Gastrointestinal Disorder-Nclex, 1345 - Perioperative, 1345 - Gastric Disorders, 1345 - Ingestion / Esophageal Disorders, 1345 - Liver Disorders, 1345 - Intestinal Disorders, NUR 1345 EXAM I-Henley,LA, Perioperative NSG (in progress), perioperative,...

A nurse is teaching a client who is newly diagnosed with a hiatal hernia about measures to prevent recurrence of symptoms. The nurse makes which statement to the client?

"Be sure to sleep with your head elevated in bed."

A nurse is teaching a client with a newly diagnosed hiatal hernia about measures to prevent recurrence of symptoms. Which statement would be included in the teaching?

"Be sure to sleep with your head elevated in bed."

A generally healthy 63-year-old man is seen in the health care provider's office for a routine examination. Which statement made by the client is important for the nurse to follow up on?

"Everyone in my immediate family has died from gastrointestinal cancer."

A sexually active 20-year-old client has developed viral hepatitis. Which of the following statements, if made by the client, would indicate a need for teaching?

"I can never drink alcohol again."

A client is seen in the ambulatory care office for a routine examination. Which statement by the client would be important for the nurse to follow up?

"I just lost a family to gastrointestinal cancer."

The nurse is teaching a plan of care to the client who has undergone a hemorrhoidectomy. Which statement by the client demonstrates a good understanding of the nurse's instruction?

"I should eat a diet high in fiber.''

A client who has undergone a barium enema is being readied for discharge from the ambulatory care unit. The nurse determines that the client has understood the discharge instructions if the client states:

"I should take a laxative and my stool should return to normal color."

A client who has undergone barium enema is being readied for discharge. The nurse determines that the client has understood discharge instructions when the client states:

"I should take a laxative, and my stool will then return to a normal color."

A nurse has taught a client about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that the client needs additional information if the client makes which statement?

"I'm glad I don't have to lie still for this procedure."

A nurse is collecting data from a client admitted to the hospital with a diagnosis of suspected gastric ulcer and is asking the client questions about pain. Which statement, if made by the client, would support the diagnosis of gastric ulcer?

"My pain comes shortly after I eat, maybe a half hour or so later."

A client being seen in a health care provider's office has just been scheduled for a barium swallow the next day. The nurse writes down which of the following instructions for the client to follow before the test?

"Remove jewelry before the test."

The nurse realizes that the patient requires additional teaching about an esophagoscopy after the patient states

"Right after the test, I want breakfast with black coffee."

Assessment and Diagnostic findings

"String sign" on X-ray of terminal ileum during barium study. H&H usually decreased. ESR usually elevated. Albumin and protein levels usually decreased.

A client has had extensive surgery on the gastrointestinal tract and has been started on parenteral nutrition (PN). The client tells the nurse, "I think I'm going crazy...I feel like I'm starving and yet that bag is supposed to be feeding me." The best response of the nurse would be:

"That is because the empty stomach sends signals to the brain to stimulate hunger."

A family member of a patient asks the nurse about the protein-restricted diet ordered because of advanced liver disease with hepatic encephalopathy. What statement by the nurse would best explain the purpose of the diet?

"The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system."

A nurse provides medication instructions to a client with peptic ulcer disease. Which statement by the client indicates the best understanding of the medication therapy?

"The nizatidine (Axid) will cause me to produce less stomach acid."

A patient with pancreatitis is NPO. The patient asks the nurse why he is unable to have anything by mouth. The best response would be

"The pancreas is stimulated whenever you eat or drink and may aggravate your condition."

Narcotic Antagonists-

Block narcotic agonists; used in opiate-induced resp. depressions or overdose.♥ Naloxone (narcan)→ observe pt for re-sedation

A client who has a history of chronic ulcerative colitis is anemic. The nurse interprets that which factor is likely responsible for this laboratory finding?

Blood loss

Hepatitis types B, C, D, and G are spread mainly through the following:

Blood transfusions Contaminated needles and instuments Direct contact with body fluids from infected people

Cullen's Sign

Bluish ecchymosis around the umbilicus

Your patient has been diagnosed with diverticulosis as a result of muscle thickening and increased intracolonic pressure. Which of the following recommendations would you give her regarding food choices?

Bran, fruits, and vegetables

Turner's Sign

Bruising of flanks

The nurse observes that a client with a nasogastric tube connected to continuous gastric suction is mouth breathing, has dry mucous membranes, and has a foul breath odor. In planning care, which nursing intervention would be best to maintain the integrity of this client's oral mucosa?

Brush the client's teeth frequently. Use diluted mouthwash and water to rinse the mouth

Gastroenterostomy

Bypass duodenum and dump lower in intestine

A client is admitted to the hospital. The graduate nurse is completing a nursing assessment and asks the client if he has an advanced directive. The client responds that he doesn't know what an advanced directive is. The registered nurse preceptor would intervene if she heard the graduate nurse inform the client that an advance directive is: a) A legal document completed by the physician to withhold food and fluids in clients with severe brain injuries b) A legal document, made by the client when he is healthy, that directs others to follow the client's wishes if he is incapacitated c) A legal opinion, instituted by the physician alone, to give the client "do not resuscitate" (DNR) status. d) A legal document that is commonly referred to as a living will and recognized in all North America.

C) A facility refers to an advance directive, a document the client writes or completes, to provide care at a time when the client can't make his own choices. The living will and health care power of attorney are both examples of advance directives. A living will is a document which a competent adult prepares and which provides direction regarding medical care if the client becomes incapacitated. health care power of attorney is an authorization enabling any competent individual to designate someone else to exercise decision-making authority on the individual's behalf under specific circumstances. The Patient Self-Determination Act of 1990 allows clients to write advance directives.

A physician orders supplemental oxygen for a client with a respiratory problem. Which oxygen delivery device should the nurse use to provide the highest possible oxygen concentration? a) Nasal cannula b) Simple mask c) Nonrebreather mask d) Venturi mask

C) A nonrebreather mask provides the highest possible oxygen concentration — up to 95%. A nasal cannula doesn't deliver concentrations above 40%. A Venturi mask delivers precise concentrations of 24% to 44%, regardless of the client's respiratory pattern, because the same amount of room air always enters the mask opening. A simple mask delivers 2 to 10 L/minute of oxygen in uncontrollable concentrations.

A nurse is to collect a sputum specimen from a client. The best time to collect this specimen is: a) before bedtime. b) any time during the day. c) in the morning, as soon as the client awakens. d) early in the evening when secretions settle in the lungs.

C) Because sputum accumulates in the lungs during sleep, the nurse should collect a sputum specimen in the morning, as soon as the client awakens. This specimen will be concentrated, increasing the likelihood of an accurate culture. Sputum specimens collected at other times during the day aren't concentrated and may not provide an accurate culture.

A client is admitted to the post-anesthesia care unit (PACU) following a left hip replacement. The initial nursing assessment findings are T 96.6 degrees F (35.9 degrees C), pulse 90, RR 14, and BP 128/80. The client only responds with moaning when spoken to. The nurse should first: a) Administer sedation reversal agent such as flumazenil. b) Observe the surgical dressing. c) Position the client on the right side. d) Remove the oral airway remaining from surgery.

C) During the immediate post-anesthesia period, the unconscious client should be positioned on the side to maintain an open airway and promote drainage of secretions; because of the type of surgery, the client should be positioned on the right side. Removing the oral airway and observing the surgical dressing is appropriate, but other actions should be implemented before these. Respiratory depression can occur in a client after a procedure requiring sedation. If the client cannot be aroused, the sedation drugs can be reversed by administering a sedation reversal agent, but this client's respiratory rate is 14 and the client is moaning, indicating expected recovery from anesthetics

A client has a nursing diagnosis of Ineffective airway clearance related to retained secretions. When planning this client's care, the nurse should include which intervention? a) Suctioning the client every 2 hours b) Increasing fluids to 1,500 ml/day c) Teaching the client how to deep-breathe and cough d) Improving airway clearance

C) Interventions should address the etiology of the client's problem — poor coughing. Teaching deep breathing and coughing addresses this etiology. Increasing fluids may improve the client's condition, but this intervention doesn't address poor coughing. Improving airway clearance is too vague to be considered an appropriate intervention. Suctioning isn't indicated unless other measures fail to clear the airway.

A female client is readmitted to the facility with a warm, tender, reddened area on her right calf. Which contributing factor should the nurse recognize as most important? a) A history of diabetes mellitus b) An active daily walking program c) Recent pelvic surgery d) History of increased aspirin use

C) The client shows signs of deep vein thrombosis (DVT). The pelvic area has a rich blood supply, and thrombophlebitis of the deep veins is associated with pelvic surgery. Aspirin, an antiplatelet agent, and an active walking program help decrease the client's risk of DVT. In general, diabetes mellitus is a contributing factor associated with peripheral vascular disease.

A nurse is providing home care to a client with a foot ulcer related to diabetes. The client needs daily insulin injections. Family caregivers do not possess the technical skills to inject insulin. Which of the following should the nurse keep in mind? a) The current reimbursement system recognizes the family's nontechnical value priorities. b) Family caregivers are always perceived to be supportive of good care. c) The nurse needs to be creative in integrating the technical and relational aspects of care. d) Nurses should avoid asking the family caregivers to conduct the skilled task.

C) The nurse needs to be creative in integrating the technical and relational aspects of care. The current reimbursement system does not recognize the family's nontechnical value priorities. Nurses are expected to educate the family caregivers to conduct the skilled task where possible. In this case, the nurse can teach the family caregivers to inject insulin. Family caregivers can be perceived to be nonsupportive of good care if the families do not follow through.

A nurse is caring for another nurse's clients while that nurse is on break. While was making rounds of the other nurse's clients, the nurse found medications left a client's bedside stand. How should the nurse best address this problem? a) Correct the problems and submit a written report. b) Inform the nurse-supervisor right away. c) Speak to the coworker when she returns to the unit. d) Ask for a meeting with the coworker and a manager.

C) When a nurse discovers substandard practice by another nurse, it's always appropriate to address the situation before conveying the information to a manager or supervisor. Informing the nurse-supervisor first doesn't promote goodwill between nurses and can affect nursing care. It may be necessary to correct the problem before the nurse returns, but a written report may not be necessary if the issues can be remedied informally. If the problem persists, it may be necessary to meet jointly with a manager, but initially the problem should be addressed only by those directly involved. (l

A laissez-faire nurse-manager takes which action? a) Identifies possible solutions to staffing problems and asks staff members for their opinions about each one b) Completes the vacation schedule without staff input c) Delegates to staff responsibility for selecting a new nursing care delivery system (model) d) Delegates responsibility for evaluating the effectiveness of new equipment to the staff members who use that equipment

C) Delegating a process that will affect all aspects of a nursing area shows a lack of accountability characteristic of a laissez-faire manager. Making critical decisions without staff input is characteristic of an autocratic manager. Delegating evaluation to staff who are intimately involved in a project is appropriate and characteristic of a democratic manager. Identifying potential solutions to a problem and asking staff members for their opinions of the solutions is characteristic of a participative manager

A client is recovering from an abdominal-perineal resection. Which of the following measures would most effectively promote wound healing after the perineal drains have been removed? a) Applying a protected heating pad to the area. b) Taking daily showers. c) Taking sitz baths. d) Applying warm, moist dressings to the area.

C) Sitz baths are an effective way to clean the operative area after an abdominal-perineal resection. Sitz baths bring warmth to the area, improve circulation, and promote healing and cleanliness. Most clients find them comfortable and relaxing. Between sitz baths, the area should be kept clean and dry. A shower will not adequately clean the perineal area. Moist dressings may promote wound contamination and delay healing. A heating pad applied to the area for longer than 20 minutes may cause excessive vasodilation, leading to congestion and discomfort.

A home health patient complains of having severe diarrhea for the past 24 hours. Which nursing action can the RN delegate to the home health aide who assists the patient daily with self-care? A) Instruct about the use of electrolyte-containing oral rehydration products. B) Give loperamide (Imodium) 4 mg from the patient's medicine cabinet. C) Check and report lying, sitting, and standing blood pressure and heart rate. D) Teach the patient how to clean the perineal area after each loose stool.

C) Check and report lying, sitting, and standing blood pressure and heart rate.

The client has vague symptoms that indicate an acute inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease? A) Abdominal pain relieved by bending the knees B) Epigastric cramping C) Chronic diarrhea, abdominal pain, and fever D) Hypotension with vomiting

C) Chronic diarrhea, abdominal pain, and fever Abd pain relieved by bending the knees is peritonitis Epigastric cramping is appendicits

Which statement differentiating Crohn's disease from ulcerative colitis is true? A) There are very few complications associated with Crohn's disease. B) Clients with Crohn's disease experience about 20 loose bloody stools daily. C) Clients with ulcerative colitis may experience hemorrhage. D) The peak incidence of ulcerative colitis is between 15 and 40 years of age.

C) Clients with ulcerative colitis may experience hemorrhage.

A patient with a history of esophageal varices has just been admitted to the emergency department after vomiting a large quantity of blood. Which action should the nurse take first? A) Obtain the charts from the previous admission. B) Listen for bowel sounds in all quadrants. C) Obtain the pulse and blood pressure. D) Ask about abdominal pain.

C) Obtain the pulse and blood pressure.

The client who has developed an intestinal obstruction has pain that has recently changed from a colicky intermittent type to a constant discomfort. Which nursing intervention is the highest priority? A) Positioning the client in a high Fowler's position B) Administering medication for pain C) Preparing the client for emergency surgery D) Changing nasogastric suction from intermittent to constant

C) Preparing the client for emergency surgery The change in pain type could be indicative of perforation or peritonitis and will require immediate surgical intervention.

Which assessment finding in an obese patient who has been discharged 10 days after being hospitalized with peritonitis and having an exploratory laparotomy indicates a need for immediate action by the home health nurse? A) The patient's temperature is 100.8° F (38.2° C). B) The patient complains of pain when coughing. C) The patient says, "I feel like the incision is splitting open." D) The patient states, "I am too tired to ambulate very much."

C) The patient says, "I feel like the incision is splitting open."

Which nursing intervention takes highest priority when caring for a client who's receiving a blood transfusion? a) Documenting blood administration in the client care record b) Assessing the client's vital signs at the conclusion of the transfusion c) Monitoring the client for itching, swelling, or dyspnea d) Informing the client that the transfusion usually takes 1½ to 2 hours

C. Because administration of blood or blood products may cause serious adverse effects such as allergic reactions, the nurse must monitor the client for these effects. Signs and symptoms of life-threatening allergic reactions include itching, swelling, and dyspnea. Although the nurse should inform the client how long the transfusion will take and should document its administration, these actions are less critical to the client's immediate health. The nurse should assess the client's vital signs at least hourly during the transfusion, not just at the conclusion of the transfusion.

The nurse should teach the client that signs of digoxin toxicity include which of the following? a) Visual disturbances such as seeing yellow spots. b) Increased appetite. c) Rash over the chest and back. d) Elevated blood pressure.

C. Colored vision and seeing yellow spots are symptoms of digoxin toxicity. Abdominal pain, anorexia, nausea, and vomiting are other common symptoms of digoxin toxicity. Additional signs of toxicity include arrhythmias, such as atrial fibrillation or bradycardia. Rash, increased appetite, and elevated blood pressure are not associated with digoxin toxicity.

The nurse is planning care for a group of clients. Which client should the nurse identify as needing the most assistance in accepting being ill? a) A 32-year-old woman diagnosed with depression related to lupus erythematosus who discusses her medication's adverse effects with the nurse. b) A 45-year-old man who just suffered a severe myocardial infarction and talks to the nurse about concerns regarding resuming sexual relations with his wife. c) A 60-year-old woman diagnosed with chronic obstructive pulmonary disease who refuses to wear an oxygen mask even though poor oxygenation makes her confused. d) An 8-year-old boy who alternately cries for his mother and is angry with the nurse about being hospitalized after a bike accident.

C. The 60-year-old woman is acting in a way that worsens her physical and mental condition because she does not want to be sick. The 8-year-old child is acting normally for someone his age who is unexpectedly hospitalized. The cooperation demonstrated by the client with lupus and the client who had a myocardial infarction indicates a level of acceptance of their illnesses and of their role as being ill.

When preparing a client with a draining vertical incision for ambulation, where should a nurse apply the thickest portion of a dressing? a) In the middle of the wound b) At the top of the wound c) At the base of the wound d) Over the total wound

C. When a client is ambulating, gravity causes the drainage to flow downward. Covering the base of the wound with extra dressing will contain the drainage. Applying the thickest portion of the dressing at the top, in the middle, or over the total wound won't contain the drainage.

The nurse is removing the client's staples from an abdominal incision when the client sneezes and the incision splits open, exposing the intestines. Which of the following actions should the nurse take next? a) Press the emergency alarm to call the resuscitation team. b) Have all visitors and family leave the room. c) Cover the abdominal organs with sterile dressings moistened with sterile normal saline. d) Call the surgeon to come to the client's room immediately.

C. When a wound eviscerates (abdominal organs protruding through the opened incision), the nurse should cover the open area with a sterile dressing moistened with sterile normal saline and then cover it with a dry dressing. The surgeon should then be notified to take the client back to the operating room to close the incision under general anesthesia. The nurse should not press the emergency alarm because this is not a cardiac or respiratory arrest. The nurse should have the visitors and family leave the room to decrease the chance of airborne contamination, but the primary focus should be on covering the wound with a moist, sterile covering.

Which of the following is the correct technique for applying an elastic bandage to a leg? a) Overlap each layer twice when wrapping. b) Secure the bandage with clips over the area of the inner thigh. c) Start at the distal end of the extremity and move toward the trunk. d) Increase tension with each successive turn of the bandage.

C. When applying an elastic bandage to a leg, start at the distal end and move toward the trunk in order to support venous return. Tension should be kept even and not increased with each turn to prevent circulatory impairment. Overlapping each layer twice when wrapping can also impair circulation. The clips securing the bandage should be placed on the outer aspect of the leg to avoid creating a pressure point on the other leg.

Lab Assessment - Blood

CBC - anemia / infection PT - coagulation Electrolytes - N&V = ↑K AST/ALT - liver function = ↑ in Hepatitis & Cirrhosis Amylase/Lipase - ↑ acute pancreatitis Bilirubin - jaundice Ammonia - ↑ hepatic dysfunction Oncofetal Antigens - test for certain types of cancer

Versed side effects

CNS depression, may be mediatied by GABA. S/E: Agitation, drowsiness, excessive sedation, HA, apnea, coughing, arrythmia, N&V, rash

diagnostic for liver

CT scan usually

The enterostomal nurse is teaching the client about caring for a new ileostomy. Which instruction is the priority for the nurse to teach this client?

Call the health care provider if the stoma has a bluish or pale look. means its blood supply may be compromised, and the health care provider must be notified immediately.

Fecal softener: patient education

Can be safely used by patients who should avoid straining. Will not evacuate hard stool because it is not a true laxative.

Stomatitis

Canker Sores -Inflamation and erosion of the protective lining of the mouth -Risk: bleed, infect -Untreated→Vincents angina or Candidiasis Albicans -Herpes bleed more -Sever cases can lead to edema blocking airway

Aphthous Stomatitis

Canker sore -Common in young women -Unknown cause -Heal spontaneously 1-3 wks -Topical or steroids

aphthous stomatitis

Canker sore small ulcerated lesions of soft tissues of oral cavity

Irreducible Hernia

Cannot be replaced

Preoperative Assessment Medical Hx:

Cardiac (↑complications from anesthesia; risk for MI), Pulmonary (↑risk of pneumonia, ↓anesthesia secretion), Renal & Liver (altered metabolism, ↓excretion of drugs, impaired wound healing), Endocrine→pts w/diabetes, thyroid, adrenal problems (cardiovascular complications, ↓wound healing) Blood Donations: Autologous (pt's own blood that is given up to 5 wks preop), Directed blood (donated by family or friends of the pt who have the same blood type), Recycling Discharge Planning: Educate pt on importance of nutrition; arrange transportation

Pts with thyroid disorders, DM, or adrenal problems might have ____ complications and decreased _____ _____

Cardiovascular complications and decreased wound healing

Barrettes esophagus

Caused by GERD causing scarring of esophagus and narrowing of esophagus near sphincter because of acid reflux

parietal cells

Cells found in gastric glands that secrete hydrochloric acid (for hydrolysis of ingested food) and gastric intrinsic factor (for absorption of vitamin B-12).

Which assessment would indicate possible gallbladder disease in an older adult?

Changes in color of urine or stool

A nurse observes that a client's nasogastric tube has suddenly stopped draining. The tube is connected to suction, the machine is on and functioning and all connections are snug. The tube is secured properly and does not appear to have been dislodged. After checking placement, the nurse gently flushes the tube with 30 mL of normal saline, but the tube still is not draining. The nurse analyzes this problem as:

Channels of gastric secretions may be bypassing the holes in the tube; turning the client will promote stomach emptying

What would you look for in a client that had a partial gastrectomy and two hours after eating is diaphoretic and confused?

Check Blood sugar

A client has just undergone gastroscopy. Which of the following is the essential post-procedure nursing intervention

Check the gag reflex before giving oral foods or fluids.

A client has undergone esophagogastroduodenoscopy (EGD). The nurse places highest priority on which of the following items as part of the client's care plan?

Checking for return of a gag reflex

Alpha interferon injections

Chronic Hep. B: (PEG-Intron, Pegasys): given subcutaneously once weekly.

Which factors may increase a patient's risk of developing cancer of the pancreas?

Cigarette smokers and people with diabetes mellitus

A nurse is providing medication instructions to a client with peptic ulcer disease. Which of the following represents correct information given by the nurse?

Cimetidine (Tagamet) results in decreased secretion of stomach acid.

A nurse has a prescription to give 30 mL of an antacid to a client through a nasogastric (NG) tube that is connected to wall suction. The nurse would do which of the following to perform this procedure correctly?

Clamp the NG tube for 30 minutes following administration of the medication.

A client receiving a high cleansing enema complains of pain and cramping. The nurse would take which corrective action?

Clamp the tubing for 30 seconds and restart the flow at a slower rate.

Osmotic agents: action

Cleanses colon rapidly and induces diarrhea.

A client with hepatic encephalopathy is receiving lactulose (Cephulac). The nurse determines that the medication is effective if which of the following is observed?

Client previously oriented to person only; can now state name, year, and present location

Prophylactic Antibiotics

Clindamycin (abd surgeries) Unasyn (abd surgeries) Gentamycin Vancomycin Kefzol - used to prevent infection - usually hang 2 hours before surgery

Viral hepatitis may be treated at home. Teach the patient's family: (Select all that apply.)

Clothes should be laundered separately with hot water. Personal items and drinking glasses should not be shared. Hands need to be thoroughly washed after toileting.

Colostomy/ Ileostomy

Colostomy has formed stool from water absorption, Ileostomy has formed liquid stool from no water absorption.

Stage 4 - PSE

Coma

Duodenal ulcers

Combined effect of hyper secretion of acid and rapid emptying of food from the stomach reduces the buffering effect of food and results in a large acid load in the duodenum. Person is usually well nourished because empty stomach causes pain

The client scheduled to undergo a liver transplantation expresses a high level of anxiety about the possibility of complications related to the surgery. What information does the nurse relay to the client?

Complications are not unexpected and usually are treatable.

What are the indications for a liver transplant? (Select all that apply.)

Congenital biliary abnormalities Hepatic malignancy Chronic hepatitis

A nurse is caring for a client with pneumonia who has a history of bleeding esophageal varices. Based on this information, the nurse plans care, knowing that it is important to prevent:

Constipation

The nurse is teaching the client about nutritional ways to help manage exacerbations of diverticulitis. Which instruction is best for this client?

Consume a low-fiber diet while diverticulitis is active. When inflammation resolves, consume a high-fiber diet.

A nurse documents that a client with a hiatal hernia is complying with the prescribed treatment if the client reports doing which of the following?

Consuming low-fat or nonfat foods

Salmonella

Contaminated food and drinks; raw eggs- Food-Borne Illness

Reducible Hernia

Contents of hernia sac can be replaced into abdominal cavity

Patient Controlled Analgesic (PCA)-

Continuous IV drip that is pt controlled; delivers a constant low dose or a high dose for BTP; as lock out intervals. Monitor pt q4h (ICU/Peds→q1h). ♥Morphine ♥Hydromorphone

Esophageal varices can rupture as a result of increases in abdominal venous pressure. Which would increase the abdominal venous pressure? (Select all that apply.)

Coughing Vomiting Performing the Valsalva maneuver

A client with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction of 15%. The client is taking warfarin (Coumadin). The expected outcome of this drug is to: a) Prevent thrombus formation. b) Regulate cardiac rhythm. c) Decrease circulatory overload. d) Improve the myocardial workload.

Coumadin is an anticoagulant, which is used in the treatment of atrial fibrillation and decreased left ventricular ejection fraction (less than 20%) to prevent thrombus formation and release of emboli into the circulation. The client may also take other medication as needed to manage the heart failure. Coumadin does not reduce circulatory load or improve myocardial workload. Coumadin does not affect cardiac rhythm

A client with a Sengstaken-Blakemore tube in place to treat esophageal varices suddenly becomes restless. The client's heart rate and blood pressure increase and the client has difficulty breathing. The important initial nursing action is to:

Cut the tube and pull it out.

Vagotomy

Cutting of vagus nerve to eliminate acid secreting stimulus to gastric cell

Which medication would the nurse expect the physician to order postoperatively for a patient who has had a liver transplant?

Cyclosporine

The nurse uses Montgomery straps primarily to achieve which of the following client outcomes? a) The client is free from falls. b) The client is free from bruises. c) The client is free from wandering. d) The client is free from skin breakdown.

D) The nurse uses Montgomery straps primarily to avoid the removal of long-term abdominal dressing tape and ultimate skin breakdown

When assessing a client's incision one day after surgery show redness and warmth around the incision site. What action by the nurse is best? a) Culture the wound. b) Apply a cool compresses TID. c) Assess for blanching. d) Note the wound edges in the client's chart.

D) Warmth and redness are normal signs of an inflammatory response, and do not require interventions such as a cool compress. There are no infectious processes that would require a culture. Blanching would not demonstrate issues with the wound infection.

An RN who usually works in the intensive care unit (ICU) is floated to the medical-surgical unit. Which of these patients will be best to assign to the float nurse? A) A patient with an exacerbation of Crohn's disease who has a draining enterocutaneous fistula B) A patient with ulcerative colitis who needs discharge teaching about the use of hydrocortisone enemas C) A patient who has many questions about how to care for a newly created ileoanal reservoir D) A patient with peritonitis who has just returned from surgery with multiple drains in place

D) A patient with peritonitis who has just returned from surgery with multiple drains in place

The client has a bowel obstruction and receives a Levin tube in the ED. Which nursing intervention is the highest priority for this client? A) Checking peristalsis by auscultating for bowel sounds with the suction connected B) Attaching the Levin tube to continuous low suction C) Flushing the Levin tube with saline every 24 hours D) Attaching the Levin tube to intermittent low suction

D) Attaching the Levin tube to intermittent low suction The Levin tube should only be attached to intermittent suction because it has no vent.

An 80-year-old patient who has had myalgia, nausea, vomiting, and diarrhea for 2 days is admitted to the medical-surgical unit with gastroenteritis. Which request by the health care provider should the nurse implement first? A) Obtain stool specimen for culture and sensitivity. B) Administer acetaminophen (Tylenol) 650 mg rectally. C) Draw blood for complete blood count and electrolytes. D) Give 5% dextrose in 0.45 normal saline at 125 mL/hr.

D) Give 5% dextrose in 0.45 normal saline at 125 mL/hr.

A client has an open cholecystectomy with bile duct exploration. Following surgery, the client has a T-tube. To evaluate the effectiveness of the T-tube, the nurse should: a) Unclamp the T-tube and empty the contents every day. b) Irrigate the tube with 20 ml of normal saline every 4 hours. c) Monitor the multiple incision sites for bile drainage. d) Assess the color and amount of drainage every shift.

D. A T-tube is inserted in the common bile duct to maintain patency until edema from the duct exploration subsides. The bile color should be gold to dark green and the amount of drainage should be closely monitored to ensure tube patency. Irrigation is not routinely done, unless ordered using a smaller volume of fluid. The T-tube is not clamped in the early post-op period to allow for continuous drainage. An open cholecystectomy has one right subcostal incision, whereas a laparoscopic cholecystectomy has multiple small incisions

A client with acquired immunodeficiency syndrome (AIDS) develops Pneumocystis carinii pneumonia. Which nursing diagnosis has the highest priority? a) Imbalanced nutrition: Less than body requirements b) Impaired oral mucous membranes c) Activity intolerance d) Impaired gas exchange

D. Although all of these nursing diagnoses are appropriate for a client with AIDS, Impaired gas exchange is the priority nursing diagnosis for a client with P. carinii pneumonia. Airway, breathing, and circulation take top priority for any client.

A client will receive I.V. midazolam hydrochloride (Versed) during surgery. Which of the following should the nurse determine as a therapeutic effect? a) Nausea. b) Mild agitation. c) Blurred vision. d) Amnesia.

D. Midazolam hydrochloride causes antegrade amnesia or decreased ability to remember events that occurred around the time of sedation. Nausea, mild agitation, and blurred vision are adverse effects of Versed.

While caring for a client who's immobile, a nurse documents the following information in the client's chart: "Turned client from side to back every 2 hours." "Skin intact; no redness noted." "Client up in chair three times today." "Improved skin turgor noted." Which nursing diagnosis accurately reflects this information? a) Constipation related to immobility b) Impaired skin integrity related to immobility c) Disturbed body image related to immobility d) Risk for impaired skin integrity related to immobility

D. The information documented in the client's chart reflects the risk for impaired skin integrity. Because the client's skin is intact, the problem is only a potential one, not an actual one, which makes the nursing diagnosis of Impaired skin integrity inappropriate. If constipation were a problem, interventions would focus on diet and activity. If body image disturbance were a problem, interventions would focus on the client's feelings about himself and his disease.

When assessing a client's I.V. insertion site, a nurse notes normal color and temperature at the site and no swelling. However, the I.V. solutions haven't infused at the ordered rate; the flow rate is slow even with the roller clamp wide open. When the nurse lowers the I.V. fluid bag, no blood returns to the tubing. What should the nurse do first? a) Discontinue the I.V. infusion at that site and restart it in the other arm. b) Irrigate the I.V. tubing with 1 ml of normal saline solution. c) Elevate the I.V. fluid bag. d) Check the tubing for kinks and reposition the client's wrist and elbow.

D. The nurse should check for common causes of a decreased I.V. flow rate, such as kinks in the tubing and poor positioning of the affected arm. The nurse should discontinue the I.V. infusion only if other measures fail to solve the problem. Irrigating I.V. tubing may dislodge any clots that are present. Elevating the I.V. fluid bag may help if the nurse finds no kinks and if repositioning doesn't resolve the problem.

A client is scheduled for an appendectomy. What is the nurse's highest priority when planning preoperative teaching for this client? a) The client should be encouraged to take food and fluids to prevent dehydration and malnutrition. b) The client's skin should be assessed hourly. c) Surgical wound infection is most likely to occur during the first postoperative day. d) The client should begin coughing and deep-breathing exercises as soon as he's able to follow instructions.

D. The nurse should encourage the client to cough and breathe deeply as soon as possible after surgery to help prevent atelectasis and pneumonia. She shouldn't encourage the client to take food or fluids until bowel sounds are present (usually 24 hours postoperatively). Wound infection is a concern, but usually not during the first postoperative day. The nurse should assess the client's skin every 2 hours when he is made to either change position or get out of bed

Which of the following should the nurse include when teaching the family and a client who was prescribed benztropine (Cogentin), 1 mg P.O. twice daily, about the drug therapy? a) Antacids can be used freely when taking this drug. b) Alcohol consumption with benztropine therapy need not be restricted. c) The drug can be used with over-the-counter cough and cold preparations. d) The client should not discontinue taking the drug abruptly.

D. The nurse should teach the client and family the importance of not discontinuing benztropine abruptly. Rather, the drug should be tapered slowly over a 1-week period. Benztropine should not be used with over-the-counter cough and cold preparations because of the risk of an additive anticholinergic effect. Antacids delay the absorption of benztropine, and alcohol in combination with benztropine causes an increase in central nervous system depression; concomitant use should be avoided

Diuretic therapy with furosemide is started for a client with heart failure. Two days after the drug therapy is started, the nurse evaluates the furosemide as effective when the client has experienced which of the following outcomes? a) Has an improved appetite and is eating better. b) Is less thirsty than she was before the drug therapy. c) Has clearer urine since starting furosemide. d) Weighs 6 lbs (3 kg) less than she did 2 days ago.

D. The primary reason to give a diuretic to a client with heart failure is to promote sodium and water excretion through the kidneys. As a result, the excessive body water that tends to accumulate in a client with heart failure is eliminated, which causes the client to lose weight. Monitoring the client's weight daily helps evaluate the effectiveness of diuretic therapy. The client should be advised to weigh herself daily. An increased appetite or decreased thirst does not establish the effectiveness of the diuretic therapy, nor does having clearer urine after starting furosemide.

What pain med for acute chlecysisits

DEMEROL

Esophageal neoplasms

DX with barium swallow, endoscope, biopsy, CT

A patient is admitted with a diagnosis of Crohn's disease. What nursing interventions would be appropriate when caring for this patient? (Select all that apply.)

Daily weight Monitor I & O every shift Accessibility to bedside commode

Treatment for Malignant Hyperthermia

Dantrium (Dantrolene) meds for hyperkalemia: IV Sodium Bicarb IV Dextrose IV Insulin give pt 100% Oxygen cooling blanket

treatment of Malignant Hyperthermia

Dantrium (Dantrolene) meds for hyperkalemia: IV Sodium Bicarb IV Dextrose IV Insulin give pt 100% Oxygen cooling blanket

Medical management of small bowel obstruction.

Decompression of the bowel via nasogastric tube. Surgical correction of adhesions, or other cause of obstruction.

Robinuol side effects

Decrease salivation, and respiratory secretions. Decrease GI motility S/E HA, confusion, drowsiness, nasal congestion, dry mouth.

For patients with diarrhea

Decreased Urine output( less than 0.5 mL/kg/hr for 2 to 3 consecutive hours), Muscle weakness, paresthesia, hypotension, anorexia, and drowsiness with Serum potassium < 3.5 mEq/L must be reported.

The nurse is monitoring the client undergoing a paracentesis. Which changes in the client's status does the nurse immediately report to the physician?

Decreased blood pressure, increased heart rate

Hepatitis D- Nursing Care

Delta hepatitis- Transmitted through transfusion, hemodialysis, IV. Dx: HBsAg present. Tx: alpha interferon.

Diarrhea/constipation in IBS may be improved by

Determination of types of foods the provoke symptoms, High fiber diet.

Blood Glucose

Diabetic 10-115mg/dl

List the reasons why someone would have surgery?

Diagnostic, Curative, Palliative, Restorative, Cosmetic, and Transplant

A nurse is reviewing the record of a client with Crohn's disease. Which of the following stool characteristics would the nurse expect to see documented in the record

Diarrhea

Clinical manifestations

Diarrhea, passage of mucus and pus, left lower quadrant pain, intermittent tenesmus and rectal bleeding. Pallor, anemia, fatigue. Anorexia, weight loss, fever vomiting, dehydration. Passage of 10 -20 liquid stools/day. Hypocalcemia and anemia.

Sedatives / Hypnotics

Diazepam (Valium) muscle relaxant Lorazepam (Ativan) muscle relaxant Midazolam (Versed) conscious sedation - also used for their anti-anxiolytic effect - can be over emotional post-op (Versed) - amnesia affect

GERD/ Hiatal Hernia- Nursing Care

Diet: Avoid irritating foods (chocolate, fats, spicy, acidic foods), eliminate carbonated beverages, give frequent small meals, sit up for 3 hrs after eating, do not eat 3 hrs before bedtime. Avoid alcohol/ smoking, sleep on 6" blocks HOB elevated

Your patient is undergoing diagnostic tests to rule out carcinoma of the oral cavity. Which of the following symptoms have been associated with the disease? Select all that apply.

Difficulty in chewing, swallowing, or speaking Constant earache Toothache Mouth edema Numbness or loss of sensation in part of the mouth

A major factor in high death rate from pancreatic cancer is: (select all that apply)

Difficulty in diagnosing it at at an early curable stage The majority of cancers have metastasized at the time of diagnosis

A client with possible hiatal hernia complains of frequent heartburn and regurgitation. The nurse should gather further information about the presence of which signs or symptoms

Difficulty swallowing

A client with a possible hiatal hernia complains of frequent heartburn and regurgitation. Which sign or symptom would support this diagnosis?

Difficulty swallowing both liquids and solids

Esophagus pain

Diffuse esophageal spasm caused by acid coming up causing pain→ spasms

Patient is NPO for surgery and is Rx digoxin, senna, and zoloft, what can be given the day of surgery

Dig.

Endoscopy:

Direct visualization of GI system by a lighted, flexible tube

A NANDA-accepted nursing diagnosis that could be written for a patient with an abdominoperineal resection and a permanent colostomy would include

Disturbed body image.

The patient, age 32, has ulcerative colitis, and his condition is deteriorating. An ileostomy is scheduled. After the procedure, this patient may be at risk for

Disturbed body image.

Aciphex/ Protonix Nursing Care

Do not crush,enteric coated- Used to treat Ulcers. (rabeprazole/pantoprazole)

Lubricant laxatives: patient eduction

Do not take mineral oil with meals because it can impair absorption of fat soluble vitamins, and delay gastric emptying. Swallow carefully because drops of mineral oil that gain access to the pharynx can cause lipid pneumonia. Glycerin suppositories must be inserted fully and retained.

A client is resuming a diet after partial gastrectomy. To minimize complications, the nurse would tell the client to avoid doing which of the following?

Drinking liquids with meals

A nurse is collecting admission data on the client with hepatitis. Which of the following findings would be a direct result of this client's condition?

Drowsiness

post-op complications of smokers, ETOH, and drug abusers

Drug users- heart problems and hypotensive crisis ETOH- alter response to anesthesia and pain meds (may need higher dose) Smoker- increase risk of pulmonary complications, difficulty clearly secretions post op

Pre-op assessment of Elderly's Skin: list what you would expect to find

Dryness, delayed wound healing, decreased amy of subQ fat increasing risk for damage and infection.

Commonly reported symptom associated with PUD

Dyspepsia (indigestion)

S/S of Gastric Cancer

Early Stage: - asymptomatic - heartburn - abdominal discomfort - change in diet - epigastric pain - back pain Advanced Stage: - progressive weight loss - nausea & vomiting - weakness - fatigue - anemia - occult blood

A nurse is reinforcing dietary instructions to a client with peptic ulcer disease. The nurse encourages the client to:

Eat anything as long as it does not aggravate or cause pain.

A nurse is providing dietary instructions to a client with peptic ulcer disease. The nurse tells the client to:

Eat anything that does not aggravate or cause pain.

A nurse documents that a client with a hiatal hernia is implementing effective health maintenance measures after the client reports doing which of the following?

Eating low-fat or nonfat foods

Turner Sign

Ecchymosis on the flank area with Cullen sign.

Cullens Sign

Echimosis around umbilical

The patient has cirrhosis of the liver and an albumin/globulin ratio of 0.9 g/dL. The normal ratio is 1.2 to 2.2 g/dL. In collecting objective data for her, the nurse would probably note which outstanding clinical sign?

Edema

Paralytic (adynamic) ileus is a functional intestinal obstruction that may result from:

Electrolyte imbalance, postabdominal surgery, or acute inflammatory reactions

A nurse is instructing a client who had a herniorrhaphy about how to reduce postoperative swelling following the procedure. Which of the following would the nurse suggest to the client to prevent swelling?

Elevate the scrotum

The client with a family history of CRC regularly visits the health care provider to detect any signs of cancer early. Which laboratory result may be an indication of CRC in this client?

Elevated carcinoembryonic antigen Hgb would decrease, occult blood would be present, increase in liver function

Nursing management of patient with constipation

Elicit information. Patient education about preventing constipation and laxative safety.

What instructions should the patient receive before undergoing a paracentesis?

Empty bladder before procedure

The client with CRC is 1 day postoperative after colostomy surgery. The client is very anxious about caring for the colostomy and is afraid that all the physician's instructions will be overwhelming. Which initial intervention by the nurse is of highest priority? A) Encouraging the client to verbalize feelings about the colostomy and its required care B) Scheduling a visit from a client who has a colostomy and is successfully caring for it C) Encouraging the client to look at and touch the stoma D) Instructing the client about the care of the colostomy

Encouraging the client to look at and touch the stoma

Which test can distinguish between peptic ulcer disease and gastric malignancy?

Endoscopy with biopsy

Management of constipation with laxatives involves

Enemas and rectal suppositories are not generally recommended unless rectal evacuation is a problem. Then glycerin suppositories are usually considered first line therapy, followed by biscodyl suppositories or mini enemas.

Analgesic Adjuvants-

Enhances primary analgesics Tricyclic Antidepressants- Neuropathic and chronic pain ♥Amitriptyline (elavil)

The home health nurse is discussing community resources available to the client who is scheduled for a colostomy after being diagnosed with colorectal cancer (CRC). Which resource referral by the nurse is of greatest value to this client?

Enterostomal therapist

A severe intestingal infection caused by contaminated undercooked beef such as hamburger from a specific pathogenic bacteria present in some cattle is called:

Escherichia coli O157:H7 intestinal infection

Barrett's Esophagus

Esophageal adenocarcinoma-from long term acid reflux.

A nurse is assigned to care for a client with a Sengstaken-Blakemore tube. The nurse should suspect that the client has which diagnosis?

Esophageal varices

The diagnostic test that involves visualization of the esophagus, stomach, and duodenum via a flexible endoscope is called a(n):

Esophagogastroduodenoscopy

EGD

Esophagus, stomach, duodenum

ERCP

Esophagusretrograde cholangiopancreatography: liver, GB, and bile ducts

Before administering an intermittent tube feeding through a nasogastric tube, the nurse checks for gastric residual volume. The nurse understands that the rationale for checking gastric residual volume before administering the tube feeding is to:

Evaluate absorption of the last feeding

Cholecystectomy nursing interventions

Explain/reinforce info regarding surgical procedure pain control post op assessment C&DB, incentive spirometer bile replacement assess and record color and volume of T tube drainage avoid tension and kinking on tube drainage bag at level of abd T tube teaching

S/S of Hemorrhoids

External: enlarged mass at anus Internal: Bleeding Rectal itching Bright red blood in stool

Blood Glucose:

FBS 70-115mg/dL (screen for DM), 2hr PPBS, HgA1C BS control over last 12 weeks w/a target of 7

Radiographic tests

FLat plate Acute Ab series CT Upper GI Modified Barium swallow Lower GI

The client is scheduled for a liver transplantation secondary to hepatitis C infection and is being transferred to the hepatic transplantation unit. The nurse collaborates with the other health care team members to modify the client's plan of care. What is the expected outcome for this client?

Failure of the transplanted organ if it becomes infected with hepatitis C

A client is scheduled for an oral cholecystography. The nurse would plan to obtain what type of diet for the evening meal before the test?

Fat-free

A client is admitted to the hospital with acute viral hepatitis. Which signs or symptoms would the nurse expect to note, based upon this diagnosis?

Fatigue

Lab Assessment - Stool

Fecal Occult Blood Test - microscopic blood Ova & parasite Fecal Fats - not breaking down fats Cdiff - overgrowth bacteria / related to antibiotics / yellowish green color

A client is admitted to the hospital with severe jaundice and is having diagnostic testing. Because the client has no complaints of fatigue, the client is encouraged to ambulate in the hall to maintain muscle strength. The client paces around the room but will not enter the hall. Which of the following problems most likely is the reason for the client's reluctance to walk in the hall?

Feeling self-conscious about appearance

Hgb

Female: 12-16 Male: 13-18

Clinical manifestation of constipation involve

Fewer than 3 bowel movements/week. abdominal distention, pain and pressure, decreased appetite, headache, fatigue, indigestion, sense of incomplete evacuation, straining at stool, small volume, lumpy hard, dry stools.

what the common medications are that are used for H. Pylori

Flagyl Biaxin or tetracycline or amoxocillin

Dumping Syndrome

Fluid moving to quickly into the bowel and not being absorbed causing diarrhea

Dumping syndrome is a disorder associated with what condition?

Following gastric resection or peptic ulcer surgery

A nurse is preparing to administer an enteral feeding through a nasogastric tube. The nurse would place the client in which position during and after the feedings?

Fowler's

A licensed practical nurse (LPN) is assisting in insertion of a nasogastric (NG) tube for an adult client. The LPN helps determine the correct length to insert the tube by measuring:

From the tip of the client's nose to the earlobe and then down to the xiphoid process

findings with portal HTN

GI bleeding, esophageal varices (sudden bleeding veins) ; hemorrhoids, anemia , gastritis, GI ulcers, prolonged clotting increased pressure backs up into veins

A patient has been admitted with right upper quadrant pain. Which would most likely be a source of her pain?

Gallbladder

The preferred diagnostic test for visualizing the biliary tree in a patient with jaundice is called a(n):

Gallbladder ultrasound

Name three herbs that can cause surgical complications and how they can do it.

Garlic decreases blood pressure but increases the risk of bleeding; Licorice increases Na and K; and St. Johns wort (herbal prozac) may interfere with anesthesia

What are 3 types of Ulcers?

Gastric Ulcer Duodenal Ulcer Stress Ulcer

Differences in Gastric & Duodenal ulcers

Gastric: - may be malnourished - normal or hypo secretion of stomach acid - pain 30-60 min after eating - worse after eating - Hematemesis more common - Atrophic gastritis Duodenal: - usually well nourished - hyper secretion of stomach acid - pain 1.5-3 hr after eating & at night - better after eating - melena more common - No gastritis

Ulcer pain

Gastric: food = pain upper epigastrium to left of midline Duodenal: Pain on empty stomach, at night, in upper epigastrium right of midline

Billroth 1

Gastroduodenostomy

Billroth 2

Gastrojejunostomy

Nissen Fundopilication

Gerd surgery management; sutures fundus -ngt teaching -slow advancement of feeding -small freq meals -early ambulation -avoid carbonated beverages -avoid straw -report dysphagia, feeling of abdominal fullness

A nurse is assisting in caring for a client with a Sengstaken-Blakemore tube. To prevent ulceration and necrosis of oral and nasal mucosa, the nurse plans to:

Give frequent oral and nasal care.

Anesthesia Adjuncts-

Given for pain relief, amnesia, and muscle relaxation; includes Hypnotics, Opioids, and Neuromuscular Blockers→♥Pancuronium (pavulon), ♥Vercuronium (norcuron), ♥Succinylcholine (anectine). Antagonist for neuromuscular blockers→Neostigmine

General Anesthesia-

Given thru inhalation→ Nitrous Oxide (laughing gas; produces more analgesia than anesthesia), and Volatile Liquids; dangerous due to risk of malignant hypothermia (end in "ane"→♥Halothane, Isoflurane, Desflurane, Enflurane); or IV→Barbiturates- ♥Thiopenthal Sodium (pentothal), ♥Methohexital Sodium (brevital) Non-Barbiturates- ♥Ketamine (ketalar)♥Propofol (diprivan)

Nursing management of the appendicitis

Goals include -relieving pain -preventing fluid volume deficit, -reducing anxiety, -eliminating infection -maintaining skin integrity, -attaining optimal nutrition.

The health care worker believes that he may have been exposed to hepatitis A. Which intervention is highest priority to prevent him from developing the disease?

Going to the emergency department (ED) for administration of immunoglobulin

famotidine (Pepcid)

H2 antagonist- management of hypersecretion- Assess for blood in stool, confusion, avoid alcohol and asprin/NSAIDS

Protein

Hair loss, muscle wasting, edema, mental confusion

You have a patient with acute diarrhea, what assessment question is best to ask?

Have you traveled out of the country recently?

A nurse has been caring for a client with a Sengstaken-Blakemore tube. The health care provider arrives on the nursing unit and deflates the esophageal balloon. Following deflation of the balloon, the nurse should monitor the client most closely for which of the following

Hematemesis

A client diagnosed with pernicious anemia asks the nurse what caused the deficiency. The nurse replies that it is likely a result of which of the following conditions that is part of the client's health history?

Hemigastrectomy

A nurse analyzes the results of laboratory studies performed on a client with peptic ulcer disease. Which of the following laboratory values would indicate a complication associated with the disease?

Hemoglobin 10.2 g/dL

After the deflation of the balloon of a client's Sengstaken-Blakemore tube, the nurse monitors the client closely for which esophageal complication?

Hemorrhage

Complications of PUD

Hemorrhage Perforation Obstruction

Complications of Peptic Ulcer

Hemorrhage Perforation Obstruction

It has been determined that a client with hepatitis has contracted the infection from contaminated food. What type of hepatitis is this client most likely experiencing?

Hepatitis A

Infection control is necessary in all areas of the health care setting. Which would be most appropriate in the prevention of hepatitis B in high-risk health workers?

Hepatitis B vaccine

Of the following infection control methods, which would be the priority to include in the plan of care to specifically prevent hepatitis B in a client considered to be at high risk for exposure?

Hepatitis B vaccine

Urine Bilirubin (Jaundice Labs)

Hepatocellular - Increased Obstructive - Increased Hemolytic - None

Serum Bilirubin Direct (Jaundice Labs)

Hepatocellular - Increased Obstructive - Moderately Increased Hemolytic - Normal

Serum Bilirubin Indirect (Jaundice Labs)

Hepatocellular - Increased Obstructive - Slightly Increased Hemolytic - Increased

Urobilinogen Stool (Jaundice Labs)

Hepatocellular - Normal to Decreased Obstructive - None Hemolytic - Increased

Urobilinogen Urine (Jaundice Labs)

Hepatocellular - Normal to Increased Obstructive - None Hemolytic - Increased

A nurse is assisting with the insertion of a nasogastric tube into a client. The nurse places the client in which position for insertion?

High Fowler's position

Nursing interventions after appendix surgery include

High Fowler's position, to reduce tension on the incision, and reduce pain. Administer pain medication as prescribed. Assess VS, esp temperature.

Total Parenteral Nutrition

High density IV solutions to pack in nutrients. Short term. Aseptic techniques Change solution and tubing q 24 hrs Dressing changes every 72 hours

A client has asymptomatic diverticular disease. What type of diet should the nurse anticipate to be prescribed

High-fiber diet

Nursing management of patient with fecal incontinence

History and Physical examination. Assessment for fecal impaction, and removal before preventive therapies. Bowel Training. Dietary teaching. Maintaining skin integrity of perineum. If necessary assisting patient and family to cope with change in continence. Fecal incontinence devices.

A client complains of stomach pain 30 minutes to 1 hour after eating. The pain is not relieved by further intake of food, although it is relieved by vomiting, and a gastric ulcer is suspected. The nurse should gather which of the following additional supportive data for this diagnosis from the client?

History of alcohol use, smoking, and weight loss

A client complains of stomach pain 30 minutes to 1 hour after eating. The pain is not relieved by further intake of food, although it is relieved by vomiting. A gastric ulcer is suspected. Which of the following data would further support this diagnosis?

History of alcohol use, smoking, and weight loss

A nurse is collecting data on a client with a diagnosis of peptic ulcer disease. Which of the following is least likely associated with this disease?

History of the use of acetaminophen (Tylenol) for pain and discomfort

A nurse is preparing to administer an intermittent tube feeding to a client with a nasogastric tube. The nurse checks the residual and obtains an amount of 200 mL. The nurse would:

Hold the feeding

The client with a long history of osteoarthritis has an extensive incision after a colon resection and is experiencing a postoperative infection. The client's wound requires extensive irrigation and packing. Which priority intervention regarding the client's care does the nurse discuss with the health care provider?

Home health consultation for wound care

Complications of Constipation include

Hypertension, fecal impaction, hemorrhoids, fissure, and megacolon.

Interventions for peptic ulcer

Hypovolemic shock assessment: ↓BP, tachy Peritonitis assess: ridged boardlike ab, no bowel sounds Replace fluids and lytes ( if needed) Antibiotic VS NO PAIN MEDS TIL DX NPO NG drain surgical management

Stages of intra-op anesthesia

I Relaxations (sedation, analgesia) II Excitement, delirium III Operative, (surgical anasthesia) IV Danger

The nurse is teaching a postgastrectomy patient about dumping syndrome. The patient wound indicate the need for further instruction if she made which statement?

I will avoid fats and increase carbohydrates

Medical management

I.V. Fluid to replenish losses from intravascular space to the peritoneal cavity. Analgesics. Antiemetics. Intestinal intubation to relieve abdominal distention. Antibiotics. Surgery to remove infectious material and correct cause.

Conscious Sedation-

IV meds used to induce a ↓ LOC while maintaining airway & ability to respond to verbal commands. Used for Cardiac Caths, Endoscopy, Fx

A nurse is reviewing the medication record of a client with acute gastritis. Which of the following medications, if noted on the client's record, would the nurse question

Ibuprofen (Motrin)

Medical management of large bowel obstruction

Immediate correction of intravascular volume, and nasogastric aspiration, and decompression. Colonoscopy to untwist and decompress the bowel.

Postoperative Nsg Dx

Impaired Gas ExchangeRisk factors- type/location of surgery, age, nutrition, duration of procedure→ NI: Assess breath sounds, Pain mgmt, hydration, breathing exercises/incentive spirometry, ambulation as ordered Impaired Skin Integrity(complications: Dehiscence,edges separate/ Evisceration, contents come out)→ NI: Dressings, Drains, Antibiotics, Assess for infection, Acute pain PC: Hypoxemia (s/s: restlessness, pallor, pulse Ox<90%, ↓ or abn breathe sounds, tachypnea, tachycardia, use of accessory muscles), Atelectasis, DVT, PE, Shock

A nurse is caring for a client with anorexia. The nurse plans care for the client, focusing on which of the following as the primary problem?

Impaired nutritional status

A nurse is working with a client diagnosed with anorexia nervosa. The nurse plans care, focusing on which of the following as the primary problem?

Impaired nutritional status

Stage 2 - PSE

Impending: - deteriorated handwriting - asterixis (flapping hands at wrist) - drowsiness - confusion - lethargy

Botulism

Improperly canned fruits and vegetables- Food-Borne Illness

♥ Restorative-

Improve functional ability (hip, knee replacement)

A nurse is caring for a client with acute pancreatitis and a history of alcoholism and is monitoring the client for complications. Which of the following data would be a sign of paralytic ileus?

Inability to pass flatus

Prokinetic Agents

Inc LES tone, improves esophageal peristalsis, inc rate of gastric emptying ex: Reglan

Reglan

Increase gastric emptying- Side effects: restlessness, anxiety, hallucinations, insomnia- tx GERD

A client is admitted to the hospital with viral hepatitis and is complaining of a loss of appetite. In order to provide adequate nutrition, the nurse encourages the client to:

Increase intake of fluids.

The client with cirrhosis has recently developed the complication of portal systemic encephalopathy and has just been discharged back into the home setting. Which intervention is the highest priority for the nurse to teach family members when the client demonstrates the first sign of encephalopathy?

Increase the daily dose of lactulose.

Clinical manifestations of Diarrhea

Increased frequency and liquidity of stool, Abdominal cramps, Distention, borborygmus, anorexia, thirst.

CEA (carcinoembryonic antigen)

Increased levels=colorectal cancer, cirrhosis, hepatic, alcoholic pancreatitis, heavy smoker

CA 19-9

Increased: pancreas, stomach and colon cancer, acute pancreatitis, IBD (most likely)

. A NANDA-accepted nursing diagnosis that could be written for the patient who is hemorrhaging and in hypovolemic shock from a bleeding peptic ulcer would include

Ineffective tissue perfusion (gastrointestinal).

. Which would be a major nursing concern to monitor postoperatively in a patient who has had a liver transplant?

Infection

Ulcerative Colitis

Inflammation of colon and rectum and proceeds upward- S/S: cramping, tenesmus (spasms), Vomiting, wt. loss, fever, bloody diarrhea, rectal bleeding.

Hepatitis

Inflammation of the Liver cells

Preoperative Nsg Interventions

Informed Consent- Surgeon is responsible for having the pt sign the consent BEFORE surgery. Reason for surgery, other options, assoc. risk, w/procedure & anesthesia, who is performing surgery, who will be present during surgery, Dietary Restrictions-NPO @ midnight, Regularly scheduled meds- w/ sips of H2O, BP, seizure, resp. meds can be taken; GI Prep- colon emptied, Skin preparation- anti microbial scrub; shaved preop

The client has developed gastroenteritis while traveling outside the country. Which is the likely cause of the client's symptoms?

Ingestion of parasites in water

What drugs increase the risk of malignant hyperthermia?

Inhalations ending in ANE

Management of Diverticulitis

Initially clear liquid diet, then progress to high fiber, low fat diet. Bulk laxatives.

Clinical manifestations of peritonitis

Initially diffuse pain with intensity increasing over time, aggravated with movement. Abdomen becomes tender and paralytic ileus may be present. Temp 100 to 101 Degrees F, (37.8-38.3 Degrees C). As condition progresses, hypotension may develop.

Epidural Anesthesia-

Injected into the epidural space; used in OB & lower extremity procedures; used for post-op pain mgmt.

Spinal Anesthesia definition

Injection into the cerebrospinal fluid in the subarachnoid space. (For lower abn, pelvic, hip, knee surgery)

Epidural Anesthesia definition

Injection into the epidural space. (For anorectal, vaginal, perineal, hip and lower extremities)

Settings:

Inpatient, Short stay, Outpatient, Ambulatory

Same day admission. Inpatient or outpatient?

Inpatient, more complicated surgeries. Key word: "admission"

Nasogastric Tube (NG Tube):

Inserted @ bedside & extends into stomach; single lumen (Levin tube), double lumen (Salem sump tube) used most often; usually attached to suction-keep pigtail port patent. Can be used short term for enteral feedings b/c of high risk of aspiration (test for placement- aspirate residual color & amt, air test→30cc of air in syringe, inject fast & listen for air bubble in abd) CHECK PLACEMENT EACH TIME BEFORE USING TUBE!! Removed when bowel sounds present & pt is tolerating PO

Gavage

Instillation of liquid nutritional supplements into stomach

Compression

Internal application of pressure by means of inflated balloon to prevent GI bleeding

General Anesthesia

Intravenous Agents Inhalation Agents reversible loss of consciousness induced by inhibiting CNS

Which substance, produced by the parietal cells located in the wall of the stomach, facilitates the absorption of vitamin B12?

Intrinsic factor The absence of the intrinsic factor causes pernicious anemia

A patient is scheduled to undergo T-tube cholangiography. Prior to administration of contrast dye, it is essential that the nurse determine if the patient has any allergy to:

Iodine

Irritable Bowl Syndrome-Nursing Care

Irregular bowl patterns, IBS constipation, IBS diarrhea, or both. S/S: Abdominal pain, gas, bloating, diarrhea, constipation. Tx: eliminate gas forming foods (grapes, apple juice, milk, sugarless gum), give anti-spasmodics.

Pt in stage II anesthesia will exhibit?

Irregular breathing

A nurse is caring for a client after a Billroth II procedure. On review of the postoperative prescriptions, which of the following, if prescribed, would the nurse question and verify?

Irrigating the nasogastric (NG) tube

Lavage

Irrigation of stomach to remove secretions

Stimulant laxatives: action

Irritates the colonic epithelium by stimulating sensory nerve endings and increasing mucosal secretions and decreasing large intestinal water absorption. Action occurs within 6 to 8 hrs.

A nurse has given postprocedure instructions to a client who has undergone a colonoscopy. The nurse determines that the client did not fully understand the directions if the client states that:

It is all right to drive an hour after the test is finished.

Your pt has Cholelithiasis what assessment finding would indicate that the stone has obstructed the common bile duct?

Jaundice

___________ is a condition characterized by yellowing of the sclera and the skin.

Jaundice

Nursing Care for Crohn/ Ulcerative Colitis

Keep NPO or NG tube inserted, Avoid high-fiber, high residue diets,

The client is scheduled to undergo a liver transplantation. Which nursing intervention is most likely to prevent the complication of bile leakage and abscess formation?

Keep the T-tube in a dependent position. Keeping the T-tube in a dependent position and secured to the client is likely to prevent bile leakage, abscess formation, and hepatic thrombosis.

Spinal anesthesia

L2-L3 or L3-L4

A nurse is assisting in planning stress management strategies for the client with irritable bowel syndrome. Which suggestion would the nurse give to the client?

Learn measures such as biofeedback or progressive relaxation.

A nurse should include which of the following in a teaching plan for a client who has peptic ulcer disease?

Learn to use stress reduction techniques

A nurse would include which of the following when reinforcing home care instructions for a client who has peptic ulcer disease?

Learn to use stress reduction techniques.

A nurse is preparing to administer a soapsuds enema to a client. Into which position does the nurse place the client to administer the enema?

Left Sim's

A nurse is administering a cleansing enema to a client with a fecal impaction. Before administering the enema, the nurse assists the client to which of the following positions?

Left Sims' position

A nurse is teaching the client about an upcoming colonoscopy procedure. The nurse would include in the instructions that the client will be placed in which of the following positions for the procedure?

Left Sims' position

Total Cholesterol:

Less than 200mg/dL (above are at risk for cardiovascular disease

Total Cholesterol:

Less than 200mg/dL (above are at risk for cardiovascular disease);

Oral Cavity Premalignant Tumors

Leukoplakia - white plaque / can't scrap it off Erythoplakia - red velvety patch / early sign for squamous cell cancer

Describe the Five Levels in the Physical Status Classification System (Am. Society of Anesthesiologists)

Level I: healthy no systemic disease Level II: well controlled disease that affects one organ Level III: controlled disease that affects a major body system OR disease that affects more than one body system, limited but not incapacitate, and is in no imminent danger Level IV: poor health, uncontrolled severe disease, incapacitated, and death is possible Level V: very poor health, high risk of death

A nurse provides instructions to a client after a liver biopsy. The nurse tells the client to:

Lie on the right side for 2 hours

The nurse is providing discharge instructions to a client after gastrectomy. Which measure will the nurse instruct the client to follow to help prevent dumping syndrome?

Limit the fluids taken with meals.

Fatty Liver (Steatosis)

Lipid infiltration which causes liver enlargement, increased firmness and decreased liver function

Saline laxatives: patient education

Liquid preparation more effective than tablet form. *Only short term use is recommended because of toxicity. Should not be take by patients with renal insufficiency*.

The largest glandular organ in the body, which functions as an accessory organ of digestion, is the:

Liver

GI labs PT

Liver is main site of proteins involved in coagulation

Nursing Dx associated with patient that has BKA surgery

Loss of Body part

Local & Regional Anesthesia-

Loss of sensation w/out loss of consciousness; includes spinal & epidural routes.

A nurse has assisted in the insertion of a Levin tube for gastrointestinal (GI) decompression. The nurse plans to set the suction to which of the following pressures?

Low and intermittent

A nurse has assisted with the insertion of a Levin tube for gastrointestinal (GI) decompression. The nurse expects that the health care provider will prescribe the suction setting at:

Low and intermittent

Pancreatitis diet

Low fat avoid alcohol

A client has been diagnosed with acute gastroenteritis. Which of the following diets should the nurse anticipate would be prescribed for the client

Low fiber

A client with acute pancreatitis is experiencing severe pain from the disorder. The nurse tells the client to avoid which position that could aggravate the pain?

Lying flat

A client with hiatal hernia chronically experiences heartburn after meals. The nurse would teach the client to avoid which of the following, which is contraindicated with hiatal hernia?

Lying recumbent after meals

A nurse is caring for a client within the first 24 hours following a total gastrectomy for gastric cancer. The nurse should focus interventions on which of the following during this time frame

Maintaining a patent nasogastric (NG) tube

A nurse who is assisting in the care of a client within the first 24 hours following a total gastrectomy for gastric cancer should focus interventions on which of the following?

Maintaining a patent nasogastric (NG) tube

Nursing management of diverticulitis

Maintaining normal elimination patterns Relieving pain. Monitoring and preventing potential complications Promoting home and community based care.

♥ Explorative/Diagnostic-

Make or confirm a Dx (biopsy, oscopy)

Stimulant laxative: patient education

May cause fluid and electrolyte imbalance, especially in the older adult. *Should be swallowed whole, not crushed or chewed.* Avoid milk or antacids within 1 hour of taking medication. *Stimulant laxatives are not intended for long term use.*

Staphylococcal

Meat, dairy products, Human carriers- Food-Borne Illness

The patient has advanced cirrhosis of the liver with an acute exacerbation of hepatic encephalopathy. What type of food might be limited in his diet?

Meats

Causes of diarrhea include

Medications, Some enteral feeding formulas, metabolic and endocrine disorders, Viral or bacterial infectious process, Nutritional and malabsorbtion disorders. Zollinger-Ellison syndrome, Paralytic ileus, intestinal obstruction. AIDS.

Preoperative Assessment Health Hx-

Medications: Antihypertensives (may be taken w/a sip of H20),Corticosteroids (may cause ↓wound healing; stopped), Insulin (pt is given a reduced or modified dose based on BG level), Anticoagulants (;stopped), Glaucoma meds (may cause cardiovascular/resp. collapse;stopped), Mycin antibiotics (mixed w/muscle relaxants may cause resp. paralysis; stopped). Herbs: Garlic (hypotension,↑ bleeding;stopped), Licorice (↑Na + K;stopped), St John Wort (interferes w/anesthesia;stopped) Substance Abuse: ETOH (pt needs↑doses of pain meds & anesthesia), Tobacco (pulmonary complications ↑).

A client in the emergency department reports right lower quadrant abdominal pain. After noting a white blood cell count of 16,500/mm3, the nurse would question a prescription for which of the following?

Milk of magnesia

A nurse is caring for a client in the emergency department who has right lower quadrant abdominal pain. After noting a white blood cell count of 16,500/mm3, the nurse should question a prescription for which of the following?

Milk of magnesia

Degree of Risk

Minor - biopsy Major - open heart surgery

Nursing management patients with peritonitis

Monitor Arterial BP, PWP, and CVP, and I7O's . Analgesics as prescribed. Position on side, with knees flexed to decrease tension on abdominal organs. I.V. Fluids. Observe for improvement. Increase oral fluids and food gradually.

The most important nursing intervention to assure the patency of a nasogastric tube (NG) is to:

Monitor NG for patency and irrigate with sterile normal saline PRN as ordered.

Bowel Obstruction-Nursing Care

Monitor NG tube patency, measurement abdominal girth (size of abdomen)

Epidual Analgesia-

Monitor catheter site, monitor q1h ♥Fentanyl ♥Bupivacaine

A nurse will be providing postprocedure care to a client who has undergone esophagogastroduodenoscopy (EGD). The nurse would plan to do which of the following first once the client arrives?

Monitor for return of the gag reflex.

A client has just undergone a gastroscopy. Which action should be taken by the nurse as the essential post-procedure nursing intervention?

Monitoring for the gag reflex

A nurse planning care for a client with hepatitis plans to meet the client's safety needs by:

Monitoring prothrombin and partial thromboplastin values

A recently approved medication for the treatment of Chron's disease, infliximab (remicade), is classified as which type of drug?

Monoclonal antibody

Narcotic Analgesics

Morphine Hydromorphone (Dilaudid) Sublimaze (Fentanyl) Meperidine (Demerol)-(very limited applications/used for shakes & shivers) - used for pain relief with anesthesia * reversal agent - Narcan

The nurse explains that morphine contraindicated in the patient with pancreatitis because:

Morphine may cause spasms of the sphincter of Oddi.

Peptic Ulcer Disease

Mucosa defenses become impaired & no longer protect the epithelium from the effects of acid & pepsin

S/S of acute acalculous cholecystitis

N/V fever leukocytosis RUQ/epigastric pain

If pt is on corticosteroids pre-op, would you want to d/c them post-op?

NO! If d/c, could cause acute adrenal insufficiency. Post-operatively, you might even need a higher dose of the steroid

Nursing interventions for a post op EGD patient

NPO until gag reflex returns Airway! VS frequently until sedation wears off monitor for signs of perforation: pain, bleeding, fever

What medications puts you at a higher risk for developing gastritis?

NSAIDS

Peptic ulcers are often common in the aging population. Which medications should be taken with caution to help prevent this problem?

NSAIDs

What e-lyres would we check pre-op?

Na, K, Cl, and Carbon dioxide

A client arrives in the emergency department with bleeding esophageal varices, and the health care provider states that a Sengstaken-Blakemore tube will need to be used to try to control the gastrointestinal hemorrhage. The nurse prepares for insertion of the tube via which of the following routes?

Nasogastric

Treatment measures have been implemented for a client with bleeding esophageal varices and have been unsuccessful. The health care provider states that a Sengstaken-Blakemore tube will be used to control the resulting hemorrhage. The nurse prepares for insertion via which of the following routes?

Nasogastric

A client with a tentative diagnosis of gastroesophageal reflux is going to undergo ambulatory pH monitoring. The nurse brings which of the following items to the bedside?

Nasogastric (NG) tube

GI LAB Electrolyte

Nausea and vomiting

Assessment in PACU-

Neurological, Fluid, Electrolyte & Acid/Base Balance, GI, Dressing/Incision, Pain

Anticonvulsants-

Neuropathic pain ♥Carbamazepine (tegretol) ♥Gabapentin(neurontin) ♥Pregablin (lyrica)

Inhalation Anesthesia Agents

Nitrous oxide (N2O) Desflurane (Suprane) Enfluane (Ethrane) Halothane (Fluothane) Isoflurane (Forane) Sevoflurane (Ultane)

NPO

No drinking, eating, smoking (nicotine stimulates gastric secretions)

A nurse is caring for a client suspected of having appendicitis. Which of the following would the nurse anticipate will be prescribed for this client?

No oral intake of liquids or food

A client with Crohn's disease is seen by the health care provider, and a complete blood count (CBC) has been prescribed. The nurse provides instructions to the client who will be reporting to the laboratory in the morning to have the blood test drawn. The nurse gives the client which of the following information about this test

No special preparation is necessary.

what instructions would you give someone that is undergoing a nuclear med test for GI bleeding study?

No special preps, because you will be giving the patient an isotope!

Type A gastritis

Non erosive Glands, fundus and body inflammation Autoimmune (parietal cells)

Lubricant laxative: action

Nonabsorbable hydrocarbons soften fecal matter by lubricating the intestinal mucosa; Action for mineral oil occurs within 6 to 8 hrs. Action for glycerin suppository occurs within 30 minutes.

What are some hormones and neurotransmitters released during the Physiologic response to surgery

Norepinephrine, epinephrine, ACTH (acts on adrenal glands to release...), cortisol, and aldosterone

Constipation is a problem for many older adults. The medical management to prevent constipation includes (Select all that apply):

Nutritional diet high in fiber Increasing fluid intake Increasing daily activity

Management of Inflammatory Bowel Disease

Nutritional therapy. Pharmacological therapy. Surgical management.

The client has developed late-stage cirrhosis. Which community resources does the nurse suggest to the client to help in managing the client's care?

Nutritionist Chaplain Support Group

Why do we draw ABGs pre-op?

O2 and CO2 Sats (necessary if pt has a pulmonary problem)

PUD medical management

Objective is to provide stomach rest avoid caffeine, alcohol, strict changes not favored stress reduction meds (triple therapy, antacids, H2 antagonists)

In evaluating the care of a young executive admited with bleeding peptic ulcer, the nurse focuses on nursing interventions. A nursing intervention associated with this type of patient is:

Observing vomitus for color, consistency, and volyme

The patient has a history of cholelithiasis. He has excruciating pain in the right upper quadrant radiating to the scapula, and severe nausea and vomiting; within a few hours he develops early signs of jaundice. The physician syspects

Obstruction choledocholithiasis

A client who has been prescribed indomethacin (Indocin) for gout is asked to provide a stool sample for guaiac testing. The nurse explains that the purpose of the test is to determine:

Occult blood

A client who has been taking indomethacin (Indocin) for gout has a prescription for guaiac testing of the stool. The nurse explains to the client that this test is necessary because it detects which of the following that may be caused or affected by this medication?

Occult blood

Melena

Occult blood in stool. More common with duodenal ulcers

Intermittent Tenesmus

Occurring at irregular intervals-feeling of constantly needing to pass stools

A client with viral hepatitis has no appetite, and food makes the client nauseated. Which nursing intervention would be appropriate

Offer small, frequent meals

Your patient has undergone a needle liver biopsy 15 minutes ago. You enter her room to discover her sitting up in bed reading the newspaper. The first action you should take is to place her:

On her right side

A licensed practical nurse (LPN) is providing follow-up teaching after a client underwent an upper gastrointestinal (GI) series. The nurse reminds the client that the stools will remain white for approximately:

One day

Same day surgery. Inpatient or outpatient? How long do they stay? Give an example of a surgery.

Outpatient, pt stays approximately 23 hrs. Ex) colonoscopy

Gastric Ulcer

Over 50 yrs, Caused by normal or hyposecretion of stomach acid, Pain increased with food, Vomiting is common.

Pain - PQRST

P-palliative (anything make it better or worse) Q-quality or quantity R-region or radiation (does it go anywhere) S-severity (1-10) T-timing (onset, how long, coming & going)

PQRST

P: precipitate/palliative/alleviate Q: quality , quantity R: region? radiate? S: severity? scale? T: Timing? WHen did it start? how often? how long?

What is the national patient safety goal mandate?

Pain assessment is a national patient safety goal

Signs and symptoms for Gallbladder problems

Pain in epigastric, subscapular or RUQ N&V Fat intolerance

Appendicitis- Nursing Care

Pain in right lower quadrant (Mcburney Point) is positive for appendicitis (Rovsing Sign). Palpate in left, pain is on right. Distended abdomen means Appendix Rupture. No laxatives and enemas. Post-op: Solid food when bowel function returns.

A 56-year-old patient with diverticulitis has been admitted to the medical unit. The nurse will most likely document which assessment in the charting?

Pain in the left lower quadrant

acute Cholecystitis (gallstones) nursing interventions

Pain meds (DEMEROL) relaxation techniques quiet environment I&O Fluids

Acute Cholecystitis Nursing Interventions

Pain meds (Tortal w/ Bentyl) relaxation techniques quiet environment I&O fluids oral intake slowly monitor for complications

LIver needle biopsy is a safe method of diagnosing pathologic liver conditions. However, the nurse must anticipate possible complications, including which nursing diagnosis?

Pain, related to leakage of blood and bile into the peritoneal cavity

Odynophagia

Painful swallowing due to a disorder of the esophagus

Esophageal varices

Painless bleeding of submucosal veins in lower 1/3 of esophagus

Treatment for anal abscess includes

Palliative treatment includes sitz bath and analgesic agents. Surgical I&D of abscess.

Which organ manufactures protease, lipase, and amylase?

Pancreas

Comando

Part of mandible removed with lesion. Usually combined with radical neck -Feeding tube and trach after surgery

Anesthesia definition

Part or total loss of sensation w/ or w/o loss of consciousness

Hepatitis B Immune Globulin

Passive immunity, exposed to Hep. B before given Hep. B vaccines.- Give 24 hrs after exposure.

Define: Autologous blood donations

Patient donates their own blood 72 hrs-5 wks prior to surgery

Define: Directed blood donations

Patients family or friends with the pts same blood type donate their blood

Dietary teaching for a patient who is treated conservatively for cholecystitis is necessary to keep the patient comfortable. Which foods should be avoided? (Select all that apply.)

Peanut butter Whole milk Glazed chocolate doughnuts

The most lethal complication of a peptic ulcer is:

Perforation

You get a patient that is two hours post op that had an esophageal rehabilitation, now they have developed increased pain in the throat, what is your concern?

Perforation

PTC Percutaneous transhepatic cholangiography

Performed when a patient has jaundice or persistent upper quad pain

Most common complication of appendicitis?

Peritonitis if perforation

A nurse is participating in a health screening clinic and is preparing teaching materials about colorectal cancer. The nurse would plan to include which risk factor for colorectal cancer in the material?

Personal history of ulcerative colitis or gastrointestinal (GI) polyps

Nasoduodenal Tube:

Placed during endoscopy; extends into duodenum. Dobhoff tube used for short term feeding use b/c its less likely to cause aspiration. Placement verified by xray.

A nurse is caring for a client with a nasogastric (NG) tube and tests the pH of the aspirate to determine correct placement. The nurse notes that the pH is 5 and determines that the:

Placement of the NG tube is accurate.

Osmotic agent: examples

Polyethylene glycol and electrolytes (Colyte)

A nurse is reviewing the health care provider's prescriptions written for a client admitted with acute pancreatitis. Which health care provider prescription would the nurse verify if noted on the client's chart?

Position the client supine and flat

A nurse is reviewing the health care provider's prescriptions written for a client admitted with acute pancreatitis. Which health care provider prescription would the nurse verify if noted on the client's chart?

Position the client supine and flat.

What would you be concerned about with someone who abuses drugs who's going in for surgery?

Possible drug interactions like fentanyl and heroin (life threatening)

The type of liver cirrhosis that is caused by viral hepatitis, exposure to hepatotoxins (e.g., industrial chemicals), or infection is called:

Postnecrotic cirrhosis

A post-gastrectomy client is at high risk for hyperglycemia related to uncontrolled gastric emptying of fluid and food into the small intestine (dumping syndrome). Because of this risk, the nurse plans to monitor the:

Postprandial blood glucose readings

The client has been diagnosed with cirrhosis. When considering potential complications of this disorder, what is the priority nursing diagnosis?

Potential for Injury related to risk of hemorrhage

Complications of diarrhea include

Potential for cardiac dysrhythmias due to significant fluid and electrolyte loss. Metabolic acidosis. Impaired skin integrity of perineum.

Perioperative Nursing

Preoperative- Begins when pt is scheduled for surgery; ends when pt is transferred to OR. Intraoperative- Begins @ admission to OR; ends when pt is transferred to recovery. Postoperative- Begins @ admission to recovery; ends when recovery is complete

The client demonstrates manifestations of appendicitis. Peritonitis is also suspected. Which is the priority nursing intervention?

Preparing the client to undergo emergency surgery

A nurse is caring for a client with a resolved intestinal obstruction who has a nasogastric tube in place. The health care provider has now prescribed the nasogastric tube to be discontinued. To determine the client's readiness for discontinuation of the nasogastric tube, the nurse should check for:

Presence of bowel sounds in all four quadrants

Mucosal Barrier Fortifiers

Prevent hydrogen ion diffusion into mucosa Binds to ulcer wall take 1 hour ac and hs sucralfate

The goals of diet management in a patient with inflammatory bowel disease are: (Select all that apply.)

Prevent weight loss. Correct and prevent malnutrition. Provide adequate nutrition. Replace fluid and electrolyte losses.

Teaching plan after surgery for self management

Prevention of infection, management of drains or catheters, nutrition therapy, pain management, drug therapy, progressive increase of activity, care and assessment of the surgical wound.

Liver Cancer

Primary: tumors that started in the liver Metastasis: Spread from another organ

Lower GI Tract Endoscopy-

Proctosigmoidoscopy (limited to a single area of colon), Colonoscopy→ Preprocedure- bowel prep as ordered Postprocedure- monitor for s/s perforation(abd firm,acute abd pain, rectal bleeding); pt should lie on side to prevent aspiration

Stage 1 - PSE

Prodromal: - fatigue - restlessness - ↓ attention span - short term memory - personality changes - sleep pattern reversal

The patient with cirrhosis has bleeding tendencies because the cirrhotic liver cannot:

Produce prothromin; finrinogen' and clotting factors VII, IX, and X or absorb Vit K

Antiemetics

Promethazine (Phenergan) Ondansetron (Zofran) Reglan Compazine (only if allergic to others) Tigan (give IM) Kytril (cancer nausea) Vistaril (given w/ narcotics) - antinausea

A client with peptic ulcer disease has been prescribed misoprostol (Cytotec) and sucralfate (Carafate). The nurse teaches the client that these two medications will work primarily to:

Protect the gastric mucosa

A client with peptic ulcer disease has been prescribed to take misoprostol (Cytotec) and sucralfate (Carafate). The nurse teaches the client that these two medications will work primarily to:

Protect the gastric mucosa.

The top priority when managing a patient with a ruptured esophageal varix is:

Protection of airway

Pre-albumin

Protein for the past 3-4 days 20-40 mg

Because vitamin K is malabsorbed in the presence of cirrhosis, which laboratory value would be elevated?

Prothrombin time

A nurse is monitoring for stoma prolapse in a client with a colostomy. The nurse would observe which of the following appearances in the stoma if prolapse occurred

Protruding and swollen

What nursing interventions would be appropriate for inflammatory bowel disease diagnoses of Imbalanced Nutrition: less than body requirements related to bowel hypermotility and decreased absorption?

Provide at least six small frequent meals per day.

A nurse is caring for a client with a Sengstaken-Blakemore tube. To prevent ulceration and necrosis of oral and nasal mucosa, the nurse should plan to:

Provide frequent oral and nasal care on a regular basis.

Nursing management of patient with IBS

Provide patient and family educations Encourage a food diary, eating on a regular schedule, chewing food slowly and thoroughly, avoid fluids with meals to reduce abdominal distention, discourage tobacco and alcohol use Encourage relaxation techniques.

Postoperative care includes

Providing emotional support. Managing skin and stoma care. Changing an appliance. Irrigating a continent ileostomy, Managing dietary and fluid needs, Preventing complications. Promoting home and community based care.

Nursing management ileostomy

Providing preoperative care. Providing postoperative care.

Nurses, as well as other health care providers are at risk for Hep B. For prophylaxis to be most effective in these workers:

Prphylaxis must be instituted before exposure

A nurse is collecting data on a client admitted to the hospital with hepatitis. Which data would indicate that the client may have liver damage?

Pruritus

Interventions Prior to Surgery-

Pt identification, Review of the consent form, Medical record review

Malnutrition Planning / Implementation

Pt will have normal: - nutrient intake - fluid intake - energy - weight-height ratio - hemoglobin & hematocrit - visceral protein levels - muscle tone - hydration

Barium Swallow X-ray

Pt. drinks a chalky colored liquid that contains barium. It coats the walls of the esophagus and stomach, and is visible on x-rays. Xray show if there are strictures, ulcers, hiatal hernias, erosions or other abnormalities.

A nurse is performing an abdominal assessment on a client. The nurse interprets that which finding is abnormal and should be reported to the registered nurse (RN) or health care provider?

Pulsation between the umbilicus and pubis

Obstruction

Pyloric from scaring N&V Surgery to remove obstruction

What should be your top priority for assessment when dealing with a pt receiving Mycin antibiotics and muscle relaxants?

RESPIRATORY STATUS because the combination of these two types of drugs are known to cause respiratory paralysis

The client has been diagnosed with cancer of the liver. Which initial treatment option does the nurse expect to be ordered for the client?

Radiofrequency ablation

Dumping Syndrome- Nursing Care

Rapid emptying of food from the stomach into the jejunum. S/S: Dizziness, Pallor, N/V, Palpitations, Abdominal distention. Tx: Limit fluids with meals, low carbohydrate intake, small frequent meals, resting in recumbent position after meals.

A patient states that he returned from a 2-week camping trip a few days ago. He complains of nausea and anorexia and dark urine. What additional information would assist in diagnosing hepatitis A?

Recent ingestion of raw fish

The use of nonabsorbably antibiotics as preparation for bowel surger is done primarily to:

Reduce bacterial flora in the colon

♥ Palliative-

Reduce intensity of illness

Your patient has recently suffered through a bout of acute pancreatitis. He is asking for a snack. You find each of the following four snack choices in the kitchen. Which one would you choose for your patient?

Reduced fat cheese and whole wheat crackers

A client with a peptic ulcer is scheduled for a vagotomy, and the client asks the nurse about the purpose of this procedure. The nurse tells the client that a vagotomy:

Reduces the stimulation of acid secretions

The older adult male client reports pain in the inguinal area that occurs while coughing. A bulge is present in the inguinal area that can be pushed back into the abdomen. Which type of hernia is this?

Reducible The hernia is reducible because its contents can be pushed back into the abdominal cavity.

Your female patient has been diagnosed with gastroesophageal reflux disease (GERD). You are beginning your patient teaching about lifestyle changes she can implement to minimize the symptoms of this disease. You will be certain to mention:

Reducing caffeine and alcohol consumption may alleviate symptoms of the disease.

A postgastrectomy client who is being discharged from the hospital tells the nurse, "I hope my stomach problems are over. I need to get back to work right away. I've missed a lot of work and I'm really behind. If I don't get my act together, I may lose my job." Based on the client's statement, the nurse determines that at this time, it is appropriate to discuss:

Reducing stressors in life

Nx

Regional lymph nodes cannot be assessed

A nurse provides information to a client following a gastrectomy about the signs and symptoms of pernicious anemia. The nurse understands that:

Regular monthly injections of vitamin B12 are used to treat this disorder

A nurse reinforces instructions to a client following a gastrectomy about the signs and symptoms of pernicious anemia, knowing that:

Regular monthly injections of vitamin B12 will prevent this complication.

Decompression

Relieve abdominal distention

Symptoms of GERD (gastroesophageal reflux disease) can be modified or eliminated by which nursing interventions?

Remain upright for 1 to 2 hours post meals

A client is admitted to the hospital with a bowel obstruction secondary to a recurrent malignancy, and the health care provider plans to insert a Miller-Abbott tube. When the nurse tries to explain the procedure, the client interrupts the nurse and states, "I don't want to hear about that. Just let the doctor do it." Based on the client's statement, the nurse determines that the best action is to:

Remain with the client and be silent.

Radical Neck dissection

Removal of al tissue under skin from jaw to clavicle and anterior border of trapezius to midline, cervical lymph nodes, sternocleidomastoid muscle, spinal accessory nerve and jugular

Mandibulectomy

Removal of mandible

Hemiglossectomy

Removal of part of tongue

Modified Radical

Removal of soft tissue and lymph nodes only

Glossectomy

Removal of tongue

♥ Curative/Ablative-

Remove body part (appendectomy)

U/A's are done pre-op to check for...

Renal disease

An ultrasound of the gallbladder is scheduled for the client with a suspected diagnosis of cholecystitis. The nurse explains to the client that this test:

Requires the client to lie still for short intervals

A nurse has given the client with hepatitis instructions about postdischarge management during convalescence. The nurse determines that the client needs further teaching if the client states to:

Resume full activity level within 1 week

General Anesthesia definition

Reversible loss of consciousness by inhibiting neuronal impulses in several areas in the CNS

A nurse has assisted the health care provider with a liver biopsy, which was done at the bedside. Upon completion of the procedure, the nurse assists the client into which of the following positions?

Right side-lying with a small pillow or towel under the puncture site

The nurse assesses a patient with cholecystitis. Which pain description is typical of biliary colic?

Right upper abdomen, radiating to the back or right shoulder

Intraoperative Nsg Dx

Risk for perioperative positioning injury→ NI: site of the operation, age & size of the pt, type of anesthetic used, mobility issues. Positions: Supine/Trendelenburg/Lithotomy/ Prone (lami, jackknife)/Lateral, Impaired skin/tissue integrity→ NI:sterile technique using sterile drapes, skin closures (sutures, staples, tape, retention sutures, dermabond wound glue→no antibiotic ointment w/this b/c it disintegrates glue), sterile dressings, RC: Hypoventilation→ NI: ABC's, BP, LOC

Antidote to Benzos

Romazican

Preparation prior to Surgery:

Room Environment, Safety, Surgical Attire, Surgical Scrubs

What to look for in esophageal cancer?

S/S Pulmonary complications C/O dysphagia, odynophagia, and or weight loss

GERD/ Hiatal Hernia- S/S

S/S: Heartburn (dyspepsia), regurgitation food and/fluid, dysphagia, increased saliva, belching, gas, chest pain, sour taste, coughing, monitor for wheezing or crackles, pH monitor. S/S: (HH) Fullness in neck

Diverticulosis

Sac-like pouching in wall of intestine- inflammation occurs when food or bacteria is trapped in the sacs. - Avoid seeded foods, diet: clear fluids to high fiber, low-fat/ increased fluids. Low-fiber during acute stage.

Cirrhosis

Scarring or fibrosis of the liver- Caused by alcoholism and hepatitis- Nodules develop blocking flow of blood in the liver; leads to liver shrinking-S/S: wt. change, dry itchy skin,

A 78yo patient is admitted with common bile duct obstruction related to cancer of the pancreas. Which clinical manifestations would the nurse expect to find:

Scleral icterus Dark, tea-colored urine Jaundice

Anesthesia Risk (ASA Score):

Score (I-V) based on pt's health, status of underlying disease, limitations on activities, and risk of death

Tranquilizers / Benzodiazepines

Secobarbitol (Seconal) Pentobarbital (Nembutal) Phenobarbital - CNS suppressant - respiratory depression - hypotension - bradycardia * reversal agent - Flumazenil (Romazicon)

Pharmacologic management of IBD involves

Sedatives. Antidiarrheals. Antiperistaltic medications. Corticosteroids to treat severe illness. Immunomodulators (azathioprine, mercaptopurine, methotrexate. cyclosporine, infliximab, adalimab, certolizamab pegol, and natalizumab)

A nurse assigned to care for a client with cirrhosis reviews the medical record and notes that the client has difficulty maintaining an effective breathing pattern due to pressure on the diaphragm. The nurse plans care, knowing that which client position will best assist in facilitating breathing?

Semi-Fowler's

Duties of the circulating nurse

Sets up OR, gathers anticipated equip., insert cath. positions PT, assess # of urine and blood loss, ensure sterile technique and field, provide supplies and equipment, communication pt info to family, Documents care, events, interventions, and findings

The staff nurse on the surgical floor is aware of pulmoray complications tha tfrequently follow upper abdominal incisions. These are most frequently related to:

Shallow Respirations to minimize pain

Dumping Syndrome

Shortened time frame for absorb. food entering small intestine instead of stomach too fast and not enough fluids are being mixed in

The patient has been admitted with right upperquadrant pain and has been placed on a low-fat diet. Which of the following trays would be accetable for her?

Skim milk, lean fish, tapioca pudding, and fruit

A client who has undergone a subtotal gastrectomy is being prepared for discharge. Which item concerning ongoing self-management should the nurse reinforce to the client?

Smaller and more frequent meals should be eaten.

A client has undergone subtotal gastrectomy and the nurse is preparing the client for discharge. Which item should be included when teaching the client about ongoing self-management?

Smaller, more frequent meals should be eaten.

Regional Anesthesia

Spinal (nerve blocks) Epidural Local (area only) Regional loss of sensation w/o loss of consciousness

Oral Cavity Malignant Tumors

Squamous Cell Carcinoma (chemical irritation) Basal Cell Carcinoma (purple lesion on lips / sun) Kaposi's Sarcoma (lesions in blood vessels / purple nodes or plaques / HIV) - usually not painful - associated w/ alcohol & tobacco use

Stages of anesthesia

Stage 1- relaxation, sedation, analgesia Stage 2- excitement, delrium Stage 3- operative/surgical anesthesia Stage 4- DANGER

Stages of Anesthesia

Stage 1: Relaxation, sedation, analgesia Stage 2: Excitement, Delirium Stage 3: Operative/surgical Anesthesia Stage 4: Danger

After an automobile accident, a patient is admitted to the emergency department with possible abdominal trauma. Which of these physician requests will the nurse implement first? A) Take the patient for computed tomography of the abdomen. B) Insert a nasogastric tube, and connect it to intermittent suction. C) Start an IV line, and infuse normal saline at 200 mL/hr. D) Obtain a complete blood count and coagulation panel.

Start an IV line, and infuse normal saline at 200 mL/hr.

The client asks the nurse to suggest ways for altering the diet to reduce the risk of colorectal cancer. Which dietary selection does the nurse suggest?

Steamed broccoli with turkey contains low-fat meat and no refined carbohydrates.

A nurse is reviewing the health care record of a client with a diagnosis of chronic pancreatitis. Which data noted in the record indicate poor absorption of dietary fats?

Steatorrhea

GI changes in seniors

Stomach:↓Hcl, ↓absorption of Fe. and B12 Large int:↓peristalsis and dulled nerve impulses Pancreas:↓lipase due to calcif, ↓fat absorb and digestion Liver: decrease in number and size of cells, ↓protein synthesis, drug metabolism,

A nurse is performing colostomy irrigation on a client. During the irrigation, the client begins to complain of abdominal cramps. Which of the following is the appropriate nursing action?

Stop the irrigation temporarily.

It is believed that gastric mucosa of the body of the stomach undergoes a period of transient ischemia in association with hypotension, severe injury, extensive burns, or complicated suregery. This results in the development of what disorder?

Stress ulcers

Evisceration

Stuff coming out

Stage 3 - PSE

Stuporous: - severe confusion - unable to follow commands - deep lethargy but arousable

Neuromuscular Blockers

Succinylcholine (Sux, Anectine) Atracurium (Tracrium) Cisatracurium (Nimbex) Mivacurium (Mivacron) Vecuronium (Norcuron) Pancuronium (Pavulon) - pt needs to be intubated *Antidote: Neostigmine (Anticholinesterase)

A licensed practical nurse (LPN) is helping a registered nurse (RN) conduct an abdominal assessment. The LPN assists the client into which of the following positions?

Supine with the head raised slightly and the knees slightly flexed

Who is responsible for getting preoperative consent

Surgeon

Roles of Surgical Team Members

Surgeon - responsible for procedure Surgical Assistant - could be anyone from RN, NP, Resident Anesthesiologist/Anesthetist - MDA, CRNA (CRNA stays the whole time) Circulating Nurse - coordinate & provide all nursing care, responsible for sterile technique & supplies Scrub Nurse/Tech - set up sterile field Perfusionist - if open heart surgery Manufactural Representative - if prosthetic

Surgical Team:

Surgeon, Surgical Assistant, Surgical Tech, Anesthesiologist/Anesthetist, Circulating Nurse

Malignant tumor tx

Surgery Radiation Chemo

When nonsurgical measures fail.

Surgery is indicated for IBD, including -laparascope guided strictureplasty. -small bowel resection. -subtotal or total colectomy, as indicated. -ileostomy. -continent ileostomy.

Nissen Fundoplication- Nursing Care

Surgery tx GERD/ Hiatal Hernia-abdominal approach to suture the fundus around the esophagus, increase in pressure or volume in stomach closes the cardia and blocks reflux into the esophagus- Assess respiratory problems, frequent small meals only (stomach size is smaller),

Postoperative Report Guidelines: PACU Admission-

Surgical procedure/pathology, Type of anesthesia, Medical Hx, allergies, VS, Fluid status (IV, blood), estimated blood loss, Tubes, drains, dressings (type, location, description of fluid), Complications

A nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which of the following symptoms indicate this occurrence?

Sweating and pallor

Fector Hepaticus

Sweet, fecal odor of breath Late sign of liver disease

Complications of Regional Anesthesia-

Systemic Toxic Rxn (initially→stress response, then hypotension, Bradycardia), Local Complications (HA, back pain)

Assessment and Diagnostic findings,

Tachycardia, hypotension, tachypnea, fever, pallor. Abdomen: bowel sounds, distention, tenderness. Stool: positive for blood. H&H: low WBC: high Albumin: low electrolytes: abnormal

a 35yo man has been admitted with a diagnosis of peptic ulcers. Which drugs are most commonly used in these patients to decrease acid secretions?

Tagamet and Zantac

A nurse who is providing instructions to a client following gastric resection would include which of the following suggestions?

Take action to prevent dumping syndrome.

A nurse is providing home care instructions to a client following a gastric resection. The nurse includes which of the following in the instructions?

Take actions to prevent dumping syndrome

A licensed practical nurse (LPN) is preparing to assist a registered nurse (RN) with removing a nasogastric (NG) tube from the client. The LPN would instruct the client to do which of the following?

Take and hold a deep breath.

Bulk forming laxatives: patient education

Take with 8 oz. of water and follow with 8 oz. of water; Do not take dry. Report abdominal distention or unusual amount of flatulence.

A client presents to the urgent care center with complaints of abdominal pain. Suddenly the client vomits bright red blood. The nurse takes which immediate action?

Takes the client's vital signs

A client had a Miller-Abbott tube inserted 24 hours ago. The nurse is asked to check the client to determine whether the tube is in the appropriate location at this time. Which of the following findings would indicate adequate location of the tube?

The aspirate from the tube has a pH of 7.45.

Which assessment finding obtained by the nurse for a patient with cirrhosis who has just had 1500 mL of fluid removed by paracentesis is most important to communicate to the physician?

The blood pressure is 88/46 mm Hg.

A nursing diagnosis of: Knowledge, deficient, related to relationship of infection to nutritional needs is critical because:

The body requires more protein intake to fight infection.

A nurse is caring for a client with a nasogastric tube. Which observation is reliable in determining that the tube is correctly placed?

The pH of the aspirate is 5.

It is especially important fo rthe patient to cough and deep breathe postoperatively following an open cholecystectomy because:

The patient tends to take shallow breaths due to the placement of the incision

Malabsorption can be a major problem with Crohn's disease when what portion of the intestine is involved?

The small intestine

Physiologic Response to Surgery

The stress response: Increased HR, BP, & BG (blood glucose); Increased peripheral vasoconstriction, increased release of ADH (leads to fluid retention & decreased u/o)

Who is responsible for obtaining preoperative consent?

The surgeon -RN makes sure it is signed

A nurse is collecting data about how well a client with a gastrointestinal (GI) disorder is able to absorb food. While carrying out this function, the nurse recalls that absorption is best defined as:

The transfer of digested food molecules from the GI tract into the bloodstream

Specific nutritional deficiencies:

Thiamine- Alcoholics (chronic alcoholics usually on a daily supplement), mental confusionVitamin C- Bleeding gums, petechiae (bruising)Iron- Thin, spoon shaped nails, pale conjunctivae, pallorProtein- Hair loss, muscle wasting, edema, mental confusion

Iron

Thin, spoon-shaped nales, pale conjunctivae, pallor

you have a client with advanced oral cancer that requires extensive surgery, which statement by the client indicates that the diagnosis is acceptable?

Think oral surgeries and taking part of the tongue and deformities

Intravenous Anesthesia Agents

Thiopental Sodium (Pentothal) Methohexital sodium (Brevital) Etomidate (Amidate) Midazolam (Versed) Ketamine (Ketalar) (animal tranquillizer) Propofol (Diprivan)

Osmotic agents: patient education

This is a large volume product. It takes time to consume it safely. It can cause considerable nausea and bloating.

The client has been diagnosed with viral hepatitis. The client's sister tells the nurse that she is alarmed because the client has begun to exhibit signs of depression and is no longer interacting with family and friends. How does the nurse interpret this client's behavior?

This is an expected emotional response to the disease process.

Which laboratory test results are most indicative of cirrhosis?

Thrombocytopenia and anemia It is possible for the client with cirrhosis to experience a decrease in platelets and red blood cells.

Which of the following is an adverse effect of vancomycin (Vancocin) and needs to be reported promptly? a) Muscle stiffness. b) Vertigo. c) Tinnitus. d) Ataxia.

Tinnitus. Explanation: The client should report tinnitus because vancomycin can affect the acoustic branch of the eighth cranial nerve. Vancomycin does not affect the vestibular branch of the acoustic nerve; vertigo and ataxia would occur if the vestibular branch were involved. Muscle stiffness is not associated with vancomycin.

Why is Lactose used in patient's with liver disease?

To treat hepatic encephalopathy & to draw out ammonia

Why would you use Lactose in patients with liver disease?

To treat hepatic encephalopathy and draw out ammonia

Why would you use Lactulose in patients with liver disease?

To treat hepatic encephalopathy and draw out ammonia

Which serum test would a physician order if jaundice was suspected?

Total bilirubin

Complications of ulcerative colitis include

Toxic megacolon. Perforation. Bleeding from ulceration. Vascular engorgement. highly vascular granulation tissue.

Hepatitis C- Nursing Care

Transmitted by Parental, Perinatal, or Sexual route. Mostly blood to blood. Iv, needle sticks.Asymptomatic. Dx: Liver biopsy. NO Vaccine. Avoid becoming pregnant while on drug treatment.

Hepatitis B-Nursing Care

Transmitted by Parental, Perinatal, or Sexual route. S/S: Malaise. Fever, Rash, Jaundice, Arthritis, RUQ pain, N/V. Dx: HBsAg in blood. Tx: Vaccines

Hepatitis A- Nursing Care

Transmitted by the fecal-oral route, contaminated water/food. Dx: Stool specimen. Tx: give Hepatitis A Vaccine, Serum immune globulin, Twinrix.

Hepatitis E- Nursing Care

Transmitted by the fecal-oral route, contaminated water/food. Dx: anti-HEV in serum. No tx: good hygiene may help.

Hepatitis G- Nursing Care

Transmitted sexually and parenterally- No TX- S/S: dark urine, Clay color stool. Jaundice, Pruritus, Hepatomegaly, RUQ pain.

Vincents stomatitis

Trench mouth acute bacterial infection of gingiva ulcers with pseudomembrane leukocytosis foul taste pain choking sensation fever

Analgesic Adjuvants

Tricyclic antidepressants - Amitriptyline (Elavil) Anticonvulsants - Carbamazepine (Tegretol) - Gabapentin (Neurontin) Corticosteriods - Dexamethazone (Decadron) Benzodiazepines

Common meds for H. Pylori

Triple therapy -Prilosec, Zantac, and Flagyl

T/F: Previous complications during surgery increases the chance for complications during all surgeries in the future

True

Potential problems of enteral nutrition

Tube obstruction Aspiration Diarrhea Distention Constipation Hyperglycemia Hyperosmolar hyperglycemic nonketotic dehydration Electrolyte abnormalities

A health care provider asks a nurse to obtain a Salem Sump tube for gastric intubation. The nurse selects which of the following tubes from the unit storage area?

Tube with a lumen and an air vent

Documentation of Intraoperative Care:

Tubes, drains, & other devices, sponges/needle count, pt position during surgery, wound irrigations/ solutions used/dressings

Preoperative Teaching

Tubes, drains, and IV's, Breathing exercises, Prevention of DVT

A nurse is evaluating the effect of dietary counseling on the client with cholecystitis. The nurse determines that the client understands the instructions given if the client states that which food item is acceptable to include in the diet?

Turkey and lettuce sandwich

Strangulated

Twisted upon itself Surgical Emergency

Regional Anesthesia definition

Type of local anesthesia that blocks multiple peripheral nerves in specific body region. (Spinal, Epidural)

Post Lab Assessment-

UA, CBC, lytes, ABG's (acidosis), BUN/Creat (renal status), BG

Preoperative Assessment Labs/Diagnostic Findings:

UA, CBC, lytes, CXR, ECG, Type & cross, Clotting studies, Pregnancy test, ABG's

what GI disorders can cause anemia

Ulcerative colitis Crohns disease Diverticulitis

An imaging technique whereby deep structures of the body are visualized by recording reflections or echoes of ultrasonic waves directed into the tissues is called:

Ultrasonography

E.Coli

Undercooked Beef and shellfish; food and water contaminated with fecal materials.- Food- Borne Illness

The client is being evaluated in the ED for a possible small bowel obstruction. Which symptoms are most indicative of a small bowel obstruction?

Upper abdominal distention, metabolic alkalosis, and great degree of vomiting

A client with ascites is scheduled for a paracentesis. The nurse is assisting the health care provider in performing the procedure. Which of the following positions will the nurse assist the client to assume for this procedure?

Upright

A health care provider is about to perform a paracentesis on a client with abdominal ascites. The nurse would assist the client to assume which of the following positions?

Upright

Lab Assessment - Urine

Urine amylase - pancreatitis Urine urobilinogen - jaundice * if present = problem

What should a patient be taught after a hemorrhoidectomy?

Use a prescribed analgesic before a bowel movement

Gastrointestinal Bleeding Nursing Care

Use heat, epinephrine, laser or clips to stop bleeding, assess for "coffee ground" blood, monitor VS for hypovolemic shock (low BP, tachycardia, low urine output), Assess for drainage in NG tube after surgery, do not irrigate/ reposition NG tube, assess for abdominal distention (perforation).

Non Narcotic Analgesics -

Used for mild to moderate pain. Includes all NSAIDS; may cause bleeding. ♥Ketorolac (toradol) ♥Ibuprofen (motrin)

The client has an anal fissure. Which nursing intervention best promotes perineal comfort in this client?

Using witch hazel wipes to relieve pain

Regurgitation

Usually caused by incompetent lower esophageal spincter

Preoperative Assessment Physical Exam:

VS, pain, allergies (latex=bananas; shellfish=iodine, contrast dye), cardiovascular/ resp., renal/urinary, neurological/musculoskeletal, nutrition, psychosocial

The patient's cirrhosis of the liver has also caused a dilation of the veins of her lower esophagus secondary to vessel hypertension, resulting in her developing the complications of:

Varices

Hemorrhoids- Nursing Care

Veins dilate in the anal area- Warm compresses, cold packs, sitz bath, astringent pads, rest, high fiber to help soften stool, increase fluids. Hemorrhoidectomy.

S/S of dumping syndrome

Vertigo Tachycardia syncope sweating pallor diarrhea nausea desire to lie down palpitations

Hepatitis Nursing Care

Viral infection that produces inflammation of the Liver. A/E:Fecal-Oral route. B,C,D,G:Parental, Perinatal, or Sexual route.-S/S: Malaise, N/V, Fever, Jaundice- Tx: Bed rest, Small frequent meals, increase fluid intake, cool baths.

A nurse is caring for a client with a diagnosis of chronic gastritis. The nurse anticipates that this client is at risk for which vitamin deficiency?

Vitamin B12

A nurse is providing discharge instructions to a client who has had a total gastrectomy. The nurse tells the client about the importance of returning to the health care clinic as scheduled for which priority assessment?

Vitamin B12 and folic acid studies

A client has been diagnosed with chronic gastritis and has been told that there is too little intrinsic factor being produced. The nurse tells the client about the need for:

Vitamin B12 injections

A client has been diagnosed with chronic gastritis and has been told that there is too little intrinsic factor being produced. The nurse tells the client that which of the following will be prescribed to treat the problem?

Vitamin B12 injections

Paracentesis Nursing Care

Void bladder prior to procedure, in high-fowler/sitting, do V/S before, during, and after, record amt. of fluid taken, monitor for hypovolemia.

Hematemesis

Vomit containing bright red blood

GI Hemorrhage

Vomiting of coffee ground material o Tarry stools Hematemesis Melena

Why are Chest X-rays required as part of the pre-op diagnostic studies for an older adult?

We figure that older adults are more likely to have been exposed to asbestos, tobacco, pneumonia, and have underlying pulmonary diseases (can ID cardiac & lung problems)

In what case would a cosmetic surgery be considered restorative?

When what's being fixed was caused by trauma

Your patient with carcinoma of the esophagus is about to undergo surgery, an esophagogastrectomy, and is very anxious about what to expect immediately after surgery. Which of the following statements would be appropriate to help calm his anxiety?

When you wake up, we will be monitoring you very closely. We will give you pain medication and do everything we can to keep you as comfortable as possible."

The surgical procedure for cancer of the pancreas involves resection of the antrum of the stomach, the gallbladder, the duodenum, and varying amounts of the pancreas. Anastomoses are constructed between the stomach, the common bile and pancreatic ducts, and jejunum. This procedure is called:

Whipple procedure

Discharge Teaching

Wound & drain assessment & care- Body temp, color of drainage, Diet-adequate, Pain mgmt, Drug therapy-prescriptions, correct dosage & time, Activity-sloe & steady; splint chest, if necessary

The client is scheduled for discharge after surgery for inflammatory bowel disease (IBD). The client's case manager is arranging for home health care, and the client indicates that family members will be helping with care at home as well. What priority information does the nurse provide to these collaborating members?

Written and oral instructions regarding symptoms to report to the physician

IBS Tx Medications

Zelnorm (Tegaserod): ↑ peristalsis Lotronex (Alosetron): ↓ peristalsis Bentyl (Dicyclomine Hyrdochloride): GI relaxant

When positioned properly, the tip of a central venous catheter should lie in the: a) superior vena cava. b) basilic vein. c) jugular vein. d) subclavian vein.

a

A patient is scheduled for surgery for a common bile duct exploration. The nurse would expect the patient to return from surgery with:

a T-tube connected to gravity drainage

Cullen Sign

a bluish discoloration of the skin around the umbilicus associated with retroperitoneal hemorrhage

Peptic ulcer disease

a break in continuity of esophageal, gastric, or duodenal mucosa

If long term laxative use is necessary,

a bulk forming agent may be prescribed in combination with an osmotic laxative.

Cushing's

a clinical triad of hypertension, tachycardia, & irregular respirations

Hiatal Hernia

a condition in which a portion of the stomach protrudes upward into the chest, through an opening in the diaphragm

Inflammatory Bowel Disease (IBD)

a group of chronic disorders that result in inflammation or ulceration of the bowel lining.

anesthesia

a method and technique of making potentially uncomfortable interventions safe and tolerable

Sepsis

a severe illness in which the bloodstream is overwhelmed by bacteria.

Define: Minimally invasive surgery

a surgery that's done laparoscopically

A patient had a ruptured diverticulum in his descending colon. He has undergone a transverse loop colostomy. He asks the nurse the purpose of this procedure, and the nurse tells him that it is

a temporary colostomy to allow healing of the bowel by diverting feces.

Anal fistula is

a tiny tubular, fibrous tract that extends into the anal canal from an opening located beside the anus in the perianal skin.

A client receives morphine for postoperative pain. Which of the following assessments should the nurse include in the client's plan of care? a) Assess urinary output every 8 hours. b) Assess mental status every shift. c) Check for pedal edema every 4 hours. d) Take apical heart rate after each dose of morphine.

a.

The nurse is preparing to give a subcutaneous injection to an elderly, emaciated client. Which needle length and angle should the nurse plan to use to administer the injection safely? a) A ½-inch (1.3-cm) needle at a 15-degree angle. b) A 5/8-inch (1.6-cm) needle at a 45-degree angle. c) A 5/8-inch (1.6-cm) needle at a 90-degree angle. d) A 3/8-inch (0.95-cm) needle at a 90-degree angle.

a.

A nurse is preparing to administer digoxin (Lanoxin) elixir to a client. Which principle regarding this medication is correct? a) Liquid digoxin should be measured with a calibrated dropper or syringe. b) The adult therapeutic level for digoxin is 2 to 3 mg/ml. c) Digoxin shouldn't be administered if the client's heart rate is below 100 beats/minute or lower. d) Although serious, digoxin toxicity isn't life-threatening.

a. The adult therapeutic level for digoxin is 0.5 to 2 ng/ml (1.0 - 2.6 nmol/L). This narrow therapeutic range makes digoxin toxicity likely, so the nurse must measure liquid preparations with calibrated droppers or syringes. Digoxin toxicity commonly causes life-threatening cardiac arrhythmias. The nurse should hold and notify the physician about digoxin for heart rates below 60 beats/minute.

At what time should the blood be drawn in relation to the administration of the I.V. dose of gentamicin sulfate (Garamycin)? a) 2 hours before the administration of the next I.V. dose. b) 4 hours before the administration of the next I.V. dose. c) 3 hours before the administration of the next I.V. dose. d) Just before the administration of the next I.V. dose.

a. To determine how low the gentamicin serum level drops between doses, the trough serum level should be drawn just before the administration of the next I.V. dose of gentamicin sulfate.

The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a corticosteroid. Which of the following indicates that the client is using the MDI correctly? Select all that apply. a) The client rinses the mouth with water following administration. b) The inhaler is held upright. c) The head is tilted down while inhaling the medicine. d) The client waits 5 minutes between puffs. e) The client lies supine for 15 minutes following administration.

a. b. The client should shake the inhaler and hold it upright when administering the drug. The head should be tilted back slightly. The client should wait about 1 to 2 minutes between puffs. The mouth should be rinsed following the use of a corticosteroid MDI to decrease the likelihood of developing an oral infection. The client does not need to lie supine; instead, the client will likely to be able to breathe more freely if sitting upright.

The nurse is preparing to administer 4 units of regular insulin to a client with type 1 diabetes mellitus. Which of the following equipment does the nurse need to perform the injection? Select all that apply. a) 27-gauge, ½" needle b) Nursing assessment sheet c) 27-gauge, 1" needle d) 22-gauge, ½" needle e) 22-gauge 1" needle f) Medication administration record

a. f.

Which of the following demonstrates that the client needs further instruction after being taught about ciprofloxacin (Cipro)? a) "I may get light-headed from the Cipro." b) "I should let the doctor know if I start vomiting from the Cipro." c) "I shouldn't take an antacid before taking the Cipro." d) "I must drink 1,000 to 1,500 ml of water a day."

a. To reduce the risk of crystalluria, the client should drink 2,000 to 3,000 ml of water a day, not 1,000 to 1,500 ml. The client should not take an antacid before taking Cipro. An antacid decreases the absorption of the Cipro. The client should let the doctor know if vomiting occurs from the medication. The client may get light-headed from the Cipro. If so, the client should not drive a motor vehicle and should contact the physician

small bowel obstructions

abd discomfort or pain upper and epigastric abd distention nausea and early profuse vomiting obstipation (no passage of stool) severe F/E imbalances metabolic alkalosis

a 56 yo patient has cirrhosis of the liver. He has an accumulation of serous fluid in the abdominal cavity called ascites. THe nurse is assisting hte physician in the procedure to remove this fluid from his abdominal cavity. This procedure is called an:

abdominal apracentesis

clinical findings of acute pancreatitis

abdominal pain persistent N/V fever tachycardia jaundice epigastric tenderness abdominal distention cullens sign turners sign

Diverticulitis leading to perforation presents with

abdominal pain localized over the involved segment, usually the sigmoid.

Diverticulitis leading to peritonitis presents with

abdominal pain, a rigid board-like abdomen, loss of bowel sounds, and signs and symptoms of shock.

The patient, age 56, has cirrhosis of the liver with severe ascites. The nurse is assisting the physician in the procedure to remove this fluid from his abdominal cavity. This procedure is called an

abdominal paracentesis.

melena

abnormally dark tarry feces containing blood (usually from gastrointestinal bleeding)

adrenal steroids

abrupt withdrawal may cause cardiovascular collapse in long term users

Large bowel obstruction results in

accumulation of intestinal contents, fluid, and gas proximal to the obstruction.

clinical findings of appendicitis

acute abdominal pain (comes in waves) pain in epigastrium or periumbilical region that shifts to RLQ pain at mcburneys point vomiting after pain starts abdominal guarding loss of appetitie low grade fever coated tongue bad breath mild leukocytosis

CT is commonly used to diagnose diverticulosis (presence of multiple diverticula in the bowel), but is contraindicated in

acute diverticulitis because the risk of perforation in the presence of local infection may result in sepsis.

Clinical manifestation of diverticulitis include

acute onset of mild to severe pain in left lower quadrant, accompanied by nausea, vomiting, fever chills, and leukocytosis.

Most common cause of small bowel obstruction is,

adhesions.

When does pain occur with GERD

after meals and is relieved with antacids or fluids

interventions for Upper GI bleeding

aimed at treating hypovolemic shock, preventing dehydration and electrolyte imbalance and stop bleeding insert n/g tube assess bleeding rate prevent gastric dilation room temp saline lavage

ABC

airway, breathing, circulation

Define: Recycling blood

aka "Bloodless surgery," is done by suctioning all of the blood out of the patient then immediately transfusing it back into them

Risk factors for oral cancers

alcohol or tobacco use excessive exposure to sunlight

Common causes of Cirrhosis

alcoholic liver disease Hepatitis C Gallbladder Disease

Thiamine

alcoholics, mental confusion

Clinical manifestations of IBS include

alteration in bowel pattern, including constipation, diarrhea, or a combination of both, often accompanied by pain, bloating, and abdominal distention. *Abdominal pain is sometimes precipitated by eating and is frequently relieved by defecation*.

Clinical manifestations of large bowel obstruction

altered shape of stool as it passes the the obstruction. iron deficiency anemia, Weakness, weight loss, anorexia. Eventually abdomen becomes markedly distended, loops of large bowel become visibly outlined through the abdominal wall. Pt has crampy lower abdominal pain. Fecal vomiting and shock.

Pancreatic tests

amylase 56-90 Lipase 0-110 elevated in acute pancreatitis only

Constipation

an abnormal infrequency or irregularity of defecation, abnormal hardening of the stools that make their passage difficult and sometimes painful, a decrease in stool volume,

Fecal impaction occurs when

an accumulated mass of dry feces cannot be expelled.

Diarrhea is

an increased frequency of bowel movements, *more than three per day,* increased amount of stool, more than 200g/day, altered consistency of stool, *increased liquidity*.

The primary medical management for a patient with duodenal ulcers is:

anacids, histamine (h2) receptor blockers, proton pump inhibitors, mucosal healing agents, antibiotic therapy

local anesthetic

anesthetic is injected into a specific area of the body. lidocaine, bupivacaine, or tetacaine. minor shot-term procedures, such as biopsy. "local w/ epinephrine can increase HR"

chronic gastritis

anorexia, feeling of fullness, pain, n/v -vague symptoms EGD used to identify

magnesium hydroxide (Maalox, Mylanta, Gaviscon)

antacids- Neutralizes gastric acid- do not give with enteric coated drugs.

chronic gastritis management

antiacids, h2 antagonists, antibiotics (h pylori), mucosal barrier modifiers

Robinul

anticholinergic - reduce secretions and GI motiliy

metoclopramide (Reglan)

antiemetic- used to relieve symptoms caused by slow stomach emptying- Monitor for Tardive Dyskinesia and Extrapyramidal.

infliximab (Remicade)

antirheumatic- decrease inflammation in joints and colon- assess Iv reaction 2 hrs after giving.

Pre-op nursing diagnosis

anxiety knowledge deficit anticipatory grieving

Bowel Obstruction- S/S

anything that interferes with the passing of contents through intestinal tract. S/S: pain in abdomen, no stool or thin and loose, N/V (with feces), abdominal distention. Metabolic Alkalosis (small bowel), Metabolic Acidosis (large bowel)

topical anesthetic

applied directly to the surface of the area to be anesthetized. includes lidocaine and benzocaine.

Pancreatitis surgical nursing interventions

appropriate assessment post op care replace pancreatic enzymes location, function, patency of drains monitor and treat hyperglycemia nutrition/diabetes education

A patient with cancer of the esophagus has been receiving radiation therapy. The nurse realizes that this patient should be assessed for

aspiration from fistula formation.

hepatitis nursing interventions

assess for risk factors, jaundice, hepatic encephalopathy, LFT's bedrest nutritious breakfast add calories

Jaundice nursing interventions

assess for yellow sclera and skin, clay colored feces, tea colored urine, pruritus, fatigue, anorexia change linen, use loose soft clothing

nonalcoholic fatty liver disease

associated with obesity, dm 2 and metabolic syndrome rapidly growing in the world can lead to cirrhosis , cancer of liver, or liver failure

In hepatic encephalopathy, when the nurse requests that the patient stretch out the arm and hyperextended to see whether rapid, irregular flexion and extension (flapping) of the wrist occur, the nurse is assessing for the presence of:

asterixis

Diet therapy for patients with celiac disease is

avoidance of gluten.

Intervention for malabsorption is aimed at

avoiding dietary substances thhiat aggravate malabsorption and supplementing nutrients that have been lost.

A nurse is completing a home visit to an older adult receiving regular dressing changes for treatment of a venous ulcer. As a provider of home healthcare, the nurse recognizes that the primary goal of this practice is: a) To prevent recurrent admissions to hospitals and other inpatient settings. b) To maximize the independence and health of clients. c) To limit the progression of chronic health problems. d) To enable clients to make informed choices about their health.

b) The goal of helping the client reach maximum independence and health is central to the philosophy and practice of home healthcare. This goal may encompass enabling client choices, preventing future admissions, or limiting the progression of existing diseases, but each of these measures is an expression of the larger goal of maximizing health and independence.

The nurse should monitor the surgical client closely for which clinical manifestation with the administration of naloxone (Narcan)? a) Urine retention. b) Bleeding. c) Biliary colic. d) Dizziness.

b.

A neonate is to receive an I.V. infusion of normal saline solution at 3 ml/hour. The nurse is setting the alarms on an I.V. infusion pump. How should the nurse set the alarms? a) To sound when the infusion is infiltrating. b) At 5% above and 5% below the keep-vein-open rate. c) Within a 15% range of the keep-vein-open rate d) At the exact drip rate as prescribed.

b. Alarms on infusion pumps should be set at 5% above and 5% below the prescribed infusion rate. A wider range is not safe. The alarms must be set to indicate a change in the drip rate, not infiltration. Setting the alarms for the exact drip rate will cause the alarms to trigger when the client moves, and this exact range is not needed to alert the nurse to an unsafe rate.

A nurse is administering I.V. fluids to a dehydrated client. When administering an I.V. solution of 3% sodium chloride, what should the nurse do? Select all that apply. a) Force fluids, especially water. b) Measure the intake and output. c) Evaluate the client for neurologic changes. d) Inspect the jugular veins for distention. e) Insert an indwelling urinary catheter.

b. d. c.

When administering an I.M. injection, the nurse should use the Z-track technique when the medication: a) Is viscous in consistency. b) Is irritating to tissues. c) Takes a long time to absorb. d) Takes effect very quickly.

b. The Z-track technique is used with medications that are irritating to tissues. It allows the medication to be trapped in the muscle and prevents it from leaking back through the tissues

ascites due to

back of up HTN ; causing the 3rd spacing ; where decrease albumin in the vascular space decrease BP compensates by increase the aldosterone to increase BP liver already has problems therefore decreased production of albumin

portal HTN

backs up into the esophagus, spleen, intestins esophageal varices , hemorrhoids, GI bleed

Clostridium Difficile- Nursing Care

bacterium that can cause symptoms ranging from Diarrhea to life-threatening inflammation of the colon- occurs in healthcare settings.- Can lead to: Pseudomembranous colitis (infection in colon), perforation of colon, Sepsis.- TX: private room, Contact precaution, Handwashing.

Why no nicotine before surgery

because it increases gastric secretions

Why would we do a pregnancy test before surgery

because the women might not even know they're pregnant

abdominal pain in acute pancreatitis

beginning in midepigastrium and radiates to back like a stabbing pain

Define: Postoperative

begins in recovery and ends @ discharge

Define: Preoperative

begins when the pt decides that surgical intervention is necessary and ends when they hit the OR bed

Define: Intraoperative

begins when the pt hits the OR bed until they are in recovery

what drugs can be used to prevent bleeding with varices

beta blockers can prevent bleeding

Appendicitis can occur at any age, but most commonly

between the ages of 10 and 30.

Malignant tumor Dx

biopsy CT

Stimulant laxatives: examples

biscodyl (Dulcolax), senna (Senokot)

Chronic gastritis diet

bland food small frequent meals same as acute diet

Hct is checked pre-op for..

bleeding and dehydration

what does black tarry stool usually indicate

bleeding from duodenum

Serotonin antagonist

block serotonin receptors in CTZ; chemo receptor triggering zofran kytril

Anticholinergics

block, acetylcholine, dec gastric secretions, dec esophageal sphincter tone, causes dry mouth scopalamine, robinul

Intestinal obstruction occurs when

blockage prevents normal flow of intestinal contents through the intestinal tract.

Local anesthesia

blocks nerves, area of insertion.

embolus

blood clot, foreign body, or air in the circulatory system; plural form is emboli

melena

blood in stool

hematemesis

blood in vomit

The end-products of carbohydrate and protein digestion are absorbed by the

blood vessels in the villi.

Turner's sign

bluish discoloration of left flank

turners sign

bluish discoloration of left flank

Cullen's sign

bluish discoloration of periumbilical area

Cullens sign

bluish discoloration of periumbilical area

shock

body's reaction to acute peripheral circulatory failure due to an abnormality of circulatory control or to a loss of circulating fluid

Megacolon can lead to

bowel perforation, acute peritonitis and death from septic shock.

Chronic gastritis interventions

brat diet meds

Cullen's Sign

bruising around the umbilicus sign of intra-abdominal bleeding

Patient with IBS may receive

bulk or antidiarrheals agents, antidepressants, anticholinergic or antispasmodic agents.

A 14-year-old with rheumatic fever who is on bed rest is receiving an I.V. infusion of dextrose 5% in water administered by an infusion pump. The nurse should verify the alarm settings on the infusion pump at which of the following times? Select all that apply. a) When the child is sleeping. b) When the child moves in the bed. c) At the beginning of each shift. d) When the child returns from X-ray. e) When the infusion is started.

c, d, e

A nurse inadvertently gives a client a double dose of an ordered medication. After discovering the error, whom should the nurse notify first? a) The pharmacist b) The client c) The prescriber d) The risk manager

c.

After reconstituting a multidose vial of medication, a nurse writes the date and time of reconstitution on the vial label. What else should the nurse write on the label? a) Prescriber's name b) Expiration date of the order c) Strength of the medication d) Route of administration

c.

When a nurse tries to administer medication, the client refuses it, saying, "I don't have to take those pills if I don't want to." What intervention by the nurse would have the highest priority? a) Explaining the consequences of not taking the medication, such as a negative outcome b) Insisting that the client take the medication because it is specifically ordered for the client c) Exploring how the client's feelings affect his/her decision to refuse medication d) Reporting the client's comments to the physician and the treatment team

c.

A client with peripheral vascular disease and chronic obstructive pulmonary disease takes theophylline 200 mg twice daily every day. The physician now prescribes pentoxifylline. To prevent problematic adverse effects, the nurse should monitor the client's: a) Serum cholesterol level. b) Partial thromboplastin time (PTT). c) Theophylline level. d) Digoxin level.

c. Pentoxifylline can potentiate the effects of theophylline and increase the risk of theophylline toxicity. Therefore, the nurse should monitor the client's theophylline level. Pentoxifylline does not interact with digoxin. Pentoxifylline can interact with heparin, and the client's PTT would need to be monitored closely if the client were taking heparin. It does not affect cholesterol levels.

Two days after surgery, a client continues to take hydrocodone 7.5 mg and acetaminophen 500 mg (Lortab 7.5/500). What should the nurse ask the client before administering the pain medication? a) "Have you emptied your bladder?" b) "Is your pain better than before you had surgery?" c) "Where is your pain located?" d) "How long has it been since your last dose?"

c. The nurse should ask the location of the client's pain because Lortab is an opioid, which can be constipating. By the third day, many clients become constipated and are feeling distended, with sharp, cramping pain due to gas, which is treated with ambulation, not more opioids. The client's emptying his bladder should not affect his pain level. The nurse should look at the client's chart to determine when the client's last dose of pain medication was administered, rather than asking the client. The client's statement regarding his pain level before the surgery is not relevant to whether the nurse should administer the Lortab.

etoh and illicit drug use

can alter the pts response to anesthesia and pain medication

causes of hepatitis

can be due to drugs, IV, inhalation, ingestion

tx pt with encephalopathy

can be due to end stage cirrhosis ; elevated ammonia levels ; confused state liver unable to convert ammonia to urea tx : with sitters/ativan

cause of liver cancer

can be due to other diseases like hep b / hep c to cirrhosis - high risk factor

alcohol withheld

can be reversible effects

alcohol use and cirrhosis

can damage the liver causing enlargement and damage to hepatocytes ; scar formation

Epidural

can diffuse up or down the spinal cord -method of choice for rectal, hip,and vagina -S/E = shivering and nausea -monitor respiration depression -commonly used: fentanyl

portal hypertension

can lead to many other complications like ascites, can cause splenomegaly (spleen enlargement) esophageal varices (veins become distended)

stomatitis

canker sores

Tis

carcinoma in situ

indiviaduals that cannot have transplant

cardiac instability, respiratory disease, metastic tumors, inability to follow instructions regarding drug therapy and self-management

hep c

cause if cirrhosis and liver failure - 2nd leading cause blood borne inflammation leads to scarring of the tissue sharing needles, drug use, multiple sex partners, unsanitary tattoo equip. intranasal cocaine

Secondary Stomatitis

caused by - cancer - HIV - viruses - bacteria - chemo - long term antibiotic use - yeast

Gastric Ulcers

caused by break in the mucosal barrier of the stomach *FOOD CAUSES PAIN, VOMITING RELIEVES IT* malnourished maybe some atrophic gastritis

Toxic Hepatitis

caused by exposure to hepatotoxins (industrial toxins, alcohol, drugs)

The nurse determines that a patient has a knowledge deficit regarding her diagnosis of achalasia. The nurse begins patient teaching by explaining that achalasia is

caused by the inability of a muscle to relax.

Vercuronium

causes muscle relaxation

Acute Acalcuous Cholecystitis

cholecystitis without stones -occurs along with major trauma, surgery, childbirth, sepsis increased risk of gangrene and perforation leads to emergency cholecystectomy

Irritable Bowel Syndrome (IBS)

chronic functional bowel disorder that affects the frequency of defecation and consistency of stool.

cirrhosis

chronic progressive condition ; liver scarring causing portal HTN

serum albumin

circulating protein status 3.5-5 Takes 3-4 weeks to change

Monitoring the color of stools of a patient with Hep A is important. The nurse caring for such a patient would expect the stools to be:

clay colored (acholic)

After a transverse loop colostomy, the nurse inspects the patient's stoma. The stoma appears mostly pink with some dusky discoloration at the lower border. An appropriate action would be to:

clean the area around the stoma, apply a clean pouch, and notify the physician about the discoloration

PT, INR, and PTT are all

clotting studies

myacin antibiotics

combined with muscle relaxants can cause resp paralysis

Balanced Anesthesia-

combining drugs to obtain the desired effects w/out disturbing physiologic function

Oral yeast Infection (thrush)

common in immunosuppressed -white patches in mouth -treated with: antimicrobials, immune modulators

spinal anesthesia

complete autonomic blockage. local anesthesia is injected into the subarachnoid space causing sensory and motor blockage

Pts with a hx of Cardiac issues have an increased risk for...

complications from anesthesia and another MI

liver biopsy

confirm the diagnosis of hepatitis and the extend of damage

The nurse is caring for the client who has experienced liver trauma. Which assessment findings are most indicative of hemorrhage and hypovolemic shock?

confusion diaphoresis hypotension tachycardia tachypnea

Lipid Panel

consists of HDL(good)want high, LDL(bad)want low, Triglycerides(less than 150)

Symptoms of megacolon include

constipation, liquid fecal incontinence, abdominal distention.

Barium Enema

contrast medium is injected into the rectum and x-rays are taken to search for lesions

The major focus of nursing intervention for the patient with pancreatitis is

controlling pain.

duties of circulating nurse

coordinate & provide all nursing care, responsible for sterile technique & supplies

Client has barrettes esophagus, which patient assessment by the nurse requires consultation with the providers?

coughing when eating or drinking

What complications can glaucoma medications have?

could have systemic effect that could lead to CV or respiratory collapse during OR

-ostomy

create openingin bowel

Angelchick prosthesis

creation of fake sphinctor (LES)

Vagotomy with pyloroplasty

cutting both vagus nerves and widening the existing exit of stomach at the pylorus. Prevents stasis and enhances emptying

vagotomy

cutting of vagus nerve to eliminate acid secreting stimulus to gastric cells

A nurse is instructing a client about the use of nitroglycerin patches. The nurse should instruct the client to: a) Use the patch only when chest pain occurs. b) Apply the patch only on alternate days. c) Change the site of the patch every day. d) Remove the patch every night.

d.

A nurse discovers that an I.V. site in a client's hand has infiltrated, causing localized pain and swelling. Which intervention would relieve the client's discomfort most effectively? a) Wrapping the arm in an elastic bandage from wrist to elbow b) Placing an ice pack on the hand c) Administering an as-needed analgesic d) Elevating the hand and wrapping it in a warm towel

d. Elevating the arm promotes venous drainage and reduces edema; applying warmth increases circulation and eases pain and edema. Ice application would relieve pain but not edema. An analgesic wouldn't correct the primary cause of the discomfort. Wrapping the arm above the hand would slow venous return and is contraindicated.

When teaching the client older than age 50 who is receiving long-term prednisone therapy, the nurse should recommend? a) Eat foods that are low in potassium. b) Exercise three to four times a week. c) Take over-the-counter drugs as needed. d) Take the prednisone with food.

d. Nausea, vomiting, and peptic ulcers are gastrointestinal adverse effects of prednisone, so it is recommended that clients take the prednisone with food. In some instances, the client may be advised to take a prescribed antacid prophylactically. The client should never take over-the-counter drugs without notifying the physician who prescribed the prednisone. The client should ask the physician about the amount and kind of exercise because of the need to establish baseline physical values before starting an exercise program and because of the increased potential for comorbidity with increasing age. The client should eat foods that are high in potassium to prevent hypokalemia.

Stave IV anesthesia

danger

garlic

dec BP and can cause bleeding

acute gastritis diet

decaffeinated tea gelatin toast simple bland foods BRAT diet

GI intubation

decompression lavage nutrition

When caring for a patient with acute exacerbation of hepatic encephalopathy, the nurse may give a lactulose enema, provide a low-protein diet, and limit physical activity. These measure are done to:

decrease ammonia production

intestinal flora modifiers

decrease growth of diarrhea causing bacteria and reestablish normal intestinal flora EX: bacid, lactinex

mesalamine (Asacol, Dipentum)

decrease inflammation of the colon- Assess for allergy to Sulfa drugs, intake of 8 glasses of fluids to prevent crystalluria and kidney stones.

anticholinergics

decrease intestinal muscle tone and peristalsis slow fecal matter movement EX: atropine bentyl

Pre-op assessment of Elderly's Renal/Urinary system: list what you'd expect to find

decreased blood flow to kidneys, decreased glomerular filtration rate, decreased ability to eliminate wastes, and nocturia is likely

Pre-op assessment of Elderly's CV system: list what you would expect to find

decreased cardiac output, increased BP, and decreased peripheral circulation

Pre-op assessment of Elderly's Resp. system: list what you would expect to find

decreased elasticity, decreased vital capacity, and decreased oxygenation of blood

chronic gastritis atrophic

deep glands and all layers of stomach -exposure to lead, benzine, and nickel

Barbs

depress CNS; causes hangover effect -can cause hypotension, resp. depression, bradycardia -Secobarbital (Seconal) -Pentobarbital (Nembutal)

phenothiazines

depress vomiting caused by chemoreceptor stimuli; inc seizure threshold

Anesthesia Stages: Danger (death)-

depression of vital functions, resp. failure possible death. Pt's resp. muscles are paralyzed; apnea occurs. Pupils are fixed & dilated

A small number of patients who have had a laparoscopic cholecystectomy report mild shoulder pain resulting from:

diaphragmatic irratation secondary to residual carbon dioxide

S/S of ulcerative colitis

diarrhea rectal bleeding colicky pain in LLQ increased bowel sounds fever wt loss recurrence after bouts of emotional stress, dietary indiscretion, ingestion of irritants such as laxatinves or antibiotics fissures, fistulas, ulcers, strictures may be present with anal disease

Clinical manifestations of malabsorption are

diarrhea, or frequent loose, bulky, foul smelling stools that have increased fat content and are often grayish in color.

Treatment of fecal impaction usually involves

digital dislodgement and enema administration.

Patients taking digitalis are at increased risk for

digitalis toxicity and hypokalemia with dehydration from diarrhea.

Megacolon is

dilated and atonic colon cause by fecal mass that obstructs the passage of colon contents.

Hemorrhoids

dilated portions of veins, in the anal canal.

Pancreatitis Nursing Interventions

diligent assessment of respiratory, heart, abd, pain, fluid status pain management antiemetics monitor I&O, labs, daily wt being PO slowly teach about disease process appropriate referrals

The nurse can prevent the transmission of hepatitis A by avoiding

direct contact through fecal matter, contaminated food, or contaminated water.

M1

distant metastasis

Patient has just returned from traditional (open) cholecystectomy and has a JP drain. The drainage is serosanguious, what should you do?

document it, this is normal

Fecal softer: examples

docusate (Colase)

Define and Give example: Diagnostic surgery

done to r/o or confirm diagnoses. Ex) Bronchoscopy, Biopsy

Define and Give example: Curative surgery

done to remove a diseased body part. Ex) Appendectomy

Salam sump tube

double lumen, pigtail port patent. Usually attached to suction

nonsurgical management of Diverticulitis

drug and nutrition therapy with rest broad spectrum antibiotics IV fluids for patients admitted to hospital rest during acute phase of illness Diet should be low fiber or clear liquids based on symptoms NGT if patient if patient has very sever symptoms and is NPO

cirrhosis physical exam

dry skin, itching, pink hands, red center radiating branches, ascites, abd fluid, vit k deficiency (increased risk for clotting factors)

fatty liver

due to fat in and around the liver, can be caused by alcohol dm obesity increased lipid 2 types : non alcoholic fatty liver disease and non alcoholic steatohepatitis

S/S of GERD

dyspepsia odynophagia dysphagia acid regurgitation eructation asthma morning hoarsness

a 78yo woman was admitted during the evening shift with a tentative diagnosis of cancer of esophagus. The nurse in her intial assessment finds the patient's major complaint is:

dysphagia

During assessment of the patient with esophageal achalasia, the nurse would expect the patient to report:

dysphagia, especially with liquids

pulmonary embolism signs and symptoms PE

dyspnea, chest pains, cough, cyanosis in extremities, rapid respirations, tachycardia, anxiety

Medical management of constipation includes

education, exercise, bowel habit training, increased fiber and fluid intake, judicious use of laxatives.

GI LAB AST?ALT

elev in necrosis, most liver disease

Pancreatic tests

elevated in acute pancreatitis amylase 56-90 lipase 0-110

Liver Function

elevated with disease AST 5-40 units ALT 3-35 LDH 115-225 Alkaline phosphatase 30-85

A nursing intervention that is most appropriate to be decrease postoperative edema and pain in the male patient following an inguinal herniorrhaphy is:

elevating hte scrotum with support or small pillow

GI LAB direct and indirect bilirubin

elevation in in impared secretion

A 63-year-old patient is admitted with acute diverticulitis. The most appropriate nursing intervention to lessen this patient's signs and symptoms of increased flatus and chronic constipation alternating with diarrhea, anorexia, and nausea would be to

encourage a diet high in fiber content.

The patient complains that he will never adjust to his colostomy. In this situation, it would be best for the nurse to

encourage him to express his concern.

Carefully monitoring the patient for signs that may indicate the development of pancreatitis (abdominal pain, nausea, and vomiting) is essential after a(n)

endoscopic retrograde cholangiopancreatography (ERCP).

♥ Cosmetic-

enhance appearance (lipo, tummy tuck)

splenomegaly

enlarged spleen due to the back up from hypertension in the liver, this causes the breakdown of platelets which increases the chances of bleeding out

Sulfasalazine is the recommended medication for treatment of Crohn's disease. Patient teaching should include:

ensuring adequate hydration to prevent crystallization in kidneys.

Pre-op nursing management for ulcerative colitis

enterostomal therapy consult ostomy support group referral

Antrectomy

entire antrum of stomach removed thereby removing cells that secrete gastrin, vagotomy also performed

Acute gastritis symptoms

epigastric discomfort, tenderness, eructation, severe nausea and vomit. Short duration 24-48 hours Diarrhea within 5 hrs after contaminated

The purpose of antibiotic therapy in treating stomach disorders is that it

eradicates H. pylori.

Stress ulcers

erosive -severe trauma or illness -drug ingestion (ASA, NSAID, alcohol) -shock, sepsis

chronic gastritis type B

erosive; caused by h pylori

infiltration

escape of fluid into subcutaneous tissue

hiatal hernia

esophageal hiatus becomes enlarged allowing part of the stomach to move into thoracic cavity tx: nissen fundopilication

NSAIDS have been found to

exacerbate IBD.

hemorrhage

excessive blood loss due to the escape of blood from blood vessels

Stage II Anesthesia

excitement, delirium

pancreas

excretes digestive enzymes like lipase, amylase, and trypsin

After barium swallow contrast studies are performed, the nurse should ensure that the patient

expels all barium rectally.

cirrhosis

extensive irreversible scarring , destruction of the hepatocytes liver shrinks in size indication is elevated liver enzymes

Cirrhosis

extensive, irreversible scarring of the liver

Fecal incontinence devices involve

external fecal incontinence collectors, internal drainage systems.

Anal fissure is characterized by

extremely painful, defecation, burning, and bleeding.

Defecient knowledge is a commonly used nursing diagnosis when patients need information regarding their conditions and diagnistic tests. Before a gstroscopy, the nurse should inform the patient that:

fasting for 6-8 hours is necessary before the examination

hep a

fecal oral route , hardly a virus, can be spread through shellfish or food handlers not many signs and symptoms

male and female alcohol causing liver problems

females drink less in less amount of time and are at risk men can drink a little more in same amount of time (10 years)

Patients with liver abscess are seen with vague signs and symptoms, which are often:

fever accompanied by chills, abdominal pain, and tenderness in the right upper quadrant

Symptoms of toxic megacolon include

fever, abdominal pain, distention, vomiting, and fatigue.

-pexy/plexy

fix it

Asterixis

flapping tremor (liver flap) commonly affecting the arms and hands that is a manifestation of hepatic encephalopathy.

The patient, age 32, is admitted with possible appendicitis after being evaluated by the physician. It is appropriate for the nurse to administer

fluid and electrolyte replacement

BUN and Creatinine are drawn to check for...

fluid status and renal function

nursing interventions for Peritonitis

fluid volume deficit monitor and replace F&E NGT management monitor VS report blood culture results antibiotic administration wound care

endoscopic retrograde cholangiopancreatogram

fluoroscopic procedure where contrast medium is injected endoscopically - to visualize biliary and pancreatic ducts, as does MRI

In planning care for a patient with metastatic cancer of the liver, the nurse includes interventions that:

focus primarily on symptomatic and comfort measures

Gastric ulcer pain

food causes pain upper epigastrium with localization to left of midline

gastric ulcer

food causes pain, vomiting relieves it. pain=aching, burning, gnawing

Dietary teaching for patients with fecal incontinence includes

foods that thicken the stool (apple sauce, and fiber products), and avoid foods the loosen stool (rhubarbs, figs, prunes, plums)

Antibiotic treatment/Triple T

for H pylori 1. Omeprazole or Rantidine 2. Flagyl 3. Tetracycline

Why do we do Pre-op vitals and labs

for baseline data that we can use as criteria for discharging them from the PACU (done on Outpatient/ambulatory pts as well)

deep vein thrombosis (DVT)

formation of a blood clot ("thrombus") in a deep vein

Disease process in Crohn's Disease results in

formation of discontinuous lesions creating a "cobblestone" appearance. As the disease advances the bowel wall thickens and becomes fibrotic and the intestinal lumen narrows.

Pilonidal cyst

found in the intergluteal cleft on the posterior surface of the lower sacrum.

hematochezia

frank blood in stool

Maintaining skin integrity if perineum involves

frequent and meticulous hygiene, Briefs only for brief periods of time. perineal cleansers, and skin protectants.

Nursing interventions for PUD surgeries

frequent assessment/ VS Coughing and Deep breathing important with abd incision Monitor NG tube for patency Wound care/monitoring ABD assessment for Bowel sounds (IAPP) Begin PO intake when bowel sounds present

Because the small intestine needs bile only a few times a day, bile is stored and concentrated in the:

gallbladder

Lab values that are often abnormal in a patient with liver disease include: (select all that apply)

gamma GT alkaline phosphatase total bilirubin

propofol (Diprivan)

general anesthetic- short acting hypnotic- assess respiratory status, aseptic technique used while handling drug, RN administration.

advanced cirrhosis s/s

gi bleeding , jaundice, poor liver function ascites, spontaneous bruising, peripheral edema, dry skin, jaundice lab results may show decreased platelet (thrombycytopenia) increase liver enzymes, ammonia may be up low h&h increase BUN decrease proteins

tx portal hypertension

give vit k , anti-hypertensives ;

Anesthesia Adjuncts

given for pain relief, amnesia and muscle relaxation -hypnotics, opioids, neuromuscular blockers Popofol: sedation mophine-pain vecuronium (norcuron)-muscle relaxation and secretion control

diuretics for ascites

given to get rid of the fluid in the abd

-oscopy

go in and visually inspect

Preventing hypervolemia post op

goal is to restore fluid volume -oxygen and IV therapy -whole blood and packed RBCs; plasma -drug therapy

Define and Give example: Radical surgery

goes beyond the area that's affected ex) exploratory surgery

Hemorrhoid symptoms and discomfort can be relieved by

good personal hygiene and avoiding straining during defecation. High residue diet rich in fruits and bran.

At what age are older adults at a higher risk for complications during surgery? Why?

greater than 65 yo due to decreased immune function and increased chronic illnesses

ulcerative colitis diagnostics

h/h wbc c-reactive protein erythrocyte sedimentation rate potassium, sodium, chloride albumin colonscopy

prior to paracentesis

have the pt void to prevent damage to the bladder

Dehiscence

heals from inside out opened / separation

vaccinations for hep

hep a & hep b

Flapping tremor (asterixis) is seen in a patient with

hepatic encephalopathy.

what usually accompanies ascites?

hernia due to increased abd pressure

What lab value may cause surgery to bepostponed

hgb

Dumping syndrome diet

high protein high fat low carb dry diet don't eat anything that is liquefied quickly no fluids 1 hr ac, with or 2 hours pc meal examples: fish, red meat, cheeseburger with no bun, beer

pts with cirrhosis diet

high protein, high carbohydrate , moderate-fat

Define and Give example: Major surgery

high risk, may be long/extensive ex) open heart surgery

race at highest risk for nfld

hispanics

Fecal softener: action

hydrates the stool by its surfactant action on the colonic epithelium; aqueous and fatty substances are mixed. *Does not exert a laxative action.*

lipase

hydrolyzes fat

TPN

hyperglycemia and hypoglycemia monitor every 6 hours taper off TPN Hang 10 detrose if next TPN isnt available

What complications can Antihypertensive medications create?

hypotension crisis when given with muscle relaxants and opioids

perforation intervention

hypovolemic shock assessment: dec BP, tachycardia -peritonitis assessment:rigid board like abdomen fluid replacement and antibiotics no pain meds until diagnosis is made

Medical management of appendicitis

immediate surgery is often indicated.

drug for transplant

immunosuppressant although greater risk for infection

postop nursing diagnosis

impaired gas exchange impaired skin integrity acute pain RC: hypoexmia, atelectasis, DVT, PE, shock

while preforming an abdominal assessment on an elderly patient, what is a normal finding related to age changes?

impaired sensation to defecate and constipation

Complications associated with ileostomy include

impaired skin integrity around stoma. diarrhea, stomal stenosis, urinary calculi, cholelithiasis.

Define and Give example: Restorative surgery

improve functional ability. ex) total knee replacement, total hip replacement

Define and Give example: Cosmetic surgery

improve physical appearance. ex) breast implants, plastic surgery, rhinoplasty

Dumping syndrome after a Billroth II procedure occurs when high-carbohydrate foods are ingested over a period of less than 20 minutes. A nursing measure that will prevent or minimize dumping syndrome is to administer the feeding

in six small daily meals high in protein and fat.

Ulcerative colitis usually begins

in the rectum and spreads proximally to involve the entire colon. Bleeding occurs as a result of the ulcerations. Mucosa becomes edematous and inflamed. Fistulas, obstruction and fissures are uncommon.

analgesia

inability to feel pain

Pilonidal cyst is treated with

incision and drainage under local anesthesia.

atelectasis

incomplete expansion or collapse of part of a part of the lungs

Ileostomy may involve

incontinent ostomy, and use of a fecal collection bag. continent pouch aka Kock pouch, and use of catheter to remove contents via a "nipple valve".

tobacco

increase the risk for pulmonary complication

lab results for fatty liver disease

increased AST, ALT or normal ALT and elevated AST

Monitoring for potential complications includes assessment for

increased abdominal pain and tenderness, accompanied by abdominal rigidity, elevated white blood cell count, elevated ESR, increased temperature, tachycardia, hypotension.

ascites

increased fluid in the peritoneal cavity ; there is albumin found here therefore it does not leave that space pt can have hypotension and edema at same time liver does not produce albumin like normal therefore less in the vascular space to pull fluids back in can cause the vasoconstriction of the kidney - RAAS system where more is absorbed causing increase fluid for abdomen

CEA

increased levels may indicate colorectal cancer, cirrhosis, hepatic disease, aclocholic pancreatitis, heavy smokers

Pre-op assessment of Elderly's Musculoskeletal system: list what you would expect to find

increased possibility for deformities r/t osteoporosis and arthritis

What complications can anticoagulants create?

increased risk for hemorrhage

Pts with a hx of COPD, chronic pneumonia or empyema, emphysema, or asthma have an an increased risk for ___, decreased anesthesia ____, decreased ______ and may need ______

increased risk for pneumonia, decreased anesthesia excretion, decreased tissue oxygenation, and may require post-op vent

Why does smoking cause complications during surgery?

increases risk for pulmonary complications, increases mucous production, and decreases ciliary action in the throat making it more difficult for the pt to clear secretions post-op

N1N2N3

increasing involvement in regional lymph nodes

T1T2T3T4

increasing size and or local extent of primary tumor

3 phases of general anesthesia

induction, maintenance, and emergence

Herpes Simplex

inflammation and ulceration r/t viral infection (IF BY EYE ITS EMERGENCY)

periodontal disease

inflammation causes loose teeth -swollen, painful, red -receding gum line -pus fill pockets -loose teeth

thrombophlebitis

inflammation in a vein associated with thrombus formation

Appendicitis

inflammation of appendix- occurs when the appendix becomes blocked by feces, a foreign object, a tumor

cholangitis

inflammation of bile duct

Acute Pancreatitis

inflammation of pancreas resulting in autodigestion & fibrosis of pancreas 90% related to excessive alcohol intake or biliary tract disease

acute pancreatitis

inflammation of pancreas resulting in autodigestion and fibrosis of the pancreas -starts mid epigasric and radiates to back -pesistent N/V, tachycardia, distention -cullens sign (blue color by belly button) -turners sign (blue color of left flank)

Peritonitis- Nursing Care

inflammation of peritoneum- collection of pus in abdomen. S/S: pain with movement, rebound tenderness, absent bowl, abdominal distention, abdomen Rigidity (hardening). -Tx: NG tube, Give Oxygen.

Cholangitis

inflammation of the bile duct common post gallbladder removal if there are still stones

Cholecystitis- Nursing Care

inflammation of the gallbladder, usually associated with gallstones blocking the flow of bile- (Female, Forty, Fat (obese), Fertile- S/S: abd. pain/distention after fatty meals, burping, gas, Clay color stool, Steatorrhea.-Tx; NPO with IV fluid, Ng tubing, Lithotripsy (break stones). Diet: non -gas forming foods,

Peritonitis

inflammation of the peritoneal membrane most common organism is E. Coli bacterial invasion via bloodstream or as a result of an abdominal disorder

Peritonitis is

inflammation of the peritoneum, usually as a result of bacterial infection.

appnedicitis

inflammation of vermiform appendix obstruction of appendix causes bacterial invasion and infection

pneumonia

inflammation or infection of the lungs

Blood, mucous, and pus in the stool suggests

inflammatory enteritis or colitis.

Prostaglandin Analog

inhibit secretion of gastric acid; used with NSAID ex: Cytotec

Antihistamine

inhibit vestibular stimulation; takes the feeling of motion sickness away dramimine, antiver, phenergan

Histamine Receptor Antagonist

inhibits gastric acid secretion; used before surgeries

H_2 Receptor Blockers-

inhibits gastric secretionsb♥Cimetidine (tagamet) ♥Ranitidine (zantac) ♥Famotidine (pepcid)

Clinical manifestations of small bowel obstructions

initially crampy wavelike pain due to persistent peristalsis above and below the blockage. Patient may pass blood, and pus, but no fecal matter, and no flatus. Vomiting, up to and including fecal vomiting.

A patient, age 36, is admitted with diarrhea and dehydration. The physician has ordered several diagnostic studies of the patient's stools. When obtaining a stool specimen to be examined for ova and parasites, the nurse should

instruct the patient to obtain three different stool specimens on subsequent days.

large bowel obstruction

intermittent lower abd cramping lower adb distention minimal or no vomiting obstipation or ribbon like stools no major F/E imbalances metabolic acidosis

Voluminous, greasy stool suggests

intestinal malabsorption.

Complications of Crohn's Disease

intestinal obstruction or stricture formation. perianal disease. fluid and electrolyte imbalance. malnutrition and malabsorption. fistula and abscess formation.

Fecal incontinence

involuntary passage of stool from the rectum.

Tardive Dyskinesia

involuntary rolling of the tongue and twitching of the face or trunk or limbs

In planning care for the patient with ulcerative colitis, the nurse recognizees that a major difference between ulcerative colitis and Crohn's disease is that ulcerative colitis:

is curable with a colectomy, wheras Chrohn's disease often recurs after surgery

production of bile with cirrhosis

is decreased ; not allowing absorption of vitamin K which helps with clotting factors (therefore the patient is more likely to bleed out) - bleeding and easy bruising

jaundice side effect

itching

bilirubin causes

itching ; excessive amounts because it cannot be excreted properly

In patients with acute pancreatitis, the algesic meperidine is no longer the opiod of choice because of:

its toxic metabolite, normeperidine, which can cause seizures

Anesthesia Stages: Surgical Anesthesia-

jaw is relaxed, breathing is quiet & regular. Pt can't hear & sensation to pain is lost

Polyarthralgia

joint pain affecting joints with inflammation, stiffness, swelling, warmth, tenderness

The patient was scheduled for a laparoscopic cholecystectomy. Complications developed during surgery, and he underwent an open cholecystectomy with a T-tube inserted into the common bile duct. The purposes of the T-tube are to:

keep the common bile duct open until edema resolves, and allow drainage of bile into drainage bag

A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T-tube inserted into the common bile duct. The purpose of the T-tube is to

keep the duct open and allow drainage of the bile until edema resolves.

To prepare the patient for endoscopic examination of the upper GI tract, the patient's pharynx is anesthetized with lidocaine (xylocaine), Nursing interventions for postendoscopic examination include:

keeping the patient NPO until gag reflex returns

After the physician has performed a liver biopsy, the nursing interventions would usually include

keeping the patient on the right side for minimum of 2 hours.

s/s of rejection after transplant

kidney failure, liver enzymes increase fever etc

The new operative procedure gaining in popularity for the removal of the gallbladder, if there is no cholecystitis or choledocholithiasis, is a(n)

laparoscopic cholecystectomy

Loose semisolid stools are more often associated with disorders of the

large bowel.

laparotomy

large incision

Peritonitis: patho

leakage of contents of the bowel or organs into the abdominal cavity, leading to edema of the tissue. Immediate response of the intestinal tract is *hypermotility soon followed by paralytic ileus with an accumulation of air and fluid in the bowel*.

Define and Give example: Emergent

life-threatening problem that requires immediate action ex) GSW, stabbing, internal bleeding, and certain MI's (LAD blocked)

GI LAB Ammonia

liver function, elevation in cirrhosis, hepatitis

right upper quadrant pain

liver is enlarged ; can be due to hep

decompensated cirrohsis

liver is scarred and liver failure occurs

compensated cirrohsis

liver is scarred but can function

nerve blocks

local anesthetic is injected around a nerve trunk supplying the area of surgery (jaw, face, and extremities)

Define and Give example: Simple surgery

localized, does not go beyond area that's affected ex) Mastectomy, prostatectomy

Anal fissure

longitudinal tear or ulceration in the lining of the anal canal.

Aging effects

loose teeth, ill fitting dentures, dry m/m, ↓ secretion of hydrochloric acid, ↓absorption of Fe & B12 (leading to anemia & bacteria proliferation), ↓ peristalsis (leading to constipation)

Anesthesia Stages: Excitement-

loss of eyelid reflex; pt has irreg. breathing, increased muscle tone, involuntary movements; still susceptible to external stimuli

hypothermia

low body temperature

hep b

low grade damage over the decades hemodialysis , unprotected sexual intercourse, acciental needle stick, sharing needles, blood transfusion close person contact by open cuts/sores

Serum Iron

low iron deficiency anemia 75-175mcg/dL

pts with liver diet

low protein

Define and Give example: Minor surgery

low risk because it's localized ex) biopsy, eye surgery, colonoscopy

Saline laxatives: examples

magnesium hydroxide, (Milk of Magnesia)

Nursing management of small bowel obstruction

maintain function of ng tube. careful I&O. assess for fluid and electrolyte imbalance.

In Chron's disease, major complications that develop due to the granulomatous collegstone lesions of the small intestine include:

malabsorption of nutrients

complications of general anesthesia

malignant hyperthermia

The chief result of malnutrition is

manifested by weight loss or other signs of vitamin or mineral deficiency.

What complications can Corticosteroids create?

masks infection, increases glucose, delays wound healing, and increases risk for hemorrhage

diuretics

may cause electrolyte imbalances, with resulting respiratory depression from anesthesia

esophageal hemorrhage

may cause problems if bleeding - life threatening heavy lifting, loss of consciousness, food pressure can cause bleeding

tranquilizers

may increase the hypotensive effect of anesthetic agents

tx for liver trauma

may need packed red blood cells, fresh frozen plasma, volume infusion for hydration

anticoagulants

may precipitate hemorrhage

oral antidiabetic medications

may react with radiologic (x-ray) iodinized contrast dyes, and cause acute renal failure. (metformin, hydrochloride)

Albumin

measures circulating protein 3.5-5

Causes of constipation include

medications, rectal or anal disorders obstruction, metabolic disease, neurologic and neuromuscular conditions, endocrine disorders, lead poisoning, connective tissue disorders.

Non surgical ulcerative colitis interventions

meds nutrition physical and emotional rest document severity of illness skin weekly wt at home

normal creatinine

men: 0.6-1.5 women: 0.5-1.2

normal Hgb

men: 14-18 women: 12-16

A medication used to treat H. pylori infection is

metronidazole

Lubricant laxatives: examples

mineral oil, glycerin suppository.

laparoscopic

minimally invasive surgery using a laparoscope. Often used for removal of gall bladder.

Post-op nursing management for ulcerative colitis

monitor stoma monitor ng tube return of bowel sounds advance diet as tolerated

Morphine vs Vecuronium

morphine given before surgery vecuronium given during surgery which causes muscle relaxation and dec secretions

Causes of peritonitis

most common is bacterial infection, but also includes injury or trauma, appendicitis, perforated ulcer, diverticulitis, bowel perforation, abdominal surgery, peritoneal dialysis.

Perforation

most frequent with duodenal ulcers -causes sudden severe pain; surgical emergency -results in peritonitis, bacterial septicemia and hypovolemic shock.

liver candidates for transplant

need to be in End stage liver disease ,

assessment for hep

needle stick , any type of drug (illicit, alcohol), sex partners, tattoos, prison, health care worker

When a patient has hepatic encephalopathy, medications often administered to relieve toxic blood chemistry include:

neomycin, lactulose.

Antacids

neutralize gastric acids -take 1 hour ac and 2-3 hrs pc

nursing management for appendicitis

never give enema, laxative or apply heat to abdomen bc could cause perforation post op and pain management

M0

no distant metastasis

T0

no evidence of primary tumor

drainage of abd

no more than 2000 mL to prevent hypovolemia

N0

no regional lymph node metastasis

Saline laxatives: action

nonabsorbable magnesium ions alter stool consistency by drawing water into the intestines by osmosis,; peristalsis is stimulated. *Action occurs within 2 hrs*.

chronic gastritis type A

nonerosive -inflammation that hasn't worn away the lining

Aphthous

noninfectious ulcer in the mouth - stomatitis

Ultrasound

noninvasive, no radiation, special prep or aftercare, used mostly with gallbladder and liver problems

Absorbents (antidiarrheal)

nonsystemic coat GI tract wallas absorb bacteria/toxins which are causing diarrhea, eliminating them in stool EX: kapectolin kaopectate pepto-bismol

pancreatic pseudocysts

not a true cyst; localized collection of pancreatic secretions; may resolve spontaneously

optional surgery

not critical to survival or function

perioperative nursing

nursing care provided for the patient before, during, and after surgery

complications of surgical management of ulcerative colitis

nutritional deficiencies anemia paralytic ileus

Anal abscess is caused by

obstruction of anal gland with dried debris, resulting in retrograde infection.

Important goal of preoperative nursing

obtain baseline vital signs

Important goals of preoperative nursing

obtaining a baseline assessment that will be used in postoperative nursing also

Melena

occult blood in stool more common in duodenal cancer

Melena

occult blood in the stool more common with duodenal ulcers

GI LAB stool

occult blood test ova and parasite fecal fats Cdiff

Fecal

occult blood: GI bleed or eary colorectal CA Stool for ova and parasites CDif

Peptic Ulcer-Nursing Care

occurs in mucous membrane of the stomach or duodenum, caused by the action of highly acid gastric juice, pepsin acid, Overuse NSAID, increase of Hydrochloric acid. - Give NSAID with food, milk, or antacids. Diet: Avoid spicy foods, high-acid foods/drinks, high-fiber foods, caffeine, alcohol, smoking, stress.

regional anesthesia

occurs when an anesthetic agent is injected near a nerve pathway in or around the operative site, inhibiting the transmission of sensory stimuli to central nervous system receptors. Client is awake but loses sensation in a specific area or region of the body. ex: nerve block, epidural, or spinal

liver trauma

one of the largest organs ; highly vascular therefore with trauma monitor for blood loss (hypovolemic chock)

hep d

only affective with people who have hep b - infection of the liver

Nursing management of patient with constipation includes the need to elicit information about

onset and duration of constipation, current and past elimination patterns, patient's expectation of normal bowel elimination, lifestyle information, past medical and surgical history, current medications, esp laxatives, and enema use.

Tx complications of Regional Anesthesia

open airway fast acting barb notify surgeon

Ostomy

opening

Stage III anesthesia

operative, surgical anesthesia

Constipation is a major issue for patients taking

opioids

Nutritional therapy for IBD involves

oral fluids and a low residue, high protein, high calorie diet with supplemental vitamin therapy and iron replacement. Avoid milk, smoking, and cold foods that increase intestinal motility. Possible parenteral nutrition.

Patients with IBD are at increased risk for

osteoporotic fractures due to bone demineralization, which may be exacerbated by corticosteroids.

manifestations of inflammatory diseases

pain tenderness distention vomiting malabsorption constipation diarrhea abdominal masses abnormal fecal contents borborymus hemorrhage

duodenal ulcer

pain occurs 90mins -3hrs after eating, awakening at night -more common

Narcotics

pain releif. adjunts to anaesthesia antidote: Narcan

Gastric ulcers

pain when anything is eaten

acute cholecystitis management

pain: demerol ( morphine or dilaudid may increase spasm of sphincter of oddi)

Defecation in diarrhea may be accompanied by

painful spasmodic contractions of the anus and tenesmus, or ineffective sometimes painful straining with a strong urge.

B12

pallor, jaundice, glossitis

chronic pancreatitis

pancreas progressively destroyed from alcoholism, bile duct obrstruction, and protein malnutrition s/s -intense abdominal pain -hyperglycemia -frequent passing of foul fatty stools

Oil droplets in the water almost always suggest

pancreatic insufficiency.

GI LAB amylase/lipase

pancreatitis

ascites tx

paracentesis ; pulling out fluids - no more than 1000-2000 mL elevate HOB low sodium low fluid intake albumin diuretics

anesthesia

partial or total loss of sensation with or without loss of cosciousness

After abdominal surgery, what is the most reliable assessment finding that suggests return of peristaltic movement

passing flatus

Murphy's Sign

patient is asked to inhale while the examiner's fingers are hooked under the liver border at the bottom of the rib cage if tender than positive for gallbladder disease

Complications of Appendicitis include

perforation leading to peritonitis usually occurs 24hrs after onset of pain. symptoms include temperature >100 degree F(37.7 degrees C), toxic appearance, continued abdominal pain, or tenderness.

The most lethal complication of a peptic ulcer is

perforation.

A progressive wavelike movement that occurs involuntarily in hollow tubes of the body, especially in the alimentary canal, to propel fluids, gas, and digestive substances forward is called

peristalsis

most common complication of appendicitis

peritonitis

Complications of diverticulitis include

peritonitis, abscess formation, fistulas and bleeding.

-ostomy

permanent surgical opening ex) ileostomy, colostomy

Antiemetics

phenothiazines antihistamines serotonin antagonist anticholinergic

Normal findings for a stoma

pink beefy red looking, anything else is not normal

Define and Give example: Elective surgery

planned, non-acute problem ex) cataracts

Bulk forming laxative: action

polysaccharides and cellulose derivatives mix with intestinal fluid, swell, and stimulate peristalsis.

pancreatic cancer

poor prognosis -whipple procedure

hepatorenal syndrome

poor prognosis for the patient with liver failure ; often cause of death decrease urine output (500ml/hr) elevated bun/creatinine increase urine osmolarity

A patient with advanced cirrhosis asks the nurse why his abdomen is so swollen. The nurse's response is based on the knowledge that:

portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space

If the patient has a T-tube in place after a cholecystectomy, the best nursing intervention would be to

position and secure the drainage bag at the abdominal level.

Diverticulum

pouches where food can become trapped and regurgitated later on -managed by small frequent feedings of semisoft foods

EGD

preop: NPO 8-12 hrs; anticholinergics to dec secretions; sedatives, local anesthetics sprayed postop: NPO until gag reflex returns; assess for perforation

Mx

presence of distant metastasis cannot be assessed

liver cancer affects

primarily asia and mediterannian areas ; usually vietamese man more than any other type could be primary (originated there) or secondary (metastasize)

Tx

primary tumor cannot be assessed

general anesthesia

produces a state of narcosis (loss of consciousness), analgesia, relaxation, and loss of reflexes.

Clinical manifestations of Crohn's Disease

prominent right lower abdominal *pain, and diarrhea unrelieved by defecation*. Abdominal cramps. Eventually anorexia, and malnutrition due to reduced intake leading to weight loss, and anemia. Clinical course varies from intermittent to fulminating.

Define and Give example: Urgent

prompt intervention is necessary, delay no longer than 48 hrs (if more, could be life threatening). ex) Obstructions and fractures

misoprostol (Cytotec)

prostaglandin- reduce the risk of stomach ulcers in patients treated with nonsteroidal antiinflammatory drugs- Causes aborption, Assess blood in stools and emesis.

Pantoprazole (Protonix)

proton pump inhibitor- Decrease gastric acid- Assess for melena and hememesis

esomeprazole (Nexium)

proton pump inhibitor- Decreases acid- Do not crush or chew, capsule can be empties and mixed with applesauce, Assess for melena and hememesis, increase risk bleeding with Warfarin.

An essential nursing measure to prevent peritonitis after a paracentesis is

providing oral or intravenous fluids.

Bulk forming laxatives: examples

psyllium hydrophilic mucilloid (Metamucil), methylcellulose (Citrucel),

ASA III

pt as disease of more than 1 body system -controlled -limitations present -no immediate danger

Barbiturates-

pt can develop a physical dependence (used pre-op→preanesthesia & post-op→insomnia/anticonvulsant); depresses CNS- causes lethargy, Bradycardia, apnea, confusion, resp. depression, hypotension, hangover effect.♥Secobarbitol (seconal) ♥Pentobarbital (nembutal) ♥Phenobarbitol

ASA II

pt has disease of 1 body system (ex htn) -well controlled -no limitations -low risk of death

ASA I

pt is in excellent health; excludes extreme age. -no limitations -low risk of death

ASA IV

pt poor health with at least 1 severe disease -end stage -limitations -possible risk of death

interventions for hep

pt rest to reduce the liver's metabolic demands and increase its blood supply

insulin on the day of surgery

pt. might be given a reduced dose

prior to liver transplants

pts undergo psychological and physical assessments by physicians and transplant coordinators

♥ Transplantation-

put in (organ)

discharge instructions cirrhosis

put pt in a reclining chair to increase the head of bed for better breathing as well as elevate feet to prevent edema not have pt take NSAIDS, herbs, vitamins, alcohol, illicit drugs

The exit from the stomach is called the:

pyloric sphincter

propofol effects

quick, no hangover effect, recovery time 8 minutes

Increased fiber and fluid intake for constipation involves

recommened daily dietary fiber intake of 25 to 30 g/day.

Criteria for diagnosis fro IBS include

recurrent abdominal pain or discomfort at least 3 days/month in the past 3 months with 2 or more of the following -improvement with defecation, -onset associated with change in frequency of stool, -onset assoicated with change in appearance of stool. Rule out structural or other disorders.

Ulcerative Colitis

recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon.

A patient is scheduled in the morning for a hemicolectomy for removal of a cancreous tumor of the ascending colon. The physician has ordered intestinal antibiotics for her preoperative to:

reduce bacteria content of the colon

Define and Give example: Palliative surgery

reduce intensity of an illness, not curative ex) ostomy, Crohn's disease, fissures, strictures, and ulcerations

Conscious Sedation

reduce level of concs. but allow pt to maintain airway and respond to verbal commands -vercet, fentanyl, morphine

Anticholingergics

reduce phaygeal secreations and dec GI motility and secretions *Robinol*

Exercise can improve symptoms of IBS by

reducing anxiety and increasing intestinal motility.

Pre Albumin

reflects protein and calorie intake for previous 2-3 days 20-40

GERD

reflux allows gastric and duodenal contents to move back into the distal esophagus; attributed to inappropriate relaxation of the lower esophageal sphincter (LES); slowed or delayed gastric emptying may contribute; ineffective clearing of the esophagus may contribute

Crohns Disease- Nursing Care

regional enteritis, inflammation of bowel resulting in swelling, thickening, and abscess formation. S/S: Cramping, diarrhea, wt. loss, malnutrition, anemia, Ulcer formation.

Patients who receive a liver transplant secondary to viral B or C hepatitis often experience ______ or ________ of the transplanted liver

reinfection or cirrhosis

Stage I Anesthesia

relaxation, sedation, analgesia

Anesthesia Stages: Onset-

relaxation, sedation; pt feels drowsy & has a reduced sensation to pain; amnesic w/exaggerated hearing

Medical management of IBS involves

relieve abdominal pain, controlling diarrhea/constipation. reducing stress.

Ectomy

removal of

-ectomy

removal of organ or gland

-ectomy

removal of organ or gland ex) appendectomy

Acute gastritis interventions

remove cause foods/fluid held until n/v suside brat diet avoid spicy foods caffeine and heavy meals meds

curative surgery

removes diseased part

Teaching in relation to home management following a lapraoscopic cholecstectomy should include:

reporting any bile-colored drainage or pus from any incision

Diverticulitis

resultant infection or inflammation of pocket-like herniations of the bowel, that leads to impeded drainage, and perforation or abscess formation.

GERD

resulting from backward flow of gastric contents into esophagus; occurs in all age groups and usually after meals -relaxation of LES

Bowel sound assessment is especially important for a postoperative patient who has had abdominal surgery as it can determine the:

return of peristalsis.

Antagonist for barbiturates→

reverses the effects of the drug is Flumaznil (romazicon)

pain for liver trauma

right shoulder pain ; right upper abd ; deep breathing

clinical manifestations of Peritonitis

rigid boardlike abdomen pain that increase with pressure of motion n/v absence of bowel sounds fever leukocytosis

A nurse is monitoring a client with a diagnosis of peptic ulcer. Which finding would most likely indicate perforation of the ulcer?

rigid, boardlike abdomen

intraoperative nursing diagnosis

risk of perioperative positioning injury impaired tissue/skin integrity RC: hypoventilation

Oscopy

scope (visual)

midazolam (Versed)

sedative/hypnotic- CNS depression- Assess respiratory depression, have resuscitative equipment and reversal drug, flumazenil (Romazicon) available. RN administration.

Pre-op assessment of Elderly's Neuro system: list what you'd expect to find

sensory deficits, slower reaction time, and decreased ability to adjust to change

what lab values increase with pancreatitis

serum amylase and lipase bilirubin WBC hyperglycemia

The patient has acute pancreatitis. The discnostic examination that would probably be ordered would include: (select all that apply)

serum amylase and lipase, ultra sound of pancrease urine, amylase

duties of scrub nurse

set up sterile field

role of scrub nurse

sets up sterile field

dumping syndrome

shift of fluid in digestive system causing: -diarrhea -vertigo -tachypnea -nausea -sweating and pallor

care of person with hemorrhoids

sitz bath stool softeners pain control

An ileostomy was performed on a patient for the treatment of debilitating ulcerative colitis disease. A problem the nurse should watch for in patients after this surgery is

skin excoriation.

Watery stools are more characteristic of disorders of the

small bowel.

dietary management of GERD

small frequent feedings adequate fluids at meals eat slowly and chew thoroughly avoid spices, fats, alcohol, coffee, chocolate, tobacco, citrus juices avoid eating and drinking 3 hours before sleep elevate HOB 6-8 inches lose weight if fat

Although food is digested throughout the almentary canal, up to 90% of digestion is accombpished in the:

small intestine

Most bowel obstruction occur in the

small intestines.

Dumping syndrome management

small meals high in protein for wound healing; high fat to rebuild; dry diet to help absorb fluid; low carb bc body wants to store it as fat. -no fluid 1 hr ac and 2 hrs pc -lying down after meals due to dizziness and vertigo

What inc risk of esophageal cancer

smoking

hep carriers

some individuals can excrete the virus out of their body, if not then stays within the body and become carriers that can infect other people

ulcerative colitis

spans entire length of colon and involves only the mucosa and submucosa usually starts in rectum and distal colon and spreads upward

amylase

splits carbs

trypsin

splits proteins

Clinical manifestation of appendicitis

starts as a vague epigastric or periumbilical pain that progresses to right lower quadrant pain that is sharp, well localized, usually associated with a low grade fever, nausea, occasionally by vomiting, and loss of appetite. Tenderness at McBurney's point, and or rebound tenderness may be present.

Nursing management for ileostomy

stoma initially swollen effluent (fecal matter) always liquid pouch worn continuously empty pouch when 1/3 to 1/2 full change pouch when ileostomy is least active (1st thing in morning) deodorizing solutions if needed Enteric coated, time release and gelatin capsules may not be absorbed in sm. intestine low residue (no corn, celery or nuts) high protein, carbs and calories food passes through 4-6 hours after ingested no laxatives adequate fluids

choledocholithiasis

stones in common bile duct

Choledocholithiasis

stones in common bile duct elevated total bilirubin

liver

stores glucose ; make vit K ; clotting factors ; bilirubin ; albumin made ; estrogen metabolized

An 84yo patient has a history of a large ventral hernia. He is complaining of nausea, comiting, abdominal distention and abdombial pain. A serious coplication of a hernia in which the blood supply to the tisshe becomes occluded is called a:

strangulated hernia

A patient, age 84, has a history of a large left inguinal hernia. He is complaining of nausea, vomiting, abdominal distention, and inguinal pain. A serious complication of a hernia in which the blood supply to the tissue becomes occluded is called a(n)

strangulated hernia.

common risk factors are for oral cancers.

sunlight (Basel cell), tobacco, alcohol, chemical irritants

Proton Pump Inhibitor

suppresses gastric acid secretion -may increase bleeding in pts with coumadin

If the patient with toxic megacolon does not respond within 24 to 72 hours to nasogastric suction, I.V. Fluids with electrolytes, corticosteroids, and antibiotics,

surgery is required.

urgent surgery

surgery that is not an emergency, but must be done within a reasonably short time frame to preserve health

elective surgery

surgery that is recommended but can be omitted or delayed without catastrophe

emergency surgery

surgery that must be performed immediately to save the persons life or a body organ

Orrhaphy

surgical or suture repair

-orrhaphy

suture/surgical repair ex) herniorrhaphy

What would you do first when you get a patient back from EGD?

swallow and gag reflux

hepatic encephalopathy

swelling of the brain due to the liver failure and cirrhosis mood changes, sleep, speech, and mood changes may be reversible with early intervention may be due to elevated ammonia levels (not always)

Patients with hepatitis A, B, C, D, or E typically are instructed to

take vitamin B, C, and K supplements.

-otomy

temporary surgical opening (intention is to heal) ex) pilonidal cyst, laperotomy

S/S of acute cholecystitis (gallstones)

tenderness in RUQ &/or epigastrium pain in epigastric, subscapular or RUQ Positive Murphys sign N/V elevated Temp fat intolerance

acute cholecystitis (gallstones)

tenderness in RUQ, epigastric subscapular; N/V; jaundice -ask pt what they ate, was it high fat content? Murphy's sign

In preparation for a cholecystography, the nurse asks if the patient has eaten since midnight. This is done to determine

the accuracy of the test.

Most important characteristic to check in PACU pt first

the dressing site: the amount and color of drainage

Acute Pancreatitis

the enzymes are only active after they reach the small intestine, where they are needed to digest food. When they become active inside the pancreas, they eat (and digest) the tissue of the pancreas causing swelling, bleeding (hemorrhage), and damage to the pancreas and its blood vessels- caused by alcoholism and biliary tract disease.

In preparing the patient for a paracentesis, the nurse must be sure

the fluid is removed over at least 30 minutes

Conditions of malabsorbtion are characterized by

the inability of the body to absorb one or more of the major vitamins (esp. A and B12), minerals (iron and calcium), and nutrients (carbohydrates, fats, protein)

In toxic megacolon

the inflammatory process extends into the muscularis, inhibiting its ability to contract, resulting in colonic distention.

One serious complication of constipation in patients with hypertension is

the occurrence of exaggerated rebound hypertension following hypotensive episode from valsalva maneuver after straining at defecation.

Who's responsible for obtaining informed consent

the surgeon

Why should you avoid tobacco & gum before surgery?

they increase gastric secretions

When dealing with someone who abuses ETOH, what would you expect to find when giving them medication/anesthesia?

they may have altered responses to medications/anesthesia. May have a tolerance, requiring higher doses

Why is it important for the circulating nurse to properly position the patient in surgery?

to avoid nerve damage, pressure ulcers, circulation and respiration obstruction

Asphyxiation

to cause to die or lose consciousness by impairing normal breathing, as by gas or other noxious agents; choke; suffocate; smother

Pexy/Plasty

to form or create

Why would we do a CT scan before surgery

to identify tumor size and/or location

What is restorative surgery?

to improve function *total knee replacement

Restorative surgery

to improve function (hip replacement)

Palliative surgery

to reduce intensity of illness (ileostomy)

Why do preoperative patients have to be NPO

to reduce risk of aspiration

palliative

to relieve or reduce intensity of an illness; not a curative. improves but doesn't cure.

Why would we do an X-ray before surgery

to visualize a fracture or a break in bone

Hememesis

to vomit blood

Local Anesthesia ("caine")-

topical or infiltration, Spinal Anesthesia ("Intrathecal")- injected into CSF in subarachnoid space; causes inhibition of autonomic, sensory, & motor functions

Medications that can cause constipation include

tranquilizers, anticholinergics, antidepressants, antihypertensives, bile acid sequestrants, diuretics, opioids, aluminum based antacids, iron preparations, some antibiotics, muscle relaxants, and cytotoxic agents.

Treating Portal Hypertension

treat underlying cause avoid alcohol limiting salt and protein

Vincent's Stomatitis

trench mouth; bacterial infection of gingiva -pain, ulcers, foul taste, choking sensation

chronic inflammatory diseases

ulcerative colitis crohns disease diverticular disease

A patient with a T-tube for an open cholecystectomy has resumed oral intake. The T-tube is clamped 2 hours before meals and unclamped 2 hours after meals to aid in the digestion of fat. During the time the tube is clamped the patient complains of abdominal pain and nausea. The best intervention would be to

unclamp the tube immediately.

Extrapyramidal

uncontrollable, involuntary, parkinsonian-like tremors and movements (disruption of the normal balance of the neurotransmitter acetylcholine and dopamine within the basal ganglia.).

The possibility of C. difficile infection should be considered in all patients with

unexplained diarrhea who are taking or have recently taken antibiotics.

Medical management of diarrhea

until C difficile is ruled out, precautions against transmission are warranted. After C difficile is ruled out antidiarrheals, especially loperamide may be used to manage symptoms. Probiotics may also be used.

GI LAB urine

urine amylase-pancratitis urine urobilinogen-hepatic and biliary obstruction

Benzos

used for antianxiety -diazepam (valium) -lorazepam (ativan) -*midazolam (versed)*

moderate sedation

used for short term and minimally invasive procedures

Megace

used to stimulate appettite especially in cachexia

antibacterial Treatment

used with H. pylori prilosec or zantac flagyl if flagyl doens't work use biacin, tetracycline, amoxicillin

s/s for liver cancer

usually asymptomatic, but later weight loss, anorexia, and weakness abd pain

gastric cancer

usually diagnosed at a late stage -tx: palliative surgery -chemo; tpn

live organ donors

usually family members ; cut off lobe and the liver grows to the necessary size of demand from body

liver transplants pts and donor

usually individuals from trauma highest priority get it first 8 hour window in between

A patient has been admitted for diagnostic procedures including an esophagogastroduodenoscopy. The nurse explains to this patient that during this procedure, the physician will

view the esophagus, stomach, and upper small intestine.

-oscopy

visual examination ex) bronchoscopy, colonoscopy

Gastroscopy

visual examination of the stomach by means of a gastroscope inserted through the esophagus- diagnose Ulcers

Following a gastrectomy, the nurse would anticipate that the patient would need to be assessed for

vitamin B12 deficiency.

Hemorrhage

vomiting coffee ground material or black tarry stool -blood that was partially digested bright red blood in vomit

hep e

water borne, fecal contamination of food and water

Hgb levels are checked pre-op because...

we want to make sure that the pt is not already anemic before we cut them open and they loose a bunch of blood

Other causes of constipation include

weakness, immobility, debility, fatigue, inability to increase intrabdominal pressure to facilitate passage of stools, poor fiber intake.

S/S of digestive cancers

weight loss vague indigestion anorexia feeling of fullness anemia from blood loss stool OB positive

tx for fatty liver disease

weight loss, glucose control, aggressive tx for lipid lowering agents

antibiotics in the mycin group

when combined with certain muscle relaxants used during surgery, may cause respiratory paralysis

Complication of peritonitis includes

widespread infection of the abdominal cavity. Sepsis. Shock. intestinal obstruction.

hepatitis

widespread inflammation of the liver cells

Acute diverticulitis may be managed by

withholding oral intake and administration of I.V. fluids and NG suction to evacuate GI system. Antibiotics. If surgery is necessary, pain management.

Acute Acalculous Cholecystitis

without stones caused by a secondary source like trauma, pregnancy, burns, surgery

IBS affects

women more commonly than men.

Complication of surgery to treat peritonitis involves

wound evisceration. abscess formation. Any suggestion of the patient that an area of the abdomen is tender or painful, or feels as if something just gave way" must be reported. The sudden occurrence of serosanguineous wound drainage strongly suggests wound dehiscence.

Pts with Hep C or B or Kidney disease may have complications with ___ and altered ___ & ____ of _____

wound healing and altered metabolism and excretion of drugs

jaundice

yellow coloration ; liver cells cannot effectively excrete the bilirubin causing increased amount in the circulatory system

Assessment and diagnostic findings common to appendicitis

younger age, elevated white blood cell count with elevation of neutrophils.

What affect does licorice have on the body?

↑ K & Na

What effect does licorice have on the body?

↑ K & Na

What affect does garlic have on the body?

↓ Blood pressure increases bleeding

what effect does garlic have on the body?

↓ Blood pressure increases bleeding

* Lab Tests for Liver Disease *

↓ RBCs ↓ Hgb/Hct ↓ WBCs ↑ Ammonia ↓ Sodium ↑ AST/ALT ↑ Bilirubin ↑ PT/INR Protein ↑=Acute ↓=Chronic

Corticosteroids-

↓ inflammation; anti-inflammatory ♥Dexamethazone (decadron)

Anticholinergics-

↓ oral secretions ♥Atropine ♥Glycopyrrolate (robinol)

Urgency of Surgery

♥ Elective- Scheduled; no acute problem (cataract) ♥ Urgent- Prompt intervention required; may be life threatening if treatment delayed more than 24-48h (open fracture) ♥Emergent- Require immediate intervention (GSW, appendicitis)

Degree of Risk

♥ Minor- Without significant risk (incision & drainage) ♥ Major- Greater risk; usually longer & ore extensive (open heart)

Extent of Surgery

♥ Simple- Only in affected area ♥ Radical- Surgery beyond area involved

Sedatives/Tranquilizers

♥Diazepam (valium) ♥Midazolam (versed) ♥Lorazepam (ativan)

Narcotics/Analgesics

♥Morphine ♥Hydromorphone (dilaudid) ♥Fentanyl (sublimaze) ♥Meperdine (demerol)

Which statement by the spouse of a client with end-stage liver failure indicates the need for additional teaching by the multidisciplinary team regarding the management of pain?

"This opioid will cause very deep sleep, which is what my husband needs."

A client is admitted to an acute care facility with complications of celiac disease. Which question would be helpful initially in obtaining information for the nursing care plan?

"What is your understanding of celiac disease?"

The client with a long-term history of ulcerative colitis began experiencing massive bleeding and underwent emergency surgery for creation of an ileostomy. The client is deeply concerned that sex with his or her spouse will cease because of how the new ileostomy pouch system looks. Which is the nurse's best response?

''A change in position is all that should be needed for you to have sex with your spouse.''

The client with a history of congestive heart failure and circulatory problems has recently been diagnosed with cirrhosis. The client asks the nurse how she could have developed cirrhosis when she does not drink and has no family history of alcoholism. What is the nurse's best response?

''Cardiovascular disease is known to be a major risk factor for development of cirrhosis.''

The client is planning on traveling outside the country and is being instructed on how to avoid contacting viral hepatitis. Which statement by the client indicates a need for further instruction?

''I should avoid any food washed or prepared with tap water, although I can use ice.''

The home health nurse, who is assigned to the client with colorectal cancer after discharge, is teaching the client about care of the new colostomy. Which statement by the client demonstrates an accurate understanding of the nurse's instruction?

''I should check for leakage underneath my colostomy.'' You don't want it to tight, a dark or purplish stoma or red or scratched skin is not normal

The client has been suffering with constipation as a result of irritable bowel syndrome (IBS). After instructing the client about a management plan, which statement by the client demonstrates an accurate understanding of the nurse's instruction?

''I should make an effort to go for a walk every evening.'' Can't have caffeinated beverages, need fiber & fluid

The enterostomal nurse is teaching the client with colorectal cancer how to care for a colostomy. Which statement by the client reflects an accurate understanding of the self-management that is needed?

''I will make certain that I always have an extra bag available.''

The nurse is caring for the client scheduled to be discharged after a bowel resection and colostomy. Which statement by the client demonstrates that further instruction is needed before discharge?

''I'll be able to drive in about 2 weeks.'' The client who has had a bowel resection and colostomy should avoid driving for 4 to 6 weeks.

The client with malabsorption syndrome asks the nurse what he may have done to cause the disorder to develop. What is the nurse's best response?

''It is the result of a flattening of the mucosa of the large intestine, so nothing you did could have caused it.''

The client has cirrhosis of the liver. Which statement by the client indicates that further instruction is needed about the pathophysiology of the disease process?

''My liver is scarred, but the cells can regenerate themselves and repair the damage.'' Although the cells and tissues will attempt to regenerate, this will result in permanent scarring and irreparable damage

The client has been admitted to the hospital with colorectal cancer and is scheduled for colostomy surgery. Which statement by the nurse is the most helpful for this client?

''Tell me what worries you the most about this procedure.''

The client's sister has recently been diagnosed with CRC and the client's brother died of CRC 5 years ago. The client asks the nurse if he will inherit the disease. What is the nurse's best response?

''The only way to know if you have a predisposition to CRC is with genetic testing.''

The adult male client involved in a monogamous heterosexual relationship is diagnosed with hepatitis C. The client tells the nurse that he is concerned that he might pass the virus on to his girlfriend. What is the nurse's best response?

''The rate of sexual transmission of hepatitis C is very low in a monogamous relationship.''

The client is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which statement by the client indicates the need for further teaching about this procedure?

'I will need to stay in the hospital overnight.''

The client is scheduled for emergency injection sclerotherapy as treatment for bleeding esophageal varices. Which statement by the client shows an accurate understanding of the procedure?

'My varices will be injected with a sclerosing agent through a catheter.'' In injection sclerotherapy, the varices are injected with a sclerosing agent via a catheter to stop the bleeding.

What are three things you should make note of when dealing with an older adult that's coming in for surgery?

(1) Delayed wound healing (2) Decreased ability to respond to surgical stress (3) Altered response to medications (including anesthesia)

Hepatitis B vaccine

(Engerix-B/Recombivax HB)- given in Deltoid in 3 doses to prevent Hep. B.

Hgb:

(F)12-16g/dL (M)13-18g/dL

-ostomy

(opening)

-pexy/-plasty

(re)form or create ex) rhinoplasty, mastopexy

-ectomy

(removal of organ or gland)

-otomy

(surgical opening)

-orrhaphy

(surgical or suture repair)

-pexy/plasy

(to form or create)

-oscopy

(visual examination)

Duodenal ulcer pain

*OCCURS 90 MINUTES TO 3 HOURS AFTER EATING AWAKENS AT NIGHT* pain on empty stomach pain at night upper epigastrium with localization to right of midline

general anesthesia

*reversible* loss of consciousnessinduced by inhibiting the CNS resulting in amnesia and analgesia -dec muscle tone and inc relaxation -IV _Inhalation: few S/E

PUD Medical Management

- 1st provide stomach rest (physical & emotional) - Avoid: caffeine & alcohol - Stress reduction

Plan of care for pt with PUD who is experiencing pain

- 6 small meals a day - no food before bed - avoid caffeine, coffee, alcohol & tobacco - bland diet - eliminate irritants that increase pain - promote adequate rest & sleep

S/S of Irritable Bowel Syndrome

- Abdominal pain relieved by defecation or falling asleep - Abd pain associated w/ changes in stool frequency or consistency - Abdominal distention - Sensation of incomplete evacuation of stool - Presence of mucus w/ stool passage

What is the Difference between Acute & Chronic Gastritis?

- Acute: rapid onset of pain - Gastric: vague pain relieved by food - Acute gastritis is often erosive and hemorrhagic but chronic gastritis is not - Endoscopically inflammatory changes are seen only in acute gastritis. - Chronic gastritis has an increased risk of gastric carcinoma, especially type A, which is considered as premalignant.

Incidence & Prevalence of Peptic Ulcer Development

- Affects about 14.5 million every year - decreased over the past few decades - PPI's & H. pylori Tx have helped it - Duodenal ulcers have increased in older women

S/S of Diverticulitis

- Altered bowel habits - Increased Flatus - Anorexia - Low grade fever - rectal bleeding

Medication Tx for Acute Gastritis

- Anitemetics - Antacids (Aluminum Hydroxide) - H2 antagonist (Ranitidine) - Cytotec if on NSAIDs

Medication Tx for Chronic Gastritis

- Antacids (Aluminium Hydroxide) - Anticholinergics - Sedatives - occasionally Corticosteroids in hope to induce parietal cell regeneration

Medical Management for Gallbladder & Pancreas disorders

- Antibiotics - NG tube for relief from vomiting - IV fluids - pain meds: Demerol (Morphine & Dilaudid may ↑ spasm of sphincter of Oddi) - Monitoring for progression of abdominal complications (bile duct obstruction, cholangitis, pancreatitis, sepsis)

To Prevent Atelectasis

- Assess breath sounds - Pain management - Hydration - Breathing exercise / IS - Early Ambulation

Psychosocial Assessment in pt's with PUD

- Assess the impact of PUD on the pt's lifestyle, occupation, family, social & leisure activities - Will pt be able to adhere to the Tx regimen & do they need social support

Cardiac Cirrhosis

- Associated w/ severe right sided long term CHF - Prolonged venous hepatic congestion - Adequate Tx of CHF required

S/S of Upper GI Bleeding

- Bright red or coffee-ground vomit (Hematemesis) - Tarry stools or bright red blood - Melena (Occult blood) - ↓ blood pressure - ↑ weak & thready pulse - ↓ in Hgb & Hct - Vertigo - Acute Confusion (in older adults) - Dizziness - Syncope

What Labs & Diagnostic test should be done before surgery?

- Bun/Creatinine= if ↑ won't do surgery - Platelets= do they have enough - Hgb= ↑ enough or need transfusion - WBC= ↑ infection - renal function - blood glucose= hyper or hypoglycemia - chest x-ray / ECG= if over 40 / cardiac prob / pulm disease - ABG= if COPD

What Labs & Diagnostic test should be done before surgery?

- Bun/Creatinine= if ↑ won't due surgery - Platelets= do they have enough - Hgb= ↑ enough or need transfusion - WBC= ↑ infection - renal function - blood glucose= hyper or hypoglycemia - chest x-ray / ECG= if over 40 / cardiac prob / pulm disease - ABG= if COPD

Postnecrotic Cirrhosis

- Caused by viral hepatitis & certain drugs or chemicals - massive loss of liver cells with irregular patterns of regenerating cells - 75% die w/ complications w/i 5 years

Nonsurgical management of Gastric Cancer

- Chemotherapy - Radiation - Combination of Chemo using cisplatin & epirubicin = best results

Causes of Fatty Liver Disease

- Chronic alcoholism - Protein malnutrition - DM - Hepatotoxins - Prolonged TPN

Irritable Bowel Syndrome

- Chronic or recurrent diarrhea, constipation and/or abdominal pain & bloating - lactose & fructose can trigger symptoms - Stress & anxiety can trigger symptoms

Risk Factors of Liver Cancer

- Cirrhosis - Smoking - Androgens or Estrogens - Anabolic Steroids - Vinyl Chloride - Hemochromatosis

* Ascites *

- Collection of free fluid w/i the peritoneal cavity caused by increased hydrostatic pressure from portal hypertension - ↓ circulating volume leads to ↑ Na & H2O retention - A fluid shift from the vascular system to the abdomen (Third Spacing)

Plan of care for pt w/ Dumping Syndrome

- Decrease amount food intake at one time - Eliminate liquid intake with meals - Eat a high protein, high fat, low to moderate carb diet - Watch for signs of hypoglycemia

Risk Factors for Peptic Ulcer Disease

- Depends upon the defensive resistance of the mucosa relative to the aggressive force of secretory activity - 90% duodenal & 70% gastric attributed to H. pylori - treated ulcers heal w/o difficulty

Hepatocellular Jaundice

- Develops because the liver cannot metabolize bilirubin - Excessive circulating bilirubin levels due to impaired uptake of bilirubin from the blood - Elevated indirect and direct bilirubin levels

Periodontal Disease

- Disorders of the gums - Inflammation causes destruction of underlying tissues leading to loose teeth

S/S of Stomatitis

- Dry, painful mouth - open lacerations - difficulty w/ swallowing or eating - severe stomatitis can have edema which can potentially block airway

Intrahepatic Obstructive Jaundice

- Edema, fibrosis or scarring of the hepatic bile channels and bile ducts, which interferes with normal bile & bilirubin excretion - Slightly increased indirect bilirubin levels - Moderately increased direct bilirubin levels

Ulcerative Colitis

- Entire length of colon - involves mucosa & submucosa - starts in rectum & spreads upward

Stress Ulcers

- Erosive - severe trauma or major illness - severe burns (Curling's ulcers) - head injury or intracranial disease (Cushing's ulcers) - drug ingestion (ASA, NSAIDs, alcohol) - shock - sepsis

Hepatitis E

- Fecal oral contamination of food or water; poor sanitation - Prevent: Hygiene, Sanitation, caution when traveling

Hepatitis A

- Fecal oral transmission; enhanced by crowding & poor sanitation - Prevent: Hygiene

Malnutrition Interventions

- Feeds via GI tract - Drug Therapy (Stimulate Appetite) - Specialized Nutrition Support (TPN/TEN)

Anorectal Abscess

- Form in several locations - May originate as cysts or abrasion of local tissues - Surgery may take 2 stages: drainage of abscess, surgical excision of associated fistulas

Pain with Peptic Ulcer Disease

- Gastric: food causes pain; upper epigastrium w/ localization to left of midline - Duodenal: pain on empty stomach; pain at night; upper epigastrium w/ localization to the right of midline - Aching, burning, cramp like, gnawing

Malignant Hyperthermia

- Genetic - ↑ in end tidal CO2 levels (1st sign) - ↓ in O2 Sat (1st sign) - ↑ skeletal muscle contraction, metabolism & breakdown - life threatening - sudden ↑ temp usually ↑ than 104 - ↑ Ca & K in blood - acidosis, dysrhythmias - tachycardia - hypotension - muscle rigidity in jaw (tetany) - tachypnea - skin mottling (all blood to organs) - very pale, red lacy skin - myoglobin in urine (muscle breakdown)

Malignant Hyperthermia

- Genetic - ↑ in end tidal CO2 levels (1st sign) - ↓ in O2 Sat (1st sign) - ↑ skeletal muscle contraction, metabolism & breakdown - life threatening - sudden ↑ temp usually ↑ than 104 - ↑ Ca & K in blood - acidosis, dysrhythmias - tachycardia - hypotensive - muscle rigidity in jaw (tetany) - tachypnea - skin mottling (all blood to organs) - very pale, red lacy skin - myoglobin in urine (muscle breakdown)

Anesthesia Adjuncts

- Given for pain relief, amnesia, & muscle relaxation Hypnotics Opioids Neuromuscular blockers

Bowel preparation

- Golytely orally 12-24 hours before - antibiotics 12-48 hours before - enemas til clear - blood transfusions as necessary

Causes of Chronic Gastritis

- H-pylori infection - gastric surgery - same factors as acute gastritis

7 Factors that may lead to Hepatic Encephalopathy

- High-protein diet - Infections - Hypovolemia - Hypokalemia - Constipation - GI Bleeding - Drugs

S/S of Obstruction

- Hypovolemic shock - Vomiting - Abdominal pain - Respiratory compromise due to bowel distention - Obstipation (no passage of stool) - No flatus - Hyperactive Bowel Sounds - Diarrhea - Metabolic Acidosis

Conscious Sedation

- IV sedative, hypnotic, & opioid - done for procedures (dental / ER) - ↓ level of consciousness - pt can breathe & respond to verbal commands

S/S of Cancer of Small Bowel

- Ileum most affected - weight loss - anemia - N&V - obstruction - palpable mass - pain - hemorrhage

Dysentery

- Inflammation affecting the colon - bacterial (C. Diff) - severe abdominal cramping & bloody diarrhea

Appendicitis

- Inflammation of appendix - abd pain in waves / McBurney's point - vomiting, low grade fever, ↓ appetite

Peritonitis

- Inflammation of the peritoneal membrane - localized pain that causes rigidity of abd muscles - N&V, low grade fever, absent bowel sounds - pain that increases with pressure or motion - Leukocytosis (20,000 or ↑)

Incidence & Prevalence of Gastric Cancer

- It's growing & half the people diagnosed die from it - Men have a slightly higher risk - Asians & Asian Americans have an especially high risk - Most its are in their 60's & 70's

S/S of Hepatitis

- Jaundice - Lethargy - Irritability - Myalgia - Anorexia - Nausea/Vomiting - ↑ LFT's - Diarrhea/Constipation - Abdominal pain - Hepatic Encephalopathy - Anemia / Bleeding tendencies

Lab & Diagnostic Tests for PUD

- Low Hgb & Hct - Occult blood in stool - Tests for H. pylori - EGD w/ biopsy - Abd X-rays - Barium follow-through

Etiology of Peptic Ulcer Development

- NSAID use - bacterial infection w/ H. pylori - Corticosteroids - Caffeine - Family History

Narcotic Antagonist

- Narcan - mixed w/ 10cc of normal saline - blocks narcotic agonists - used in opiate induced respiratory depression or overdose - observe for resedation

Parenteral Nutrition

- PPN/TPN - usually done thru PICC line - ordered daily - Crohns, burn, or cancer patient - if used long term creates liver failure -Complications: fluid & electrolyte imbalances

* Complications of Cirrhosis *

- Portal Hypertension - Ascites - Portal-sytemic encephalopathy - Coagulation defects - Jaundice - Hepatorenal Syndrome - Spontaneous bacterial peritonitis - Bleeding esophageal varices

Dumping Syndrome

- Postprandial problem caused by rapid movement of extracellular & intravascular fluids into bowel to convert hypertonic bolus into isotonic mixture - Fluid shift decreases circulating intravascular volume

Obstruction (PUD Complication)

- Pyloric obstruction caused by scarring from repeated ulceration & healing - Nausea & Vomiting - Surgical intervention necessary to relieve obstruction

Medical management of Chronic Gastritis

- R/O CA - bland diet - small frequent meals - avoid symptom causing foods

S/S of Cholelithiasis

- RUQ pain - pain can radiate to back & right shoulder - may feel like a heart attack - sweating - jaundice - N&V

Surgical Management Goals for PUD

- Reduce stomach acid-secreting ability - Remove a malignant or potentially malignant lesion - Treat surgical emergency that develops as a complication of PUD - Treat pt's who do not respond to medical interventions

Clinical signs of Hypoxia

- Restlessness - Pallor - Pulse Ox <90% - Accessory muscle use - Tachypnea / Tachycardia - Decreased or absent breath sounds

Hemolytic Jaundice

- Results from excessive RBC destruction, impaired bilirubin uptake due to excessive amounts - Caused by transfusion reactions, hemolytic anemia, sickle cell crisis - Increased indirect & normal direct bilirubin levels

Surgical Management of Chronic Gastritis

- Subtotal Gastrectomy - Pyloroplasty - Vagotomy - Total Gastrectomy

Whipple Procedure

- Surgery for Acute Pancreatitis - removal of distal third of stomach, duodenum, common bile duct, gallbladder & head of pancreas - extensive surgery & recovery

Anal Fistula

- Tract that leads from the anal canal to the skin outside the anus or from an abscess to either the anal canal or perianal area - May heal over temporarily, then open & drain periodically - Chronic condition - surgery involves excision of tract & cleaning of area

Hepatitis D

- Transmitted by blood & body fluids - Must coexist w/ Hepatitis B - Prevent: Hygiene, blood donor screening, disposable equipment, no sharing personal items, sterilization of instruments, condom use

Hepatitis B & C

- Transmitted by blood & body fluids - Prevent: Hygiene, blood donor screening, disposable equipment, no sharing personal items, sterilization of instruments, condom use

Anal Fissure

- Ulceration or tear in lining of anal canal - pain upon defecation, followed by burning - chronic fissure requires surgery - keep stool soft - daily bowel movement - clean area

Diagnostic Tests for Liver Disease

- Ultrasound - CT - MRI - X-Rays

Hemorrhage (PUD Complication)

- Usual manifestation - Vomiting of coffee ground material or passing of tarry stools - Hematemesis: vomiting bright red blood - Melena: occult blood in stool more common with duodenal ulcers

S/S of Dumping Syndrome

- Vertigo - Tachycardia - Syncope - Sweating - Pallor - Diarrhea - Nausea - Desire to lie down - Palpitations

Treatment of Fatty Liver Disease

- Weight loss - Glucose control - Lipid lowering agents - Monitor LFTs

Jaundice Assessment

- Yellow sclera - Yellow skin - Clay colored feces - Tea colored urine - Pruritus - Fatigue - Anorexia

Diffuse Esophageal Spasm

- abnormal contractions of the muscles in the esophagus - does not move food effectively to the stomach - difficulty swallowing or pain - pain in chest or upper abdomen - pain can radiate to jaw, arms, or neck * Tx: Nitroglycerine, Calcium Channel Blockers, antidepressant

Symptoms of Chronic Gastritis

- absent or vague findings - anorexia - feeling of fullness - dyspepsia (heartburn) - belching - vague epigastric pain - N&V - intolerance of spicy or fatty foods

Causes of Hiatal Hernia

- aging - congenital muscle weakness - trauma - surgery - obesity - pregnancy - ascites

Radical neck dissection

- all tissue under skin from jaw to clavicle - anterior border of trapezius to the midline - cervical lymph nodes - sternocleidomastoid muscle - spinal accessory nerve - resect the jugular vein

What meds should be stopped prior to surgery?

- anticoagulants: ASA, Coumadin - steriods - glaucoma meds (accumitive systemic affects) - mycin antibiotics combined w/ muscle relaxants cause respiratory paralysis - lower insulin

What meds should be stopped prior to surgery?

- anticoagulants: ASA, Coumadin - steriods - glaucoma meds (accumitive systemic affects) - mycin antibiotics combined w/ muscle relaxants cause respiratory paralysis - lower insulin (give 50%)

What meds should be stopped prior to surgery?

- anticoagulants: ASA, Coumadin -antihypertensive- alter response to muscle relaxants and opioids, cause hypotensive crisis - steroids - glaucoma meds (cumulative systemic effects) - mycin antibiotics combined w/ muscle relaxants cause respiratory paralysis - lower insulin (give 50%)

Questions during Assessment of GI?

- any blood or tar in stool - color consistency of stools - change in bowel habits - better or worse w/ food - weight loss/gain - changes in appetite - any new excercise - alcohol / tobacco use - changes in skin (color/brusing)

Gastric Cancer

- begins in the glands of the stomach mucosa - atrophic gastritis & intestinal metaplasia are precancerous conditions - Inadequate gastric secretions in pts w/ atrophic gastritis creates an alkaline environment allowing bacteria

Lab & Diagnostic tests to diagnose Gastritis

- blood test to detect IgG or IgM anti-H. pylori antibodies - urea breath test - stool testing - EGD w/ biopsy

Marasmic-Kwashiorkor

- both protein & calorie/energy malnutrition - Look cachectic - ↓ activity intolerance - lethargic - ↓ threshold to cold - dry flakey skin

Marasmus

- calorie malnutrition - body and fat protein being wasted - anorexia

Percutaneous Endoscopic Gastrostomy (PEG tube)

- cannula into stomach thru abdominal incision - suture threaded thru cannula - physician uses endoscope to pull suture thru pt's mouth - PEG tube attached & advanced down esophagus thru abdominal incision - tube secured by crossbars internally & externally - Long-term enteral feedings

Hiatal Hernia

- cardiac sphincter is enlarged - part of stomach passes into the thoracic cavity - related to muscle weakness in the esophageal hiatus

Gastric Ulcer

- caused by a break in the mucosal barrier of the stomach - food causes pain, vomiting relieves it

Alcoholic Cirrhosis (Laennec's)

- caused by chronic alcoholism - small nodules form as a result of persistence of offending agent - prognosis depends on presence of complications & continued abuse

Biliary Cirrhosis

- caused by chronic biliary inflammation or obstruction, usually from gallbladder disease - Bile flow is ↓ w/ concurrent cell damage to hepatocytes around bile ductules - Tx aim is to relieve mechanical obstruction

Acute Acalculous Cholecystitis

- cholecystitis w/o stones - occurs in association of other conditions (burns/trauma)

Crohn's Disease

- chronic relapsing disease that can happen in any segment of the bowel - Involves entire thickness of bowel wall - common location is terminal ileum

Total Proctocolectomy

- colon & rectum removed - anus closed - ileostomy formed

Obesity Interventions

- diet programs - nutrition therapy - exercise program - drug therapy - behavioral management - complementary & alternative therapies - bariatric / gastric bypass - BMI ↑ 40 or 3 or more comorbidities

Achalasia

- disorder characterized by progressively increasing dysphagia - 20's & 30's - unknown cause - impaired motility of the lower 2/3 of the esophagus - regurgitation of undigested food eaten many hours earlier & large amounts of mucous

S/S of Chronic Pancreatitis

- dull pain alternates w/ severe pain - vomiting - fever - jaundice - hyperglycemia - abdominal distention w/ flatus & cramps - frequent passage of foul, fatty stools

S/S of Esophageal Neoplasms

- dysphagia - weight loss - odynophagia (painful swallowing) - food goes into lungs thru holes

Obesity Assessment

- economic status - usual food intake - cultural background - eating behaviors / attitude towards food - chronic diseases / drugs - appetite - physical activity / functional ability - family h/o obesity - diets they have tried - calculate BMI - effects ED & fertility

Malnutrition Assessment

- economic status / occupation / educational level - living / cooking arrangements - mental status changes - problems with ADLs - change in eating habits - difficulty or painful swallowing - look at albumin / prealbumin / transferrin - Can affect every organ (neuromuscular / nails, hair, skin / Musculoskeletal)

S/S of Peptic Ulcer Disease

- epigastric tenderness - hyperactive bowel sounds - Dyspepsia - Vomiting - made worse when eating tomatoes, hot spices, fried foods, onions, alcohol, caffeine

Achalasia management

- esophageal dialation - Barium swallow - endoscopy / EGD - calcium channel blockers or nitrates - small frequent feedings - avoid hot, spicy, iced foods, alcohol, tobacco - chew foods thoroughly - sleep w/ HOB elevated

Obesity

- excess amount of body fat when compared with lean body mass - Complications of obesity are cardiovascular, respiratory, musculoskeletal - Can affect all organs, including skin - Etiology & Genetic Risk

Nasoduodenal Tube

- extends into duodenum - short term feedings - less likely to cause aspirations - verify placement by x-ray

Nasogastric Tube

- extends into stomach - short term enteral feedings - high risk for aspiration - removed when bowel sounds present & tolerating PO

S/S of Cirrhosis (Early Manifestations)

- fatigue - significant change in weight - GI symptoms - Abdominal pain & liver tenderness - pruritus

Cholelithiasis

- gallstones - bile undergoes a change in composition - common in 5 F's (female, fertile, fat, fair, forty)

S/S of Gerd

- heartburn - odynophagia (painful swallowing) - dysphagia - acid regurgitation - eructation (burping)

Complications of Laparoscopic Cholecystectomy

- hemorrhage - bile duct injury - organ injury - N&V - shoulder pain

Complications of Cholecystectomy

- hemorrhage - pneumonia - thrombophlebitis - urinary retention - ileus

What alternative & complementary therapies are used for gastritis & peptic ulcer disease?

- hypnosis - imagery - yoga - herbs - licorice - zinc - Vitamin A, C, & E - Ginger - Cranberry - Green Tea - Chamomile

Gastrostomy Tube

- incision into abdomen wall & suturing the tube to the gastric wall - long-term use

Jejunostomy Tube (J-Tube)

- incision into abdominal wall & suturing tube to jejunum - long-term enteral feedings

Complications of Regional Anesthesia

- incorrect delivery method - systemic absorption - overdose - CNS stimulation (stress response) - then CNS & cardiac depression - hypotension & bradycardia

Physiological Stress Response to Surgery

- increased HR & BP - peripheral vasoconstriction - increased blood glucose - increased ADH secretion - cold hands & feet - sympathetic / flight & fight response

Etiology of Gastric Cancer

- infection w/ H. pylori is the largest risk factor for gastric cancer - Pts w/ pernicious anemia, gastric polyps, chronic atrophic gastritis, and achlorhydria are 2 to 3 times more likely to develop gastric cancer - eating pickled foods, salted fish, salted meats, processed foods, high consumption of salt, low intake of fruits & veggies - Genetic - Gastric surgery / GERD

Acute Sialadenitis

- inflammation of a salivary gland - could have stones in salivary glands - secretions decrease, bacteria invade gland & multiply - caused by gland inactivity r/t diuretics, prolonged NG tube intubation, lack of PO intake * promote secretions & frequent hydration

Diverticulitis

- inflammation of diverticulum due to bacterial invasion - can lead to perforation - chronic can lead to scarring & obstruction

Gastroenteritis

- inflammation of stomach & intestinal tract that primarily affects the small bowel - viral or food poisoning - abdominal cramps, diarrhea, vomiting & fever

Acute Cholecystitis

- inflammation of the gallbladder - tenderness in RUQ and/or epigastrium - pain in epigastric, subscapular, or RUQ - N&V - Elevated temp - fat intolerance - Murphy's sign: extreme tenderness & stop breathing on inspiration

Symptoms of Acute Gastritis

- inflammation of the gastric mucosa - epigastric discomfort - abdominal tenderness - cramping - eructation - severe N & V - sometimes hematemesis - diarrhea usually developed w/i 5 hr of ingestion of contaminated food - usually short duration - H pylori

S/S of Cirrhosis (Late Manifestations)

- jaundice - GI bleeding - Ascites - Bruising - warm & bright red palms - dry skin / rashes - edema of extremities - clubbing of nails - spider angiomas

Kwashiorkor

- lack of protein quality & quantity - adequate calorie intake - alcoholics

Psychosocial Assessment

- level of anxiety (not really listening to you) - coping ability - support systems

What are variations of the GI tract in the elderly?

- loose teeth or dentures - dry mucous membranes - ↓ secretion of hydrochloric acid - ↓ peristalsis which leads to constipation - ↓ fluids / diuretics & sedentary - ↓ absorption of iron & B12 which leads to anemia & bacteria proliferation

Primary Stomatitis

- most common - usually from herpes simplex

Viral Hepatitis

- most common - virus caused by 1 of 5 major categories of viruses (Hep A-E)

Bleeding with Peptic Ulcer Disease

- occurs when the ulcer erodes through blood vessels - may occur as massive hemorrhage or slow oozing - CBC shows decrease H/H - Stool OB positive

Tx for Regional Anesthesia complications

- open airway / Oxygen - notify surgeon ASAP - fast acting barbituate

Meckel's Diverticulum

- out pouching of bowel found on ileum, w/i 10 cm of cecum - surgery required

Interventions for Cholelithiasis

- pain meds - relaxation technique - quite environment - I & O (FVD) - fluids - oral intake slowly - surgical management dependent upon infection

Stomatitis

- painful single or multiple ulceration (Canker sores) - inflammation & erosion of the protective lining of the mouth - painful & open areas at risk for bleeding & infection

Chronic Pancreatitis

- pancreas is progressively destroyed by repeated attacks of mild pancreatitis - causes are chronic alcoholism & protein malnutrition

Chronic Gastritis

- patchy, diffuse inflammation of the mucosal lining - usually no scarring, but mucosal changes remain - TYPE A: non-erosive / glands, fundus & body inflamed - TYPE B: antrum glands, possibly entire stomach - ATROPHIC: deep glands & all layers of stomach

Informed Consent

- reasons for surgery - risks for procedure - risks for anesthesia - who's performing procedure - who will be present

S/S of Colon Cancer

- rectal bleeding - changed bowel habits - intestinal obstruction - Abd pain - weight loss - N&V - anemia - palpable mass

S/S of Ulcerative Colitis

- rectal bleeding - diarrhea - colicky pain in LLQ - fever - ↑ bowel sounds - reoccurs w/ stress, diet, laxatives 0r antibiotics

Nursing Interventions for Cirrhosis

- reduce protein - prevent GI bleeding - monitor stools - monitor labs, daily weights and I&Os

Complications of Enteral Feedings

- refeeding syndrome (body breaks down fats & proteins but doesn't use carbs for energy - tube misplacement or dislodgment - abdominal distention / N&V (from overfeeding / check residuals) - Fluid & electrolyte imbalances

Medical Management of Acute Gastritis

- remove cause - NPO until N&V subside - bland foods - avoid spicy, caffeine, large & heavy meals

Chronic Cholecystitis

- repeated episodes of cystic obstruction causing chronic inflammation - can cause inflammation of pancreas & jaundice

Nursing Interventions for Hepatitis

- rest the liver - diet high in carbs & calories - moderate protein & fats - small frequent meals - no alcohol

GERD

- results from back flow of gastric contents into esophagus - relaxation of the LES allowing reflux - pain usually occurs after meals & is relieved w/ antacids or fluids

Diverticula

- saclike outpouchings in 1 or more layers of the esophagus - food gets trapped in a diverticulum & can later be regurgitated

Postirraditation Sialadenitis

- salivary glands sensitive to radiation - can cause xerostomia (severe dry mouth) associated w/ thyroid cancer * frequent water, mouth care, salivary substitutes

Percutaneous Endoscopic Jejunostomy (PEJ)

- same procedure as PEG but inserted into the jejunum - may have G port & J port - Long-term enteral feedings

Propofol

- short acting - colonoscopy procedures - onset 1 min - recovery time 8 min - can burn so give lidocaine 1st

* S/S of Hepatic Encephalopathy *

- sleep disturbances - mood changes - mental status changes - speech problems - Altered LOC - Neuromuscular problems

S/S of Crohn's Disease

- slow & unaggressive - Diarrhea - intermittent abd pain (possible relief by passing stool or gas) - weight loss - foul smelling, fatty stools - rarely blood in stool

Plan of care for pt with PUD who is experiencing a GI bleeding

- start 2 large bore IV's for packed RBC's & 0.9% NS - monitor vitals, Hgb, Hct, & O2Sat - NG tube for gastric lavage

What can cause health problems to the GI system?

- structural - infection - cancer - impaired motility - mechanical

Nissen Fundoplication

- surgery for GERD - suture fundus around esophagus complications: dysphagia epigastric fullness bloating hyperactive bowel sounds

Perforation (PUD Complication)

- surgical emergency - gastroduodenal contents empty through the wall of the stomach into the peritoneal cavity w/ or w/o hemorrhage - results in chemical peritonitis, bacterial septicemia, & hypovolemic shock - most frequent w/ duodenal ulcers - sudden, sharp, severe pain beginning in the mid-epigastrium

Surgical management of Gastric Cancer

- surgical resection - total gastrectomy - partial gastrectomy

Intraoperative Documentation

- tubes, drains & other devices - sponge/needle count - pt during surgery (waking up during) - wound irrigations/solutions used, dressings (any transfusions)

Oral Cavity Malignant Tumor Interventions

- use of alcohol or tobacco - oral hygiene habits - exposure to sun - difficulty swallowing - pain - oral cavity inspection - surgical tx - post-op nursing care (trach tube)

Pilonidal Cyst

- usually occurs at the base of sacrum - contains hair, becomes infected, forming an abscess & sinus tract - common in young adult males - requires surgical excision of abscess - antibiotics

Duodenal Ulcer

- usually occurs with 1.5 cm of pylorus - combined effect of hypersecretion of acid & rapid emptying of food from the stomach reduces the buffering effect of food & results in a large acid load in the duodenum - pain occurs 90 min to 3 hours after eating, awakens at night

Esophageal Neoplasms

- usually squamous cell carcinoma or adenocarcinoma - links to smoking, alcohol, hot food & drinks, nutritional deficiencies - expand locally & very rapidly w/ early spread to lymph nodes - outcome poor - usually tx is palliative

S/S of Acute Pancreatitis

- vary from mild abdomen pain to shock w/ coma & death - abd pain begins in midepigastrium & radiates to back - persistent N&V - Fever - Tachycardia - death - hyperglycemia - Tunner sign - Cullen's Sign

S/S of Diverticula

- vomiting blood - chest pain - ↑ temp - Sub Q emphysema - dysphagia - burping - halitosis - coughing - sour taste in mouth - regurgitation of undigested food

S/S of Liver Cancer

- weight loss - anorexia - weakness - abdominal pain

Prevention of Gastritis

- well-balanced diet - avoid excessive amounts of alcohol, caffeine - avoid large doses of NSAIDs, ASA, & corticosteroids - stress management - stop smoking - non-contaiminanted food & drink - protect yourself from exposure of toxic substances - seek medical Tx if you experience esophageal reflux

Discharge Teaching

- wound & drain assessment/care - diet - pain management - drug therapy - activity

Oral Candidiasis

- yeast infection - white plaque-like lesions - tongue, palate, pharynx, buccal mucosa - if patches are wiped away, underlying areas red & sore - can be painful, dry, or hot

Labs & Diagnostic Tests for Liver Cancer

- ↑ AFP - ↑ Alkaline Phosphate - Ultrasound - CT w/ contrast

Labs & Diagnostic Tests for Fatty Liver Disease

- ↑ AST/ALT - MRI - Ultrasound

Lab Tests for Hepatitis

- ↑ in AST / ALT - ↑ Bilirubin - ↑ liver enzymes

Causes of Acute Gastritis

-ASA, NSAID,steroids, chemo drugs -alcohol, nicotine, caffeine, food poisoning -hot foods -lye, drain cleaner -H. pylori

Vincents Stomatitis (Trench mouth)

-Acute bacterial of gingiva -↓resist→ ↑suscept. to own flora -Foul taste like metal or rotten eggs, choking, fever -Tx: debridement, correct underlying problem, pain management -Augmentin

Malignant tumors

-Adenocarcinoma -surgical excision -Radiation

Benign Tumors Interventions

-Analgesic -Pureed diet-Avoid spicy, citrus, hot liquids -Dental hygiene with gauze

GERD management

-Antacids, Histamine receptor antagonists, cholinergics, prokinetic agents, proton pump inhibitor -Avoid anticholinergics, calcium channel blockers, thophyline and valium (decrease in LES pressure and delay gastric emptying)

Gastric CAncer

-Arise from mucous lining of stomach -Spreads by direct extension into the pancreas -Resectable in early stages -advance stages: zero survival

GERD DX

-Barium swallow -Esophagoscopy -24 hr pH monitoring

Achalasia diagnosis

-Barium swallow shows non productive waves and esophageal dialation -endoscopy for view of gastric mucosa

Gastritis treatment

-Bland food, avoid foods causing symptoms -small frequent meals -Medications: antacids, H2 antaognists, mucosal barrier fortifiers, antibiotics and occasional corticosteroids (induce regeneration

Achalasia management

-Calcium channel blockers or nitrates to ↓ LES pressure -Botox -Small requent meals -Avoid hot, spicy, alcohol, tobacco -Chew food -↑ HOb -Esophagomyotomy

Gastritis diet

-Decaf tea, gelatin, toast and simple bland foods -small meals -avoid spicy, hot and large meals

Esophagomyotomy

-Dx with EGD -Balloon didnt work -Open wall (leave muscle) to give more room

GERD S/S

-Dyspepsia, odynophagia, dysphagia, acid regurge, erucation, asthma, morning hoarseness

Esophageal neoplasm TX medically

-Early can be cured -late=palliative -Radiation to ↓ sizw Chemo symptom relief -thickened liquids -entral feedings, TPN -↑ HOB

Surgical treatment

-Excision of small tumors -Glossectomy -Mandibulectomy -Hemiglossectomy- part of tongue -( Modified) Radical Neck

Calculi

-Forms in inactive glands and metabolic conditions precipitate salts -Chewing causes pain and swelling -Surgical excision

Nausea and Vomiting

-From gastric stasis or pyloric obstruction -undigested food indicative of gastric ulcer or pyloric obstruction -normal to excessive appetite with duodenal

laboratory malnutrition assessment

-HOH -Albumin/prealbumin -transferrin

Acute Sialadentitis Interventions

-Hydrate -Frequent oral hygiene -Warm compress -Saliva sub -Stimulate secretions (sugarless gum/candy)

GI hemorrhage interventions

-Hydrate to prevent shock -Prevent electrolyte imbalance -Stop bleeding -NG tube to assess bleed rate, prevent gastric dilation, room temp saline lavage -Cauterize -Vasopressin drip

Stress Response to Surgery

-Inc HR and BP -peripheral vasoconstriction -inc BG -Inc ADH

Herpes Simiiplex

-Inflame r/t viral infect -Vesicles rupture→ulcers, -Tongue coated white -Lesions last 1 wk -Tx acyclovir (start early)

Acute Sialadentitis

-Inflamed salivary gland caused by gland inactivity (diuretics, prolonged NG tube, ↓ intake and radiation -↓ secreations = ↑ bacteria in gland

Acute Gastritis (erosive)

-Inflammation of gastric mucosa from irritants (ASA, NSAIDS, chemo, steroids, alcohol, caffeine, nicotine, rough foods, lye, drain cleaner and H pylori

Histamine receptoor antagonists

-Inhibit histamine action-inhibits gastric acid secretion. meals and hs -Tagamet -Famotidine -Nizatidine -Ranitidine

Premalignant Tumors/Mouth

-Leukoplakia- yellow /white/gray, rough, defined borders, from chronic infection -Erythroplakia: red velvet, early squamous Ca

Nutritional Hx

-Needs being met? -special diet? Kosher? Gluten free... -allergies -health problems affecting nutrition

Benign TumorsMouth

-Occupy space, cause pressure -Fibromas -Lipomas -Neurofibromas -Hemangiomas

Odynophagia

-Painful swallowing -Usually severe, deep, long lasting and may radiate to neck, back, upper thorax and shoulder -triggered by cold and carbonation

Surgical Nursing Interventions

-Pre and post op teaching -Maintain patent airway -Resp asssessments -Protect sutures ( no tooth brush, lots of rinsing -Pain -Nutrition

Stomatitis Oral History

-Recent infections? -Nutrition changes? -Hygiene? -_Trauma? Stress? -Drugs? -Outbreaks interfering with swallowing, eating?

Diverticula

-Sacs where food becomes caught and the reguritated -Esophageal weakness from congenital defect, trauma, scar tissue or inflammation (from vomiting)

Oral Candidiasis

-Secondary infect caused by candida albicans -Common in immune suppressed -overgrowth of normal flora -White patches, difficult to remove -Mycostantin. Swish and swallow -May need debridement

Esphageal Neoplasms

-Squamous cell carcinoma or adenocarcinoma -R/T heavy smoking, nutritional deficits, habitual indigestion of alcohol, hot foods and hot drinks -Rapid expand to lymph -pulmonary complications -tracheoesophageal fistula -c/odysphagia, odynophagia . weight loss

Post op interventions

-airway maintenance -monitor spo2 -dressing, wound care, drains

pancreatitis labs

-amylase -lipase -bilirubin -wbc -hyperglycemia

GERD medical management

-antacids, histamine antagonists, cholinergics, prokinetic agents, proton pump inhibitor avoid: -anticholinergics, ca channel blockers, valium

Glaucoma meds

-cumulate systemic effects, can lead to CV or resp collapse

Signs of improvement in the patient recovering from peritonitis include

-decrease in temperature, and pulse rate, softening of the abdomen, return of bowel sounds, passing flatus, and bowel movements.

changes of elderly and surgery

-decreased immune functioning -increased chronic illness -cardiovascular- harder for heart to respond to surgical stress -respiratory- COPD, emphysema, smoker -renal/urinary- kidneys harmed easier -neurological- longer to recover -musculoskeletal- muscles atrophy -skin- diabetic: wound healing

Effects of Steroids on surgery

-delay wound healing -inc glucose -inc risk of hemorrhage -dec. s/s of infection must take with acute adrenal insufficiency

Age related changes to GI system

-dental changes -dry mucous membranes and dysphagia -Dec secretion of HCl (dec absorption of iron, B12, bacterial proliferation) -Dec peristalsis -Dec lipase and liver enzymes

Diverticula symptoms

-dysphagia -ecrutation -regurgitation of undigested food -halitosis -sour taste in mouth -dx: barium swallow -manage with small meals, semisoft foods, loose clothing

Acute Gastritis

-epigastric discomfort, tenderness, cramping, severe N/V, sometimes hematemesis. -short duration -diarrhea usually develops within 5hrs of ingesting contaminated food

Esophageal neoplasm surgery

-esophagectomy- part or all replaced with dacron graft -Esophagogastrostomy- resect lowerportion of esophagus and anastomosing remainder to the stomach brought to the neck -Esophagoenterostomoy: colon interposition ( resect and replace part of esophagus with decsending colon

Acute Gastritis Management

-foods and fluids held until n/v subsides -diet of soft bland foods (bind to bacteria) Meds: antiemetics, antacids, H2 antagotist, cytotec with nsaid

Regional or Local anesthesia

-gag reflex intact; allows participation -no control after administration

Goals of bowel training involve

-help patient achieve continence, or if that is not possible, -help patient achieve predictable elimination.

Achalasia

-impaired mobility of lower 2/3 esophagus -men/women 20→30 -progressive ↑ dysphagia, regurg of undigested food from hours earlier and lots mucous

Complications after abdominal surgery

-inc risk of prolonged N/V -reduced peristalsis -constipation -distention

Complications of Regional Anesthesia

-incorrect delivery method -systemic absorption -overdose

complications of obese patients in surgery

-increased risk of poor wound healing due to excessive adipose tissue -stresses the heart and reduces lung volumes which can affect recovery -may need larger doses and may retain them longer

acute pancreatitis

-inflammation of the pancreas resulting in autodigestion and fibrosis of the pancreas -amylase, lipase, and trypsin opening up too soon in the pancreas

Prostaglandin Analog

-inhibit secretion of acid use with NSAIDS Cytotec

Effects of Antihypertensives on surgery

-inhibits NE and can cause hypotensive crisis

S/S of Complication of Regional Anesthesia

-initial stress response followed by cardiac depression, hypotension and bradycardia

malignant hyperthermia

-life threatening sudden deviation of temp; genetic so pt edu is key. S/S -tachycardia, rigid, cyanosis, tachypnea, elevated temp TX -IV -Dantrolene

Effects of Anticoagulants to surgery

-may cause hemorrhage

Inhalation anesthesia

-most controlled method -nausea and shivering common -must be used with other agents for painful and prolonged operations -forane

Assessments in PACU

-neuro -fluid and electrolyte acid/base -GI -Incision/dressing -pain

Antacids

-neutralize gastric acid -1 hr ac and 2-3 hrs pc to =ize pH -Aluminum contaning=constipation -Calcium/tums=rebound hyperacidity -Magnesium /MOM=diarrhea -Aluminim/magnesium-maalox, mylanta

Chronic pancreatitis managment

-pain control -insulin -pancreatic enzyme therapy -low fat, no alcohol -make sure they can tolerate liquid first

Esophageal Disorders Intervention

-pre op teaching -nutritional support -monitor wt, fluid, and electrolytes -wound assessment -oral care -post op respiratory care -pain management -referrals -surgery

Oral Cancer Nursing Interventions

-pre op teaching of management of trach post op, feeding tubes, communications -maintain patent airway -respiratory assessment -protect suture lines from trauma -pain management -nutrition

Hemorrhage Intervention

-prevent hypovolemic shock -prevent dehydration and electrolyte imbalance -stop bleeding -insert ng tube -cauterization of lesion

peptic ulcer disease

-provide stomach rest -physical and emotional rest -avoid caffeine, alcohol, -stress reduction

IV anesthesia

-rapid and pleasant induction -must be metabolized and excreted from the body to be reversed -Contraindicated in liver and kidney disease -cardiac and resp depression

Spinal or Epidural

-regional loss of sensation without loss of consciousness. -can diffuse up or down, if diffuse up can cause resp. depression

acute pancreatitis medical management

-replace lost fluids -demerol is drug of choice -antibiotics -npo until pain improves

General anesthesia

-reversible loss of consciousness induced by inhibiting CNS. -IV or inhalation agents - analgesia and amnesia effect -decreased LOC -loss of muscle tone

Dumping syndrome management

-small meals -maintain high protein, high fat, low CHO, dry diet -No fluids 1 hr ac, with or 2 hrs pc meal -lying down after meals

Esophageal Neoplasm

-spreads rapidly due to vascularity of esophagus -pt c/o dysphagia, odynophagia, wt loss

Mucosal barrier modifiers

-stimulate mucous production -bind to ulcer wall and helps the healing process ex: sucralfate, carafate

Proton pump inhibitors

-suppress acid secretions -May ↑ bleeding with coumadin -May interfere with absorb of ampicillin and digoxin -Lansoprazole -Omeprazole -Rabeprazole -end in zole

Nissen Fundopilication

-suture fundus around LES -increase pressure of volume in stomach closes the cardia and blocks reflux

-orrhaphy

-suture or repair

GERD

-syndrom resulting from backward flow of gastric contents -Inappropriate relax of LES -Usually painful after meal -Obese: too much weight for LES to work properly

Risk Factors for post op pulmonary complications

-type/ location of surgery -age -nutrition -duration of procedure

N/V

-undigested food indicative of gastric ulcer or pyloric obstruction

Malignant Tumors/mouth

-usually no pain -Basal cell- lips/sun damage -Squamous: leading type, chemical irritants, goes to mets to lymph and mandible (alcohol, tobacco)

Dumping syndrome

-vertigo -tachy, palpitations -syncope -sweating -pallor -diarrhea -n&V -desire to lie down

Prokinetic Agents

-↑ LES tone -↑ peristalsis -↑ rate of gastric empty -AC and HS -reglan

PUD surgical goals

-↓ acid secretion ability -remove (possible) malignant lesion -treat surgical complications of PUD -treat those who don't respond to med tx

A nurse is providing post-procedure teaching after a client underwent an upper gastrointestinal (GI) series. The nurse reminds the client that the stools will remain white for approximately:

1 to 2 days

The client has developed abdominal ascites as a result of alcohol-induced cirrhosis. What type of diet is recommended for the client initially in an attempt to decrease the fluid accumulation in the abdominal cavity?

1 to 2g sodium diet

5 areas looked at before pt can be discharged from PACU

1) Activity 2) Respirations 3) Circulation 4) Consciousness 5) O2 Sat ↑ 92% on room air Min of 8 points to get discharged from PACU, but want 10

Pancreatitis Nursing interventions

1. ASSESS (respiratory, cardiac, ab pain, fluid status) 2. Pain management 3. anti emetics 4. I&O, labs, daily weights 5. slow start of intake 6. teaching about disease process 7. appropriate referrals

Pancreatic surgery Nursing interventions

1. Appropriate assessment based on surgery type 2. post op care 3. location, function, patency of drains 4. hyperglycemia 5. nutritional and diabetic teaching

Nursing Dx for preoperative pts

1. Deficient knowledge 2. Anxiety

Peptic ulcers result from: (select all that apply)

1. Excess of gastric acid or a decrease in the natural ability of the GI mucosa to protect itself from acid and pepsin. 2. invasion of the stomach and/or duodenum by H. Pylori 4. Taking certain drugs, including corticosteroids and antiinflammatory medications

Treatment of Acute Gastritis

1. Hold foods and fluids till N&V subside 2. BRAT diet, no caffiene, spicy foods and heavy meals 3. antiemetics, antacids H2 antagonists, cytotec if on NSAIDS

Duodenal Ulcers

1. Increase in acid going into small intestine 2. Fast emptying of stomach 3. pain occurs 90 min-3 hrs after

Gallstone diet

1. NPO during acute attacks 2. Avoid fatty meals 3. avoid large meals after fasting 4. Oral cholesterol dissolving agents (ursodial)

Nursing interventions for cholecystectomy

1. Pain control 2. Post-op assess 3. C and DB incentive spirometer 4. bile replacement 5. T tube drainage (color, amt) 6. Avoid tension and kinking of t tube 7. drainage bag at level of abdomen

Nursing interventions for gallbladder

1. Pain medication 2. relaxation techniques 3. quiet enviroment 4. I&O 5. fluids

Nursing and acute cholecystitis

1. Pain medications 2. relax techniques 3. quiet enviro 4 I&O 5. fluids 6. slow oral intake 7. monitor for complications

Peptic ulcers occur

1. Pyloric sphincter 2. duodenal 3. Lesser curvature

Describe the physical changes that occur during middle age

1. dental changes 2. dry mucouse membranes and dysphagia 3. Decreased secretions of HCL acid decreased absorption of fe & B12 bacterial proliferation 4. decreased peristalsis 5. Decreased lipase production 6. Decreased liver enzymes

Chronic Gastritis

1. patchy, diffuse inflammation of mucosal lining 2. mucosa not scarred but changed

What factors are most commonly are found in acute pancreatitis

1. premature activation of pancreatic enzymes causing inflammation s. 2. Pain is midepigastrium radiating to back/ feels like a sword thru them 3. N&V 4. Fever 5. Tachy 6. epigastric tenderness 7. abdominal distention 8. Cullens and Turners sign

Peptic Ulcer management

1. rest stomach 2. stress reduction 3. avoid caffeine, alcohol 4. Medications: triple therapy: H2, prostaglandin analog, proton pump inhibit, antacid, mucous barrier fortifier

dumping syndrome diet

1. small meals 2. maintain high protein, high fat, low CHO, dry diet 3. No fluids 1 hr ac, with or 2 hrs pc meals 4. lie down after eating

Stress ulcers/erosive

1. trauma, illnes 2. curlings ulcers (severe burns) 3. Head injury or intracranial disease 3 Drug ingestion 4. shock 5. sepsis

Lab ranges for pancreatitis

1. ↑ serum amalyse (n 25-125)**** 2. ↑ serum lipase (n10-140) 3. ↑ bilirubin (n 0.3-1.9) 4. ↑ WBC 5. hyperglycemia 6. fight or flight response

5 Reasons for Surgery

1.) Diagnostic: make or confirm a diagnosis (biopsy) 2.) Curative: removed diseased body part (appendectomy) 3.) Restorative: improve function (total knee replacement) 4.) Palliative: ↓ intensity of illness, but not cure it (crohns = ostomy) 5.) Cosmetic: to enhance the appearance (rhinoplasty)

Types of surgeries

1.) Diagnostic: make or confirm a diagnosis (biopsy) 2.) Curative: removed diseased body part (appendectomy) 3.) Restorative: improve function (total knee replacement) 4.) Palliative: ↓ intensity of illness, but not cure it (crohns = ostomy) 5.) Cosmetic: to enhance the appearance (rhinoplasty)

3 Levels of Urgency of Surgery

1.) Elective: planned / choose 2.) Urgent: required / needed w/i 48 hours 3.) Emergent: life threatening / performed now

3 Extents of Surgery

1.) Simple 2.) Radical: surgery goes beyond area / diseased part (cancer surgeries) 3.) Minimally Invasive: ↓ LOS & recovery / may still be major

Colonoscopy should be performed every ________ years.

10

normal lipase

10-140

normal BUN

10-20

Normal ALT

10-40

PACU discharge criteria

10= complete recovery 8= discharge activity: voluntary movement 4 limbs respirations: cough and deep breathing circulation: +/- 20 consciousness: fully awake O2 saturation >92 urine output >30 cc surgical site integrity Tolerate po fluitds

How much pancreatic juices does the pancreas produce daily?

1200-1300 cc

noraml Na

135-145

Normal AST

14-20

normal pre-albumin

15-30

A nurse is preparing to perform an abdominal assessment on a client. The nurse places the client in which best position to perform the assessment? Refer to figure.

2

Serum PreAlbumin:

20-40mg/dL Reflects protein & caloric intake for the past 2-3 days

normal Amylase

25-125

A nurse is preparing to administer a soapsuds enema to a client. Into which position does the nurse place the client to administer the enema? Refer to figure.

3

normal K

3.5-5

normal albumin

3.5-5

Serum Albumin:

3.5-5g/dL Measures circulating protein status; gives indication of nutritional status- produces slow change in levels (over 3-4 weeks), rapid changes are due to other factors (fluid status, blood loss, liver dysfunction, trauma). Ordered frequently w/elderly; can be given IV

A client with Crohn's disease has a prescription to begin taking antispasmodic medication. The nurse should time the medication so that each dose is taken:

30 minutes before meals

Action for glycerin suppository occurs within.

30 minutes.

Duodenal Ulcer

30-60 years, Caused by hyperscretion of stomach acid, occurs 3 hrs after meals, is relieved by food, melena (dark stools).

A nurse is checking a client for the correct placement of a nasogastric (NG) tube. The nurse aspirates the client's stomach contents and checks their pH level. Which of the following pH values indicates the correct placement of the tube?

4.0

What age are EKGs apart of baseline data for surgery

40 yo because by this time they probably have plaque build up in their arteries or a hx of heart problems

Flexible sigmoidoscopy should be performed every ________ years.

5

Action for mineral oil occurs within

6 to 8 hrs.

Stimulant laxatives action occurs within

6 to 8 hrs.

End recovery usually occurs in _-_ ___

6-8 weeks

normal glucose

60-110

An adult client with hepatic encephalopathy has a serum ammonia level of 120 mcg/dL and receives treatment with lactulose (Chronulac) syrup. The nurse determines that the client has the best and most optimal response if the level changes to which of the following after medication administration?

70 mcg/dL

Serum Iron

75-175

Serum Iron

75-175 mcg/dl

Serum Iron:

75-175mcg/dL If low, may be indicative of iron deficiency anemia not anemia of chronic disease, ie., kidney (oral or IV supplements can be given)

acute liver failure

80% liver destroyed (cells) can be due to aspirin, acetominophen , viruses , antibiotics, monitor for bleeding , clotting, encephalopathy , NPO

% of ulcers caused by H pylori

90% duodenal 70% gastric

Total Cholesterol

<200

The most common form of hepatitis today, having an incubation period of 10 to 40 days, is hepatitis:

A

Which tpes of hepatitis now have vaccines for prevetion?

A and B

A nurse has been reinforcing dietary teaching for a client with peptic ulcer disease who has a routine follow-up visit. Which behavior is the best indicator of a successful outcome for this client?

A decrease in sour eructation

A patient was recently diagnosed with colorectal cancer. His wife asks the nurse, "What prevents colon cancer?" The nurse's answer should include which factors?

A diet high in fiber Familial predisposition of a cancer-causing gene Regular checkups

Antiemetics-

A drug that is effective against N&V ♥Promethazine (phenergan) ♥Ondansetron (zofran) ♥ Metoclopramide (reglan)

Nursing interventions for the patient with cholecystitis associated with cholelithiasis are based on the knowledge that:

A heavy meal with a high fat content may precipitate the signs and symptoms of the disease

A client has just returned from the radiology department following an upper gastrointestinal (GI) series. The nurse reviews the health care provider's prescriptions, expecting to note which of the following needed for routine post-procedure care?

A laxative

After a liver biopsy, the nurse places the client in which of the following positions?

A left side-lying position with a small pillow or folded towel under the puncture site

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. To aid the client in symptom management, the nurse suggests foods that are on which of the following diets?

A low-fiber diet

A nurse is collecting data about how well a client with a gastrointestinal (GI) disorder is able to digest food. The nurse recalls that digestion is best defined as:

A mechanical and chemical process involving the breakdown of foods

Apply disposable gloves,Lubricate the enema tube and insert it approximately 4 inches,Clamp the tubing if the client expresses discomfort during the procedure,Ensure that the temperature of the solution is between 100° F (37.8° C) and 105° F (40.5° C).

A nurse is preparing to administer an enema to an adult client. Choose the interventions that the nurse would perform for this procedure

A nurse is caring for a client with esophageal varices who is going to have a Sengstaken-Blakemore tube inserted. The nurse brings which priority item to the bedside so that it is available at all times?

A pair of scissors

* Portal Hypertension *

A persistent increase in pressure w/i the portal vein A major complication of Cirrhosis

A client with peptic ulcer disease is scheduled for a pyloroplasty and the client asks the nurse about the procedure. The nurse bases the response on which of the following?

A pyloroplasty involves an incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum.

The client has had a total colectomy and a continent ileostomy was created. Which postoperative instruction does the nurse emphasize to this client?

A small dressing must be worn over the stoma.

A health care provider asks the nurse to obtain a Salem Sump tube for gastric intubation. The nurse would correctly select which of the following tubes from the unit storage area?

A tube with a larger lumen and an air vent

The nurse explains to the client that the primary reason a back rub is used as therapy to relieve pain is because the massage: a) Blocks pain impulses from the spinal cord to the brain. b) Stimulates the release of endorphins. c) Distracts the client's focus on the source of the pain. d) Blocks pain impulses from the brain to the spinal cord.

A) A back rub stimulates the large-diameter cutaneous fibers, which block transmission of pain impulses from the spinal cord to the brain. It does not block the transmission of pain impulses or stimulate the release of endorphins. A back rub may distract the client, but the physiologic process of fiber stimulation is the main reason a back rub is used as therapy for pain relief.

A nurse who works on an obstetrical inpatient unit has been assigned to the Client Safety Committee. What client safety goals are most applicable to this setting? Select all that apply. a) Involving clients in education to prevent cesarean sections, episiotomies, and cord infections b) Ensuring that health care providers complete preprocedure verification for any invasive procedure c) Providing effective and timely hand-off reports between labor and birth staff and mother-baby staff d) Giving car seat instructions that allow infants to ride facing backward in the front seat e) Identifying safety risks specific to the unit, such as infant abduction

A) B) C) E) Specific safety concerns on an obstetrical unit include providing very specific hand-off reports after completion of childbirth and recovery and the couplet transition to mother-baby care. In an invasive procedure (eg, tubal ligation, circumcision), preprocedure verification is standard. Education concerning the potential for infection in obstetrics is essential for clients with any incision. Infant abduction is an ever-present concern for those working in a mother-baby unit. Car seat instructions for new parents involve the infant facing backward in the back seat of a car, not in the front seat. Education for the family includes this important area.

A nurse is caring for a client with emphysema. Which nursing interventions are appropriate? Select all that apply. a) Administer low-flow oxygen. b) Teach use of postural drainage and chest physiotherapy. c) Keep the client in a supine position as much as possible. d) Encourage alternating activity with rest periods. e) Reduce fluid intake to less than 2,500 ml/day. f) Teach diaphragmatic, pursed-lip breathing.

A) B) D) F) Diaphragmatic, pursed-lip breathing strengthens respiratory muscles and enhances oxygenation in clients with emphysema. Low-flow oxygen should be administered because the client with emphysema has chronic hypercapnia and a hypoxic respiratory drive. Alternating activity with rest allows the client to perform activities without excessive distress. If the client has copious secretions and has difficulty mobilizing secretions, the nurse should teach him and his family members how to perform postural drainage and chest physiotherapy. Fluid intake should be increased to 3,000 ml/day, if not contraindicated, to liquefy secretions and facilitate their removal. The client should be placed in high Fowler's position to improve ventilation.

A client on prolonged bed rest has developed a pressure ulcer. The wound shows no signs of healing even though the client has received skin care and has been turned every 2 hours. Which factor is most likely responsible for the failure to heal? a) Inadequate protein intake b) Low calcium level c) Inadequate massaging of the affected area d) Inadequate vitamin D intak

A) Clients on bed rest suffer from lack of movement and a negative nitrogen balance. Therefore, inadequate protein intake impairs wound healing. Inadequate vitamin D intake and low calcium levels aren't factors in poor healing for this client. A pressure ulcer should never be massaged.

The client tells the nurse that he is allergic to shellfish. The nurse should ask the client if he is also allergic to: a) Iodine skin preparations. b) All other seafood. c) Caffeine. d) Alcohol-based skin preparations.

A) Clients who are allergic to shellfish are allergic to iodine skin preparations (Iodophor and Betadine) or any other products containing iodine, such as dyes. Clients who are allergic to shellfish do not necessarily have an allergy to any other substances or seafood.

A client with ascites and peripheral edema is at risk for impaired skin integrity. To prevent skin breakdown, the nurse should: a) Use an alternating air pressure mattress. b) Elevate the lower extremities. c) Massage the abdomen once a shift. d) Institute range-of-motion (ROM) exercise every 4 hours.

A) Edematous tissue is easily traumatized and must receive meticulous care. An alternating air pressure mattress will help decrease pressure on the edematous tissue ROM exercises are important to maintain joint function, but they do not necessarily prevent skin breakdown. When abdominal skin is stretched taut due to ascites, it must be cleaned very carefully. The abdomen should not be massaged. Elevation of the lower extremities promotes venous return and decreases swelling.

Following surgery, a client is receiving 1000 ml normal saline (IV) with 40 mEq (40 mmol/l) KCl which has been ordered to be infused at 125 ml/hr. The client states, "My IV hurts." What should the nurse do first? a) Assess the IV site for signs of phlebitis, extravasation, or IV-related infection. b) Contact the client's physician for a different IV order. c) Check the hanging parenteral fluid and administration set for documentation as to when they were last changed. d) Slow down the infusion to a keep-open rate (20-50 ml/hr).

A) Potassium in an IV solution may be irritating to a vein. The nurse should assess the IV site before taking any of the other actions listed. The infusion may have to be slowed and/or stopped, and the physician contacted. An outdated parenteral fluid setup does not cause pain, but may be a source of infection.

A client is being admitted with a nursing home-acquired pneumonia. The unit has four empty beds in semiprivate rooms. The room that would be most suitable for this client is the one with a: a) 60-year-old client admitted for investigation of transient ischemic attacks. b) 24-year-old client with non-Hodgkin's lymphoma. c) 55-year-old client with alcoholic cirrhosis. d) 45-year-old client with an abdominal hysterectomy.

A) The client with a possible transient ischemic attack is the only client who has not had surgery and is not immunocompromised. The client with a recent surgery and incision should not be exposed to a client with infection. Clients with cancer or alcoholic cirrhosis are very susceptible to infection, and it would not be safe to expose them to a client with a respiratory infection.

A nurse is providing wound care to a client 1 day after the client underwent an appendectomy. A drain was inserted into the incisional site during surgery. Which action should the nurse perform when providing wound care? a) Clean the area around the drain moving away from the drain. b) Gently irrigate the drain to remove exudate. c) Remove the drain if wound drainage is minimal. d) Remove the dressing and leave the incision open to air.

A) The nurse should gently clean the area around the drain by moving in a circular motion away from the drain. Doing so prevents the introduction of microorganisms to the wound and drain site. The incision cannot be left open to air as long as the drain is intact. The nurse should note the amount and character of wound drainage, but the surgeon will determine when the drain should be removed. Surgical wound drains are not irrigated.

A severe winter storm has prevented most staff members from getting to work on a busy medical-surgical unit. One registered nurse, two licensed practical nurses, and three nursing assistants have been able to get to work. A nurse-manager must decide which nursing care delivery system (model) (NCDS) should be implemented for the best possible client care during this staffing crisis. The nurse-manager directs the staff to implement which NCDS (NCDM)? a) Functional nursing b) Team nursing c) Primary nursing d) Case management

A) Functional nursing best uses the skills of all staff in a timely manner during this crisis. This delivery system (model) requires the fewest staff and delegates tasks to those who can best perform them. Team nursing doesn't allow for the best use of a limited number of staff who must care for a large number of clients. Primary nursing and case management require more registered nurses than are currently available.

A client is being admitted with a nursing home-acquired pneumonia. The unit has four empty beds in semiprivate rooms. The room that would be most suitable for this client is the one with a: a) 60-year-old client admitted for investigation of transient ischemic attacks. b) 24-year-old client with non-Hodgkin's lymphoma. c) 55-year-old client with alcoholic cirrhosis. d) 45-year-old client with an abdominal hysterectomy

A) The client with a possible transient ischemic attack is the only client who has not had surgery and is not immunocompromised. The client with a recent surgery and incision should not be exposed to a client with infection. Clients with cancer or alcoholic cirrhosis are very susceptible to infection, and it would not be safe to expose them to a client with a respiratory infection.

The nurse is changing the dressing of a client after an abdominal hysterectomy. Which of the following nursing measures would be most appropriate if the dressing adheres to the client's incisional area? a) Moisten the dressing with sterile normal saline solution and then remove it. b) Lift an easily moved portion of the dressing and then remove it slowly. c) Remove part of the dressing and then remove the remainder gradually over a period of several minutes. d) Pull off the dressing quickly and then apply slight pressure over the area.

A) When a dressing sticks to a wound, it is best to moisten the dressing with sterile normal saline solution and then remove it carefully. Trying to remove a dry dressing is likely to irritate the skin and wound. This may contribute to tension or tearing along the suture line.

A client receives an I.V. dose of gentamicin sulfate (Garamycin). How long after the completion of the dose should the peak serum concentration level be measured? a) 30 minutes. b) 10 minutes. c) 20 minutes. d) 40 minutes.

A.

A nurse is monitoring a client who is receiving moderate sedation during a breast biopsy. Which symptom should the nurse assess first? a) Coarse crackles in both upper lobes b) Mild bleeding at the surgical site c) Lower back pain d) Heart rate of 84 beats/minute

A. Coarse crackles may indicate aspiration — a potentially life-threatening complication of conscious sedation. A heart rate of 84 beats/minute is within the normal range. Mild bleeding is expected at the surgical site. Poor positioning during surgery commonly causes lower back pain. Although the nurse should ultimately assess this pain, it isn't her first priority

Which of the following is an expected outcome when a client is receiving an I.V. administration of furosemide? a) Increased urine output. b) Increased blood pressure. c) Decreased premature ventricular contractions. d) Decreased pain.

A. Furosemide is a loop diuretic that acts to increase urine output. Furosemide does not increase blood pressure, decrease pain, or decrease arrhythmias

The nurse notices redness, swelling, and induration at a surgical wound site. What should the nurses next action be? a) Assess the clients temperature b) Clean with antiseptic material and re-dress the site c) Notify the health care provider d) Evaluate the clients white blood cell count

A. Infection produces signs of redness, swelling, induration, warmth, and possibly drainage. Since there could be a worsening situation occurring, further evaluation of the client is needed to determine the urgency of the situation. Assessment of the temperature should be the next step to determine how the client is responding to the infection. The white blood cells can also determine patient's response but the priority should be the temperature. The wound needs to be re-dressed but his would occur after speaking with the health care provider in case a culture may be ordered with would be inaccurate if the wound was cleaned first.

The client has been managing episodes of angina with nitroglycerin. Which of the following indicates the drug is effective? a) Decreased chest pain (angina). b) Increased blood pressure. c) Decreased heart rate. d) Decreased blood pressure.

A. Nitroglycerin acts to decrease myocardial oxygen consumption. Vasodilation makes it easier for the heart to eject blood, resulting in decreased oxygen needs. Decreased oxygen demand reduces pain caused by the heart muscle not receiving sufficient oxygen. While blood pressure may decrease ever so slightly as a result of the vasodilating effects of nitroglycerin, it is only secondary and not related to the client's angina. Increased blood pressure would mean the heart would work harder, increasing oxygen demand and thus angina. Decreased heart rate is not an effect of nitroglycerin.

When teaching a client how to take a sublingual tablet, the nurse should instruct the client to place the tablet: a) on the floor of the mouth. b) on the top of the tongue. c) on the roof of the mouth. d) inside the cheek.

A. The nurse should instruct the client to touch the tip of the tongue to the roof of the mouth, then place the sublingual tablet on the floor of the mouth. Sublingual medications are absorbed directly into the bloodstream from the oral mucosa, bypassing the GI and hepatic systems. No drug is administered on top of the tongue or on the roof of the mouth. With the buccal route, the client places the tablet between the gum and the cheek.

The nurse-manager on the oncology unit wants to address the issue of correct documentation of the effectiveness of analgesia medication within 30 minutes after administration. What should the nurse-manager do first? a) Complete a brief quality improvement study and chart audit to document the rate of adherence to the policy and the pattern of documentation over shifts. b) Consult the pharmacist. c) Change the policy of documentation to 45 minutes. d) Consult the nurses on the evening shift where documentation of analgesia is the greatest problem.

A. To determine the cause of this problem, a quality improvement study should be conducted. Before implementing solutions to a problem, the precise issues in the hospital system must be observed and documented. It is not the pharmacist's role to provide consultation about documentation of drugs administered by nurses. Consulting the evening nurses may be helpful, but this is a systems issue of the entire unit and involves every registered nurse administering analgesia.

Immediate Assessment in PACU-

ABC's (q15 for 4h, then q30 for 2h)

tumor marker for liver cancer

AFP (alpha fetoprotein) , increase alkaline phosphate

Causes of Acute Gastritis

ASA NSAIDS digitalis chemo drugs steroids acute alcoholism food poisoning caffeine nicotine

Liver Function Tests:

AST (5-40 units/L), ALT (3-35 units/L) Elevated in liver disorders, usually in the 100's; icterus(jaundice, yellow eyes), ascites (distended abd)-sounds mostly tympanic b/c of fluid

Liver Function Test

AST: 5-40 ALT:3-35 LDH: 115-225 phosphates: 30-85

If a patient is scheduled for an ultrasound of the pancreas, which two situations would cause the examination to be postponed?

Abdomen distended with gas, recent barium enema examination

Which findings would the nurse expect in a patient with acute pancreatitis?

Abdominal pain that increases with lying down

The client is scheduled for discharge after surgery for IBD. The client's spouse will be assisting home health services with the client's care. What is most important for the home health nurse to assess in the client and spouse regarding post-discharge care?

Ability to perform incision care and dressing changes

Gastritis symptoms

Absent or vague Anorexia, fullness, dyspepsia, belching, vague, epigastric pain, n/v intolerance of spice or fat EGD to dx

Your patient has alcoholic cirrhosis of the liver. Which of the following items written on the nursing Kardex would you question with the R.N. prior to implementing?

Acetaminophen prn pain

PACU Discharge Criteria-

Activity, Respirations, Circulations, Consciousness, O_2saturation, Pain control, Urine output>30cc/h, Surgical site integrity, Drink fluids

Elevated serum amylase and serum lipase levels, and decreased calcium levels are a sign of?

Acute Pancreatitis

Acute cholecystitis (usually caused by stones that have passed through)

Acute inflammation of the gallbladder wall Infection

A nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Choose the interventions that the nurse would expect to be prescribed for the client.

Administer antacids, as prescribed,Encourage coughing and deep breathing,Administer anticholinergics, as prescribed

A nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Choose the interventions that the nurse would expect to be prescribed for the client. Select all that apply.

Administer antacids, as prescribed. Encourage coughing and deep breathing. Administer anticholinergics, as prescribed.

A client arrives at the emergency department and complains of severe abdominal pain. The initial diagnosis is acute abdomen, and an x-ray and an abdominal ultrasonogram are prescribed to be obtained immediately. The nurse prepares the client for these diagnostic tests and reviews the health care provider's prescriptions. Which of the following prescriptions would the nurse question if written on the health care provider's prescription form?

Administration of an analgesic

postprandial

After a meal

A client is scheduled for an endoscopic retrograde cholangiopancreatography (ERCP). The nurse includes which intervention in the plan of care for the client?

After the procedure, keep client nothing by mouth (NPO) until the gag reflex returns.

Assessment and Diagnostic findings

Air and fluid levels as well as distended bowel loops on Abdominal X-ray. Abscesses and fluid collection on abdominal US. Abscesses on abdominal CT. Peritoneal aspirate for C&S may reveal causative organisms.

what is your priority for a patient that has had a partial glossectomy?

Airway!

Nursing assessment priority PACU

Airway, Breathing, Circulation. Breathing, mental status, surgical incision site, vitals, IV fluids, other tubes.

Which factors are most commonly associated with pancreatitis?

Alcoholism and biliary tract disease

Opioids

Alfentanil (Alfenta) Fentanyl (Sublimaze) Remifentanil (Ultiva) Sufentanil (Sufenta)

Which abnormal lab value would be found in a patient with a pathological condition of the liver?

Alkaline phosphatase

CT scan contraindications

Allergy to iodine or shellfish metal in body?

A client is admitted to the hospital with a diagnosis of acute pancreatitis. The nurse plans care, knowing that which problem occurs with this disorder?

Alteration in comfort related to abdominal pain

As a result of cirrhosis of the liver, the patient's condition deteriorates and he slips into a hepatic coma. The nurse would anticipate increasing levels of:

Ammonia

Which of the following medications would be the most effective in treating a duodenal ulceration caused by Helicobacter pylori?

Amoxicillin

Pancreatic tests

Amylase 56-90 Lipase 0-110 Elevated in acute pancreatitis only

Malignant Hyperthermia-

An ↑ metabolism & breakdown of skeletal muscle causes ↑levels of Ca & K s/s→acidosis, dysrhythmias, tachycardia, hypotension, muscle ridgity in jaw, tachypnea, skine mottling, tetani, myoglobinuria (muscle protein in urine), high temp (>104; late sign). If suspected, Stop drug!! Give 100% O_2, check ABG's (acidosis). Managed w/early Dx, Dantrolene (dantrium), and IV fluids

Hemoglobin

Anemia, GI Bleed

GI Lab/ CBC

Anemia, infection

Meds for GERD

Antacids / Histamine receptor antagonists / cholinergics / Prokinetic agents / PPI AVOID: Anticholinergics / Calcium Channel Blockers / Theophylline / Valium

Anal fistula is treated with

Antibiotics, Surgical excision of the fistula.

Preoperative care of patient with ileostomy

Antibiotics. If corticosteroids are being use, they will be continued. Patient education of stoma care after surgery.

Common pain meds for Gastric disorders

Antiemetics 1. Neuroleptic agents 2. Serotonin antagonists 3. Anticholinergics 4. Antihistamin 5. Prokenetic agents 6. weed/tigan

Medication that should be stopped

Antihpertensives, corticosteroids, Anticoagulants, glaucoma meds, Mycin, Garlic, licorice, St. John's wort

What are some routine medications that can cause surgical complications?

Antihypertensives, Corticosteroids, Insulin, Anticoagulants, Glaucoma medications, and Mycin antibiotics

Which group of medications should be avoided in patients with E. coli 157:H7

Antimotility drugs

Type B gastritis

Antrum glands, possibly entire stomach Atrophic, deep in glands and all layers of stomach H pyloric Older adults exposed to more toxinz

What are the three psychological components you should assess pre-op

Anxiety, Coping, and Support systems

Preoperative Nsg Dx

Anxiety, Knowledge deficit, Anticipatory grieving

Acute inflammatory diseases

Appendicitis Peritonitis Gastroenteritis

The emergency room staff is caring for a patient with an acute inflammatory intestinal disorder who is being observed to rule out appendicitis. Which intervention is contraindicated?

Apply heat to the abdomen

A client who has undergone a colostomy several days ago is reluctant to leave the hospital and has not yet looked at the ostomy site. Which measures are most likely to promote coping?

Ask a member of the local ostomy club to visit with the client before discharge, Ask the enterostomal nurse specialist to consult with the client before discharge,Ask the client to begin doing one part of the ostomy care and increase tasks daily.

A nurse notes that the medical record of a client with cirrhosis states that the client has asterixis. To verify this information, the nurse would do which of the following?

Ask the client to extend the arms.

The client with a recent surgically created ileostomy refuses to look at the stoma and asks the nurse to perform all required stoma care. What does the nurse do next?

Asks another client with a stoma who performs self-care to come and talk with the client

A nurse gathers data from a client admitted to the hospital with gastroesophageal reflux disease (GERD) who is scheduled for a Nissen fundoplication. Based on an understanding of this disease, the nurse determines that the client may be at risk for which complication?

Aspiration

What meds predispose a patient to peptic ulcer disease and GI bleeding?

Aspirin NSAIDS Steriods

Nursing management of patients with diarrhea

Assess and monitor stool. Health History. Assess abdomen and perineum. Encourage bedrest and intake of fluids and low bulk foods until acute episode passes. Avoid caffeine, carbonated beverages, very hot or cold foods. Report any indication of electrolyte imbalance immediately. Perianal care.

Home care assessment for a pt with ulcer disease

Assess gastrointestinal & cardiovascular status: - vitals / hgb & hct - skin color - abd pain - bowel sounds Assess nutritional status: - dietary patterns - intake of caffeine & alcohol - relationship w/ food Assess medical history: - use of NSAIDS, steroids, OTC Assess pt's coping style Assess pt's understanding of illness & ability to adhere to the therapeutic regimen: - symptoms to report to doctor - expected side effects of meds - food & drug interactions - need for smoking cessation

The young adult client has come to the emergency department (ED) with a stab wound to the abdomen. Once stabilized, the client is admitted to the general medical-surgical unit. Which nursing intervention is the highest priority for this client?

Assessing vital signs Assessment of vital signs should be done first to determine the adequacy of the airway and circulation. Vital signs initially reveal the most about the client's condition.

Which nursing intervention would be the highest priority in evaluating a patient with peritonitis from a ruptured appendix?

Assessment of severity, location, and duration of pain

A client with viral hepatitis states to the nurse, "I am so yellow." The nurse would appropriately:

Assist the client in expressing feelings

Oral problems in older adults

Atrophy of oral mucosa Decrease I'm salivation More cavities Decreased motor function (chewing/swallowing) Inability to perform hygiene

Anticholinergics

Atropine Glycopyrrolate (robinol) - ↓ GI Motility - ↓ pharyngeal secretions

The client has progressed into late-stage cirrhosis and has been placed on lactulose. Which adjustment to the client's home environment does the home health nurse make to manage side effects of the medication?

Availability of a bedside commode Lactulose therapy increases the frequency of stools, so a bedside commode should be made available to the client, especially if he or she has difficulty reaching the toilet.

You administered the medication GoLYTELY to a 78-year-old woman in preparation for diagnostic tests. In planning for her care, which would be most appropriate?

Available bedside commode for possible weakness

PUD diet

Avoid caffeine and alcohol

A nurse is getting a client who underwent umbilical hernia repair ready for discharge. The nurse tells the client that it is important to continue to do which of the following after discharge?

Avoid coughing.

A client will undergo a barium swallow to determine whether the client has a hiatal hernia. The nurse provides pre-procedure instructions and tells the client to:

Avoid eating or drinking after midnight before the test

A client will undergo a barium swallow to confirm a diagnosis of a hiatal hernia. In preparation for the test, the nurse instructs the client to:

Avoid eating or drinking after midnight before the test.

The nurse is teaching the client with Crohn's disease about managing the disease with adalimumab (Humira). Which instruction about the treatment plan does the nurse emphasize to the client?

Avoid large crowds and anyone who is sick.

Avoiding Barrettes esophagus

Avoid nitrosamines which are found in pickled or fermented food foods high in nitrate EAT more fresh fruits and vegetables

The client has developed an Escherichia coli infection after recently attending summer camp. Which action would have been most effective in preventing this infection?

Avoiding swallowing water while swimming

A client who suffered a stroke has a nursing diagnosis of Ineffective airway clearance. The goal of care for this client is to mobilize pulmonary secretions. Which intervention helps meet this goal? a) Administering oxygen by nasal cannula as ordered b) Repositioning the client every 2 hours c) Keeping the head of the bed at a 30-degree angle d) Restricting fluids to 1,000 ml/24 hours

B) Repositioning the client every 2 hours helps prevent secretions from pooling in dependent lung areas. Restricting fluids would make secretions thicker and more tenacious, thereby hindering their removal. Administering oxygen and keeping the head of the bed at a 30-degree angle might ease respirations and make them more effective but wouldn't help mobilize secretions

A nurse is preparing a client for bronchoscopy. Which instruction should the nurse give to the client? a) Don't ambulate for 2 hours prior to the procedure. b) Don't eat for 6 hours prior to the procedure. c) Don't talk for 4 hours prior or 4 hours following the procedure. d) Don't the day of the procedure.

B) Bronchoscopy involves visualization of the trachea and bronchial tree. To prevent aspiration of stomach contents into the lungs, the nurse should instruct the client not to eat or drink anything for approximately 6 hours before the procedure. It isn't necessary for the client to avoid walking, talking, or coughing.

The RN has just received a change-of-shift report about these four patients. Which patient should be assessed first? A) A 20-year-old with ulcerative colitis who has had six liquid stools during the previous shift B) A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102° F C) A 56-year-old who has had a colon resection and whose colostomy bag does not have any stool in it D) A 60-year-old admitted with acute gastroenteritis who is complaining of severe cramping and nausea

B) A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102° F

The RN working on the medical-surgical unit has just received report about these four patients. Which patient should the RN assess first? A) A patient who has returned to the unit after a colon resection with a new colostomy stoma, which is dark pink B) A patient who has been admitted after a motor vehicle accident and has ecchymoses on both flanks C) A patient with pneumonia who has abdominal distention and markedly decreased bowel tones D) A patient with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy

B) A patient who has been admitted after a motor vehicle accident and has ecchymoses on both flanks

The nurse is caring for patients in the outpatient clinic. Which of these phone calls should the nurse return first? A) From the patient with hepatitis A complaining of severe and ongoing itching B) From the patient with severe ascites who has a temperature of 100.4° F (38° C) C) From the patient with cirrhosis who has had a 3-pound weight gain over 2 days D) From the patient with esophageal varices and mild right upper quadrant pain

B) From the patient with severe ascites who has a temperature of 100.4° F (38° C) The patient with ascites and an elevated temperature may have spontaneous bacterial peritonitis, and the nurse should call this patient first. The other patients' data are not unusual for their diagnoses, although the nurse will need to assess these patients after calling the patient with ascites.

The client with an exacerbation of ulcerative colitis has been prescribed a low-residue diet. Which meal plan is best for this client? A) Chef's salad B) Scrambled eggs, white toast with margarine C) Tuna salad sandwich on whole wheat bread D) Fried chicken with rice, cooked green beans

B) Scrambled eggs, white toast with margarine No raw veggies, whole wheats

The RN has just received change-of-shift report on an inpatient medical unit. Which patient should the RN see first? A) The patient with ascites who had a paracentesis 2 hours ago and is complaining of a headache B) The patient with portal-systemic encephalopathy who has become increasingly difficult to arouse C) The patient with hepatic cirrhosis and jaundice who has a hemoglobin of 10.9 g/dL and thrombocytopenia D) The patient with hepatitis A who has elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

B) The patient with portal-systemic encephalopathy who has become increasingly difficult to arouse

The nurse empties a Jackson-Pratt drainage bulb. Which of the following nursing actions ensures correct functioning of the drain? a) Irrigating it with normal saline. b) Compressing it and then plugging it to establish suction. c) Connecting it to low intermittent suction. d) Connecting it to a drainage bag and clamping it off.

B. After emptying a Jackson-Pratt drainage bulb, the nurse should compress the bulb, plug it to establish suction, and then document the amount and type of drainage emptied. Irrigating a Jackson-Pratt drain is inappropriate because it could contaminate the wound. The Jackson-Pratt drain is not usually connected to wall suction. The purpose of the Jackson-Pratt drain is to remove bloody drainage from the deep tissues of the incision; clamping the drain would be counterproductive.

A nursing instructor is instructing group of new nursing students. The instructor reviews that surgical asepsis will be used for which of the following procedures? a) Instilling eye drops b) I.V. catheter insertion c) Nasogastric tube irrigation d) Colostomy irrigation

B. Caregivers must use surgical asepsis when performing wound care or any procedure that involves entering a sterile body cavity or breaking skin integrity. To achieve surgical asepsis, objects must be sterilized or kept free of all pathogens. Because inserting an I.V. catheter disrupts skin integrity and involves entry into a sterile cavity (a vein), surgical asepsis is required. Medical asepsis is used when instilling eye drops. The GI tract isn't sterile; therefore, irrigating a nasogastric tube or a colostomy requires only clean technique.

The nurse assesses a client who has just received morphine sulfate. The client's blood pressure is 90/50 mm Hg; pulse rate, 58 bpm; respiration rate, 4 breaths/minute. The nurse should check the client's chart for an order to administer? a) Doxacurium. b) Naloxone hydrochloride. c) Remifentanil. d) Flumazenil.

B. Naloxone hydrochloride is the antidote for morphine sulfate. The signs of overdose on morphine sulfate are a respiration rate of 2 to 4 breaths/minute, bradycardia, and hypotension. Flumazenil is the antidote for midazolam. Doxacurium is a nondepolarizing muscle relaxant. Remifentanil is an opioid used as an anesthetic adjunct.

Which of the following physician prescriptions is written correctly? a) Give 4 U regular insulin IV now b) Fentanyl 50 micrograms given IV every 2 hours as needed for pain > 6/10 c) 60.0 mg toradol given IM for c/o pain d) .5 mg MS given IM for c/o pain

B. Prescriptions should be written clearly to avoid confusion or misinterpretation. Clearly written prescriptions do not use a "trailing" zero (a zero following a decimal point) and do use a "leading" zero (a zero preceding a decimal point). Additionally, the prescribed medication should be written in full and avoid abbreviations of the drug and the dosage, for example "morphine sulfate" (avoiding use of "MS"), "ml" instead of "cc," and "micrograms" instead of "mcg."

Which of the following medications should the nurse anticipate administering in the event of a heparin overdose? a) Acetylsalicylic acid (ASA). b) Protamine sulfate. c) Warfarin sodium (Coumadin). d) Atropine sulfate.

B. Protamine sulfate is a heparin antagonist. It is administered intravenously very slowly (over at least 10 minutes). Warfarin sodium and ASA have anticoagulant properties and would be contraindicated. Atropine sulfate is an anticholinergic drug and would not be effective in treating a heparin overdose.

Which of the following is a serious adverse effect of ibuprofen (Advil, Motrin) in the elderly? a) Neuropathy. b) Impaired renal function. c) Hypoglycemia. d) Rebound headaches.

B. Renal function may already be compromised in the elderly, and ibuprofen can further impair renal or liver function. Nonsteroidal anti-inflammatory drugs can also cause nephrosis, cirrhosis, and heart failure in elderly persons. Rebound headaches are not a serious adverse effect of ibuprofen. Neuropathy is not an adverse effect of ibuprofen. Hypoglycemia is not an adverse effect of ibuprofen.

A priority for nursing care for an adult female who has pruritus and is continuously scratching the affected areas and demonstrates agitation and anxiety regarding the itching sensation would be: a) Avoiding soical isolation b) Preventing infection c) Instructing the client not to scratch d) Increasing fluid intake

B. The client is at risk for infection because of the pruritus, and the nurse should institute measures to help the client control the scratching, such as cutting fingernails, using protective gloves or mitts, and if necessary administering anti-anxiety medications. More information is required regarding the knowledge level of the client, but learning cannot take place when an individual's attention is distracted with pruritus. Increasing fluid intake is not a priority at this time. There is no data to indicate the client is experiencing social isolation.

A loading dose of digoxin (Lanoxin) is given to a client newly diagnosed with atrial fibrillation. The nurse begins instructing the client about the medication and the importance of monitoring his heart rate. An expected outcome of the education program will be: a) Verbalization of the need for the medication. b) A return demonstration of how to take the medication. c) A return demonstration of palpating the radial pulse. d) Verbalization of why the client has atrial fibrillation.

B. The goal of the education program is to instruct the client to take his pulse; therefore, the expected outcome would be the ability to give a return demonstration of how to palpate the heart rate.

The intrinsic factor is a gastric secretion necessary for the intestinal absorption of vitamin:

B12

Malabsorption problems

B12 and folic acid deficiency Decreased absorption of calcium and vit D

Meds that can be given for surgery

BP, seizure, and resp meds.

GERD

Backward flow of gastric contents into the esophagus Inappropriate relaxation of the LES

Define: Perioperative

Begins when pt decides to have surgery and goes until the end of recovery

Versed

Benzodiazepine used for amnesia effect

Jaundice, a yellow discoloration of body tissues, results when there is an excess amount of __________________ in the bloodstream.

Bilirubin

Narcotic Opioids-

Binds to pain receptors; causes resp. depression (hypotension, confusion). Used for moderate to severe pain; physical dependence can develop:Parenteral- ♥Morphine, ♥Fentanyl, ♥Hydromorphone Combo Oral Drugs- ♥Acetaminophen & Codeine (Tylenol 3)♥Propoxyphene Napsylate (darvocet) ♥Hydrocodone & Acetaminophen (vicodin)♥Oxycodone & Acetaminophen (percocet)

Vit C

Bleeding gums, petechiae

Upper GI bleed causes

Bleeding ulcers Esophageal varices Mallory-Weiss tear (from binging) Cancer