse will rapidly assess and treat the patient with low blood glucose. The other patients also have symptoms that require assessments or interventions, but they are not at immediate risk for life-threatening complications.

After change-of-shift report, which patient should the nurse assess first? a. A 40-yr-old male patient with celiac disease who has frequent frothy diarrhea b. A 30-yr-old female patient with a femoral hernia who has abdominal pain and vomiting c. A 30-yr-old male patient with ulcerative colitis who has severe perianal skin breakdown d. A 40-yr-old female patient with a colostomy bag that is pulling away from the adhesive wafer

A 30-yr-old female patient with a femoral hernia who has abdominal pain and vomiting ANS: B Pain and vomiting with a femoral hernia suggest possible strangulation, which will necessitate emergency surgery. The other patients have less urgent problems.

After change-of-shift report, which patient will the nurse assess first? a. A 40-yr-old woman whose parenteral nutrition infusion bag has 30 minutes of solution left b. A 40-yr-old man with continuous enteral feedings who has developed pulmonary crackles c. A 30-yr-old man with 4+ generalized pitting edema and severe protein-calorie malnutrition d. A 30-yr-old woman whose gastrostomy tube is plugged after crushed medications were administered

A 40-yr-old man with continuous enteral feedings who has developed pulmonary crackles ANS: B The patient data suggest aspiration has occurred, and rapid assessment and intervention are needed. The other patients should also be assessed soon, but the data about them do not suggest any immediately life-threatening complications.

After change-of-shift report, which patient will the nurse assess first? a. A 19-yr-old patient with type 1 diabetes who was admitted with possible dawn phenomenon b. A 35-yr-old patient with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL c. A 60-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa d. A 68-yr-old patient with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain

A 60-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa ANS: C The patient's diagnosis of HHS and signs of dehydration indicate that the nurse should rapidly assess for signs of shock and determine whether increased fluid infusion is needed. The other patients also need assessment and intervention but do not have life-threatening complications.

What are manifestations of diabetic ketoacidosis (DKA) (select all that apply)? a. Thirst b. Ketonuria c. Dehydration d. Metabolic acidosis e. Kussmaul respirations f. Sweet, fruity breath odor

ALL a, b, c, d, e, f. In DKA, thirst occurs to replace fluid used to eliminate ketones in the urine in trying to decrease the blood glucose and ketonemia. The metabolic acidosis leads to the Kussmaul respirations trying to decrease the acid in the system. The sweet, fruity breath odor is from acetone. Thirst and dehydration are found with both DKA and hyperosmolar hyperglycemic syndrome (HHS).

A patient with dermatomyositis is receiving long-term prednisone therapy. Which assessment finding by the nurse is important to report to the health care provider? a. The patient has painful hematuria. b. Acne is noted on the patient's face. c. Fasting blood glucose is 112 mg/dL. d. The patient has an increased appetite.

ANS: A The patient has painful hematuria. Corticosteroid use is associated with an increased risk for infection, so the nurse should report the urinary tract symptoms immediately to the health care provider. The increase in blood glucose, increased appetite, and acne are also adverse effects of corticosteroid use but do not need diagnosis and treatment as rapidly as the probable urinary tract infection.

Prednisone Implementation

Administer in the morning to coincide with the body's normal secretion of cortisol; Administer with meals to minimize GI irritation; Tablets may be crushed and administered with food or fluids if pt has difficulty swallowing; Swallow delayed-release tablets whole, do not crush, break or chew.

When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Communicate the blood glucose level and insulin dose to the circulating nurse in surgery. b. Discuss the reason for the use of insulin therapy during the immediate postoperative period. c. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery. d. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period.

Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery. ANS: C LPN/LVN education and scope of practice includes administration of insulin. Communication about patient status with other departments, planning, and patient teaching are skills that require RN education and scope of practice.

Prednisone adverse effects, Assess for / Monitor for

Adverse/Effects (mostly just bad ones) GI: Peptic Ulceration Hemat: Thromboembolism CV: Hypertension CNS: depression, headache, restlessness ENNT: cataracts & increased intraocular pressure Derm: Decreased wound healing, acne, ecchymoses, fragility, hirsutism, petechiae Endo: Adrenal suppression F&E: Fluid retention, hypokalemia MS: muscle wasting, muscle pain, necrosis of joints, osteoporosis Misc: Cushing syndrome appearance; Increased susceptibility of infection Monitor s/s adrenal insufficiency (ie hypotension, weight gain, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness, hypoglycemia) Daily Weights (observe for edema, steady weight gain, rales/crackles or dyspnea) Notify HCP Labs: glucose (may cause hyperglycemia especially in pts w/ DM); may cause hypoglycemia too; electrolytes- may decrease serum potassium and calcium and Increase serum sodium; May decrease WBC count; Increase serum cholesterol and lipid values

Cardiac Catheterization POST- OP

After: Frequently assess circulation to extremity used for catheter insertion. Check peripheral pulses, color, and sensation of extremity. Observe insertion site for hematoma and bleeding. Place compression device over arterial site to achieve hemostasis, if indicated. Monitor vital signs and ECG. Assess for hypotension or hypertension, dysrhythmias, and signs of pulmonary emboli (e.g., respiratory difficulty).

Ostomy teaching Effects of Food on Stoma Output: Diarrhea causing

Alcohol Beer Cabbage family Spinach Green beans Coffee Spicy foods Fruits (raw)

What is nephrotic syndrome?

Alterations in the glomerular membrane allow proteins, especially albumin, to pass into the urine, resulting in decreased serum osmotic pressure

symptoms of metabolic acidosis

Altered Breathing,Confusion, Drowsiness, Weakness, Decreased cardiac output, Vasodilation, Hyperkalemia

Epistaxis management

Anterior bleed: 1) Pinch nose for 10 min +/- suck on ice cube 2) Cotton balls soaked in lignocaine + adrenaline 3) Cautery 4) Rapid Rhino Posterior bleed: - Rapid Rhino - endoscopic sphenopalatine artery ligation for persistent bleed

Rosiglitazone (Avandia) is an ___________ Adverse Effect___________________

Antidiabetic Myocardial ischemia

Acyclovir

Antiviral

Antiplatelet Therapy

Aspirin is recommended for most people at risk for CVD. Low-dose aspirin if not at increased risk for bleeding (e.g., history of GI bleeding), Normally, if there's a bleed- platelets respond. They rush to the site and becoming super sticky and start to clump together... then fibrin will encase the clump of sticky platelets to stop bleeding. Aspirin (and other antiplatelets) will inhibit the sticky factor of the platelets

Ostomy teaching Effects of Food on Stoma Output: Gas Forming

Beans Cabbage family Onions Beer Carbonated beverages Cheeses (strong) Sprouts

Unfracted Heparin's effect

Breaks up/prevents the clot as it Disrupits the process of blood clot formation with it's "aNTI-Thombin". Look at the clotting cascade and if Pt is being administered IV, Look at pTT IV- breaks up a Clot SQ (Profilactic) - prevent clots from forming

Lab results to determine if prednisone is working

C reactive Protein Serum glucose and electrolytes should also be monitored for side effects

what to do if a patient is tachycardia and apneic

CPR

A young adult with extensive facial injuries from a motor vehicle crash is receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG). Which action will the nurse include in the plan of care? a. Keep the patient positioned on the left side. b. Check the gastric residual volume every 4 to 6 hours. c. Avoid giving bolus tube feedings through the PEG tube. d. Obtain a daily abdominal radiographs to verify tube placement.

Check the gastric residual volume every 4 to 6 hours. ANS: B The gastric residual volume is assessed every 4 to 6 hours to decrease the risk for aspiration. The patient does not need to be positioned on the left side. Bolus feedings can be administered through a PEG tube. An x-ray is obtained immediately after placement of the PEG tube to check position, but daily are not needed.