Med surge exam#4
Loperamide (Imodium) may be prescribed to supress intestinal motility
As an intervention for Gastroenteritis along IV fluids
Anticholinergics
Atropine GI - Slows motility, spasm Eyes - Dilates pupils *DO NOT GIVE TO GLAUCOME PTS* Heart - Increase HR Resp - bronchodilator (Atrovent) anticholinergics reduce GI motility and secretion;block acetylcholine
The patient with osteoporosis has a spontaneous hip fracture, How would you document this as
pathologic fracture
A pt with a colostomy is experiencing weakness when the colostomy is irrigated What manifestations requires the nurse to contact the physician
perforated bowel
The Older Adult Amputee
requires smaller units of information, more repetition, more time During teaching process patients with glasses or hearing aids should have them in place Remind that phantom sensations are not uncommon or bizarre; this can reduce fear or anxiety of these sensations Many have one or more chronic health problems The loss of a limb can be especially difficult; it is important to provide psychological support Older people may lack confidence that they can adapt and gain strength. Empathy, patience, and respect are essential in approaching older patients.
Kock pouches made of
section of the ileum
What are the signs of arterial occlusion? Venous congestion?
Arterial occlusion: 4 P's Pain Pulselessness or absent pulse Pallor Paresthesia Venous congestion?enlarged, swollen veins
A pt with a history of peptic ulcer disease would most likely complain about what type of pain?
Burning
With any tube feedings with a syringe, what must be done prior to the feeding
Chech for residual and return residual to the patients stomach
Education being provided about avoiding regurgitation in a pt who had esophageal surgery is?
Eat only small meals
To help reduce c/o heartburn, regurgitation, and eructation in a pt w/a hiatal hernia should be
Eating nothing for several hours before bedtime
The nurse working in the ED is evaluating a client for signs and symptoms of appendicitis. Which of the client's signs/symptoms should the nurse report to the physician?
Nausea Nausea, with or without vomiting, is typically associated with appendicitis. Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt upon the release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.
Which of the following is the most common symptom of a polyp?
Rectal bleeding The most common symptom is rectal bleeding. Lower abdominal pain may also occur. Diarrhea and anorexia are clinical manifestations of ulcerative colitis.
Fracture of the Pelvis
most common complications, internal trauma, laceration of colon, hemorrhage rupture urethra or bladder, pelvic fx heal within 6-8 wks A less severe non-weight-bearing fracture treated with bedrest on a firm mattress or bed board for a few days to 6 weeks Severe weight-bearing fracture may require a pelvic sling, skeletal traction, double hip spica cast, or external fixation Monitor patient so injuries can be treated immediately Check for presence of blood in urine and stool, and watch abdomen for signs of rigidity or swelling
Stages of dumping syndrome
patient experience abdominal fullness and nausea within 10 to 20 min after eating patient feels flushed and faint Symptoms in this stage are probably caused by distention of the small intestine by consumed food and fluid Patient hearts races and patient breaks sweat as results of pooling of blood into the abdominal organs
Sudden,sharp pain starting in the mid epigastric region and spreading across the entire abdomen in pts with PU may indicate
perforation
most serious complication of gastric endoscopy
perforation of the Digestive tract
complication of colostomy irrigation
perforation of the bowel
As adding ginger root to tea can calm the stomach, it also enhances the action of what drug?
Anticoagulants
When a leg is amputated and is receiving a prosthesis, post-op teaching should included what?
To accommodate the prosthesis, a rigid dressing will be used
what surgical procedure is done for the presence of compartment syndrome
fasciotomy
a pt with ileostomy has 120 pulse ,resp 28/min,temperature of 101°degrees ,and rigid abdomen.What this might indicate
peritonitis
Healing Stages of bone
Stage 1: hematoma formation Immediately after a fracture, bleeding and edema occur In 48 to 72 hours, a clot or hematoma forms between the two broken ends of the bone Stage 2: fibrocartilage formation Hematoma that surrounds fracture does not resorb, as it does in other parts of the body Instead, other tissue cells enter the clot, and granulation tissue replaces the clot The tissue then forms a collar around each end of the broken bone, gradually becoming firm and forming a bridge between the two ends Stage 3: callus formation Within 1 to 4 weeks after injury, granulation tissue changes into a callus, which is made up of cartilage, osteoblasts, calcium, and phosphorus. The callus is larger than the diameter of the bone and serves as a temporary splint Stage 4: ossification Within 3 weeks to 6 months after the break, a permanent bone callus, known as woven bone, forms During this stage, the ends of the broken bone begin to knit Stage 5: consolidation and remodeling Consolidation occurs when the distance between bone fragments decreases, then closes During bone remodeling, immature bone cells are gradually replaced by mature bone cells Excess bone is chiseled away by stress to the affected part from motion, exercise, and weight-bearing Bone then takes on its original shape and size
What commonly causes stress fractures?
repetitive movements bone damage or breaks caused by stress on bone surfaces during exercise
major long term complication caused by coughing in a pt with colostomy
prolapse
following ileostomy stoma what the nurse examine the base of the stoma
purulent drainage redness skin breakdown
patient with gastric surgery is more likely to experience dumping syndrome because
related to hypovolemia and cardiac output decrease
Dyphenoxylate HCL/atropine sulfate(Lomotil) is contraindicated for?
Elder it causes drowsiness increasing risk for falls
After undergoing a total cystectomy and urinary diversion, a client has a Kock pouch (continent internal reservoir) in place. Which statement by the client indicates a need for further teaching?
"I'll have to wear an external collection pouch for the rest of my life." The client requires additional teaching if he states that he'll have to wear an external collection pouch for the rest of his life. An internal collection pouch, such as the Kock pouch, allows the client to perform self-catheterization for ileal drainage. This pouch is an internal reservoir, eliminating the need for an external collection pouch. A well-balanced diet is essential for healing; the client need not include or exclude particular foods. The client should drink at least eight glasses of fluid daily to prevent calculi formation and urinary tract infection. Intervals between pouch drainings should be increased gradually until the pouch is emptied two to four times daily.
Fracture healing occurs in stages. Which stage is described in the following statement?"Within 3 weeks to 6 months after the break, a permanent bone callus, known as woven bone, forms. It is during this stage that the ends of the broken bone begin to knit." Stage 1 Stage 2 Stage 3 Stage 4
On stage 4 Rationale: A bone begins to heal as soon as an injury occurs. New bone tissue is formed to repair the fracture, resulting in a sturdy union between the broken ends of the bone. Healing occurs in the following five stages: STAGE 1: Hematoma formation. Immediately after a fracture, bleeding and edema occur. In 48 to 72 hours, a clot or hematoma forms between the two broken ends of the bone. STAGE 2: Fibrocartilage formation. The hematoma that surrounds the fracture does not resorb, as does a hematoma in other parts of the body. Instead, other tissue cells enter the clot and granulation tissue forms, replacing the clot. The granulation tissue then forms a collar around each end of the broken bone, gradually becoming firm and forming a bridge between the two ends. STAGE 3: Callus formation. Within 1 to 4 weeks after injury, the granulation tissue changes into a callus formation. Callus is made up of cartilage, osteoblasts (bone cells that form new bone), calcium, and phosphorus. The callus is larger than the diameter of the bone and serves as a temporary splint. STAGE 4: Ossification. Within 3 weeks to 6 months after the break, a permanent bone callus, known as woven bone, forms. It is during this stage that the ends of the broken bone begin to knit. STAGE 5: Consolidation and remodeling. Consolidation occurs when the distance between bone fragments decreases and eventually closes. During bone remodeling, the immature bone cells are gradually replaced by mature bone cells. The excess bone is naturally chiseled away by stress to the affected part from motion, exercise, and weight-bearing. The bone then takes on its original shape and size.
Closed amputations
Create a weight-bearing residual limb, important for lower extremity amputations
Fistulas commonly develop
Crohn's disease
In the post-op period, what are the late signs of hemorrhage after an amputation?
Cyanosis and hypotension
Which drug is considered a stimulant laxative?
Bisacodyl Bisacodyl is a stimulant laxative. Magnesium hydroxide is a saline agent. Mineral oil is a lubricant. Psyllium hydrophilic mucilloid is a bulk-forming agent.
The most endoscopic procedure for examining the small intestine is what?
Capsule camera
Suspect what in a crushed forearm that is swollen, cool, cyanotic, and has weak distal pulses
Compartment syndrome
Your pt is sweaty with abd distention and diarrhea after getting a tube feeding. The cause is?
Dumping syndrome
A portion of the stomach herniates through the diaphragm and into the thorax is called
Hiatal hernia
A pt with a history of a connective tissue disease, what is important for the nurse to obtain?
History of a prior injury to a specific body part
The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program?
It is the third most common cancer in the United States. Colorectal cancer is the third most common type of cancer in the United States. The lifetime risk of developing colorectal cancer is 1 in 20. The incidence increases with age (the incidence is highest in people older than 85). Colorectal cancer occurrence is higher in people with a family history of colon cancer.
In a patient with vertebral fracture , what should th enurse teach the patient to do
Log roll to keep the spine straight when turning
What pre-op tests are appropriate for a pt getting a below knee amputation?
Pulse volume recording and WBC count
What instructions can be given to a pt with PVD who wants to help prevent an amputation?
Stopping smoking would help prevent vasoconstriction
A closed amputation is usually performed is
To create a weight-bearing residual limb
Hiatal hernia is agravated by
obesity,pregnancy,ascites, heavy lifting and tumors
Regarding connective tissue function, which of the following is true?
provides protection to body parts
A pt with severe pain after abdominoperineal resection, what position would promote comfort?
side lying
nephrostomy
surgical created opening in the kidney to drain urine
why is a nasogastric tube placed in a pt with bowel obstruction
to decompress the bowel
Antiemetic drugs
treat nausea and vomiting and motion sickness
antifungals
treat yeast infection in the mouth
What affects bone healing
Healing affected by location and severity of the fracture, type of bone, other bone pathology, blood supply to the area, infection, and the adequacy of immobilization Also age, endocrine disorders, and some drugs affect healing
We must encourage our pts to TC&D after abd surgery, how can we best achieve this?
Help the patient splint the incision with a pillow
"J pouch"
Ileoanal reservoir
In a pt receiving TPN, what assessment finding would indicate hyperglycemia?
Increase in urine output
When educating a patient with gout, they should be told that they are at an increased risk for?
Kidney stones
What part of the body does connective tissue diseases affect?
Bones ,ligaments, carilage and tendons
Which drug is often used in older patients for pain management of moderate to severe diverticulitis?
MSO4 (Morphine)
Which of the following is considered a bulk-forming laxative?
Metamucil Metamucil is a bulk-forming laxative. Milk of Magnesia is classified as a saline agent. Mineral oil is a lubricant. Dulcolax is a stimulant.
To measure achievement of verbalized microvascular precautions would be which of the following?
Patient knowledge of therapeutic measures
When ed a pt w/gout about a low-purine diet, what would indicate the need for further teaching?
Seafood platter with scallops and mussels
Your pt has amputated his thumb by accident and is in a jar. What is the best action?
Wrap the thumb in a cloth saturated with NS and put in a bag This is a correct answer
which is a sign of bowel obstruction
abdominal distention
Open amputation
also called stage amputation and guillotine amputation
mucosal barrier(cytoprotective)
clinger to the surface of an ulcer and protect it so that healing can take place
pyloric sphincter
opening from the stomach into the duodenum
uterestomy
opening in the uterer; on one or both ureters are brought out through opening in the abdomen or flank
After insertion of a gastric tube feeding is not started until?
placement is certain
caries
tooth decay
What gaits are used with a cane?
** Think COAL** C= Cane O= Opposite A= Affected L= Leg
What factors contribute to developing delirium?
- disruption in brain function due to medication side effect, circulatory disturbance, dehydration, low or high blood pressure, low or high thyroid activity, low or high blood glucose, surgery, stress, etc.
What is the most common age for primary bone tumors?
Primary bone tumors occur most frequently at adolescence but can occur at any age. Approximately 1/3 of these individuals are 11 to 20 yrs of age
Skeletal traction
Provides a strong, steady, continuous pull and can be used for prolonged periods Examples of skeletal traction are Gardner-Wells, Crutchfield, and Vinke tongs and a halo vest, in which pins are inserted into the skull on either side
What assessment should be a priority for a pt immediately after total knee replacement?
Quality of pulses in the affected limb This is a correct answer
Colles Fracture
A break in the distal radius (wrist area) Medical diagnosis Radiography Medical treatment Closed reduction or manipulation of the bone and immobilization in either a splint or a cast Colles fractures often occur in older adults, particularly older women, when an outstretched hand is used to break a fall. What are the major signs and symptoms of a Colles fracture? The most common complication is impaired circulation in the area resulting from edema.
After teaching a group of students about intestinal obstruction, the instructor determines that the teaching was effective when the students identify which of the following as a cause of a functional obstruction?
Abdominal surgery In functional obstruction, the intestine can become adynamic from an absence of normal nerve stimulation to intestinal muscle fibers. For example, abdominal surgery can lead to paralytic ileus. Mechanical obstructions result from a narrowing of the bowel lumen with or without a space-occupying mass. A mass may include a tumor, adhesions (fibrous bands that constrict tissue), incarcerated or strangulated hernias, volvulus (kinking of a portion of intestine), intussusception (telescoping of one part of the intestine into an adjacent part), or impacted feces or barium.
To ensure effectiveness of Stool softeners, which of the following is most appropriate?
Adequate fluid intake
What is the most common cause of small-bowel obstruction?
Adhesions Adhesions are scar tissue that forms as a result of inflammation and infection. Adhesions are the most common cause of small-bowel obstruction, followed by tumors, Crohn's disease, and hernias. Other causes include intussusception, volvulus, and paralytic ileus.
PUD is
An ulceration in the mucosal wall of the stomach,pylorus,duodenum, or esophagus
The most effective strategy when treating pain associated with arthritis is?
Apply warm, moist compresses before doing activity
When caring for a pt with a compound fx, what action should the nurse implement?
Assess for pulses distal to the injury
The new nurse shows understanding about Gastroeneteritis when she stated that it can
Be Viral or Bacterial(will see an increase in WBCs)
Three-point gait pattern
Both crutches and the foot of the affected extremity are advanced together, followed by the foot of the unaffected extremity This gait requires strength and balance Used for partial or no weight bearing on affected leg
Swing-to gait
Both crutches are advanced together, then both legs are lifted and placed down again on a spot behind the crutches The feet and crutches form a tripod
A patient is admitted to the hospital after not having had a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem?
Bowel perforation Megacolon is a dilated and atonic colon caused by a fecal mass that obstructs the passage of colon contents. Symptoms include constipation, liquid fecal incontinence, and abdominal distention. Megacolon can lead to perforation of the bowel.
What post-op observation should be reported to the physician immediately ?
Bright red bleeding
A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet.
Broiled chicken with low-fiber pasta A low-residue, high-protein, and high-calorie diet is recommended to reduce the size and number of stools. Foods to avoid include yogurt, fruit, salami, and peanut butter.
Skin traction
Buck's traction For hip and knee contractures, muscle spasms, and alignment of hip fractures Weight used during skin traction should not be more than 5 to 10 pounds to prevent injury to the skin
The patient wprks on a computer all day. What kind of repetitive strain injury did he sustained?
Carpal tunnel syndrome
Classification of Fractures
Closed or simple fracture The bone does not break through the skin Open or compound fracture Fragments of the broken bone break through skin
Gas gangrene is caused by
Clostridium perfringens
Which type of stoma will a patient with diverticulitis most likely have postoperatively?
Colostomy
What complications may occur with traction?
Complications Impaired circulation, inadequate fracture alignment, skin breakdown, and soft tissue injury Pin track infection and osteomyelitis can occur with skeletal traction
Which of the following diseases is not known to cause impaired circulation, therefore potential amputation? Arteriosclerosis Diabetes mellitus Peripheral vascular disease Peyronie's disease
Correct answer: D Rationale: Some examples of diseases leading to impaired circulation are peripheral vascular disease, diabetes mellitus, and arteriosclerosis
Five to six soft, loose stools per day that are non-bloody
Crohn's disease
A client with a 10-year history of Crohn's disease is seeing the physician due to increased diarrhea and fatigue. Additionally, the client has developed arthritis and conjunctivitis. What is the most likely cause of the latest symptoms?
Crohn's disease The systemic nature of Crohn's disease is evidenced by symptoms outside the GI tract, referred to as extraintestinal manifestations of IBD. They include arthritis, arthralgias, skin lesions, eye inflammation (uveitis, conjunctivitis, and iritis), and disorders of the liver and gallbladder.
H2Receptor Antagonists
Decrease HCL acid production by competing with receptor sites
A pt diagnosed w/Osteoarthritis asks "what does that mean". The best explanation would be?
Degeneration of articular cartilage
What is considered abnormal for a pt in skeletal traction when performing neurovascular checks?
Delayed capillary refill
term used for an amputation through the joint
Disarticulation
Patient education about GERD includes all except
Eat meal 2-3 hours before going to bed
the nurse notices the patient is showing s/S of GERD when he states that he is
Experiencing dysphagia,regurgitation.dyspepsia, epigastric pain
Fat Embolism
Fat globules released from marrow of broken bone into bloodstream, then migrate to the lungs They lodge in capillaries and obstruct blood flow The fat particles break down into fatty acids, which inflame the pulmonary blood vessels, leading to pulmonary edema Common with fractures of the long bones, multiple fractures, and severe trauma
The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be
Fecal incontinence The nurse should anticipate fecal incontinence as one of the assessment findings. Other possible assessment findings include constipation and abdominal distention.
Most commmon peptic ulcers
Gastric and Duodenal
normal age related changes in the Digestive tract
Gums recede walls of stomach and esophagus thin muscle layer and mucosa in large intestine atrophy anal sphincter strength decrease
The patient shows need for further teaching with PUD when he states that
He will notify physician if his vomits pink in color
A pt who had an amputation, what is the greatest risk for this pt in the early post-op period?
Hemorrhage
For a pt who has had diarrhea for 2 days now, what assessment should be anticipated?
Hypotension and fatigue
A pt placed in a cast for a fx radius, what would
I am going to rest in bed w/my arm elevated above my heart
Further ed. might be needed for a pt w/UC and with an ileostomy, if he makes which statement
I will be glad when the surgeon closes this ileostomy
example of an opiate-related antidiarrheal agent
Loperamide Loperamide and diphenoxylate with atropine sulfate are examples of opiate-related antidiarrheal agents. Bismuth subsalicylate and kaolin and pectin are examples of absorbent antidiarrheal agents. Bisacodyl is a chemical stimulant laxative.
drug to help treat rash around the stoma of a pt with uterestomy
Nyastin
treatment for yeast infection around the uterestomy stoma
Nyastin powder
Assessment of fractures on the elderly
Older patients are particularly prone to developing delirium after a broken hip; therefore note mental status and problem behaviors related to confusion.
Assessment
Pain and swelling following treatment of the fracture Interventions Extremity should be supported and protected and can be elevated on a pillow during the first few days Encourage patients to move their fingers and thumb to promote circulation and reduce swelling, and to move their shoulders to prevent stiffness and contracture Teach proper cast care
What is phantom limb pain?
Pain felt in an area that has been amputated
A diverticulosis diagnosed pt has a temp of 102 and abd rigidity. What is most likely the cause
Perforation
The gold standard for patients with UC
Restorative proctolectomy with ileo pouch-anal anastomosis (RPC-IPAA)
Which has the highest priority after an open reduction and external fixation of an ankle?
Risk for infection
What diet is appropriate to reduce excess gas or diarrhea in a pt with a colostomy?
Roast beef, mashed potatoes, and peeled stewed tomatoes
What action is first in a pt with a peptic ulcer hemorrhaging and c/o sharp sudden pain?
Roll the patient flat and assess the vital signs
Performed because the sigmoid colon is the most common site of diverticulitis
Sigmoid colon
What should be included in the teaching plan for a pt with carpal tunnel syndrome?
Splinting to prevent flexion and hyperextension
complication of stoma involving narrowing of the abdomen opening around the base of the stoma
Stenosis
For a diagnosis of RA, the nurse should recognize which of the following characteristics?
Symmetric bilateral joint swelling This is a correct answer
Patients diagnosed with malabsorption syndrome may have vitamin and mineral deficiency. Patient who easily bleed have which of the following deficiencies?
The chief result of malabsorption is malnutrition, manifested by weight loss and other signs of vitamin and mineral deficiency (e.g., easy bruising [vitamin K deficiency], osteoporosis [calcium deficiency], and anemia [iron, vitamin B12 deficiency]).
Which is a true statement regarding regional enteritis (Crohn's disease)?
The clusters of ulcers take on a cobblestone appearance. The clusters of ulcers take on a cobblestone appearance. It is characterized by remissions and exacerbations. The pain is located in the lower right quadrant. The lesions are not in continuous contact with one another and are separated by normal tissue.
two-point gait (crutches)
The crutch on one side and the opposite foot are advanced at the same time Used with partial weight-bearing limitations and with bilateral lower extremity prostheses
What post-op teaching should be included for a pt who has had a ureterostomy?
The significance of the ureteral catheter for the first week
Removal of the colon, rectum, and anus with surgical closure of the anus
Total proctocolectomy with a permanent ileostomy
Begins in the rectum and proceeds in a continuous manner toward the cecum
Ulcerative colitis
Increased risk for colon cancer
Ulcerative colitis
What important points should be remembered when a patient is in traction?
Weights must always hang freely Ensure the correct weight is used, clamps are tight and ropes move freely over pulleys. Maintain body alignment so that the line of pull is correct Report skin breakdown or irritation Assess affected extremities for temperature, pain, sensation, motion, capillary refill time and pulses With skeletal traction, assess pin sites for redness, drainage or odor
The goal of treatment is to relieve pressure of compartment syndrome
When internal pressure, a surgical fasciotomy, which entails making linear incisions in the fascia, may relieve pressure on the nerves and blood vessels For external pressure, cast or dressings are replaced
What action should be done for a pt whose index finger is partially amputated and hanging?
Wrap hand & finger securely and place on an ice filled bag
What population has the highest incidence of upper extremity amputations?
Young men
lower esophageal sphincter
a muscular ring that controls the flow between the esophagus and stomach
To avoid amputation the physician may perform what?
angioplasty or surgical bypass of obstructed vessels
How can blood loss from the residual limb be minimized?
apply a pressure dressing over the existing dessring,elevate the residual limb and notify doctor asap.A leg BP cuff should be left by bedside to use as a tourniquete
Aspiration of stomach contents,strangulation, and incarceration of the stomach in the chest
are complications of Hiatal hernia
ostomy
artificial opening into a body cavity
following ileostomy surgery, the stome is inspected for
bleeding and color
esophagoscopy
examination of the esophagus with an esophagoscope
capsule endoscopy
examination of the small intestine made by a tiny video camera placed in a capsule and then swallowed; images are transmitted to a waist-belt recorder and then downloaded onto a computer for assessment of possible abnormalities; traditional endoscopy cannot completely access the small intestine because of its length and complexity a tiny video camera in a capsule that the patient swallows transmission of entire Digestive tract may detect obscure GI bleeding detects inflammation caused by NSAIDs and radiotherapy Detects small bowel tumors
Which erb is effective in calming an upset stomach,reducing flatulence and prevents motion sickness
ginger root
Hiatal hernia S/S
heartburn, fullness after eating, regurgitation, dysphagia
most serious complication of peptic ulcers
hemorrhage
which complication of uterestomy
hydronephrosis
what contribute to a prolapsed stoma in a colostomy
increased abdominal pressure coughing poor attached stoma
dyspepsia
indigestion
A pt with ileoanal reservour is prescribed metronidazole(Flagyl) this med treats?
inflammation
esophagitis
inflammation of the esophagus caused by acid reflux
gingivitis
inflammation of the gums
stomatitis
inflammation of the oral mucosa
the nurse notices the colostomy is not draining properly
inform the physician
Proton Pump Inhibitors
inhibits gastric acid secretion and used in peptic ulcer disease and GERD
serious consequences of UTI following uterestomy
kidney damage and septicemia
result of the loss of bicarbonate in ileostomy drainage
metabolic acidosis
The type of acid base imbalance that results from prolonged vomiting is
metabolic alkalosis
A post OP ileostomy pt becomes confused , what is is the nurse intervention for the mental state status change
monitor serum electrolytes
Antiacids
neutralize stomach acids
ascending colon
passes liquid material
descending colon
passes softly formed stool
Abdominal wall rigidity is a classic finding in patients with
peritonitis
A pt with RA takes Leflunomide which is a DMARD. What is the action of this medication?
slows the progress of the disease
residual limb
stump; partial limb remaining after amputation
if you find the ideal conduit stoma is black
the circulation is impaired
Stress fracture
Caused by either repeated or prolonged stress
gas gangrene
foul-smelling watery drainage with significant redness and swelling
A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of:
increasing fluid intake to prevent dehydration. Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy.
Disadvantages of open reduction and internal fixation of a fracture compared to closed reduction
infection
Which of the following is the diagnostic of choice if the suspected diagnosis is diverticulitis?
Computed tomography scan A computed tomography scan is the diagnostic of choice if the suspected diagnosis is diverticulitis; it can also reveal one or more abscesses. A barium enema or colonoscopy may be used to diagnosis diverticulosis. Magnetic resonance imaging would not be used to diagnose diverticulitis.
The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication?
Peritonitis The nurse should report to the physician that the client has signs/symptoms of peritonitis. Signs/symptoms of a pelvic abscess include anorexia, chills, fever, diaphoresis, and diarrhea. Signs/symptoms of an ileus include absent bowel sounds, nausea, and abdominal distention. Signs/symptoms of hemorrhage include tachycardia, hypotension, anxiety, and bleeding.
A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client?
Suggest fluid intake of at least 2 L/day The nurse should suggest a fluid intake of at least 2 L/day to help the client avoid constipation. The nurse should also offer prune or apple juice because they promote elimination. The nurse should encourage the client to eat regular meals. Dieting or fasting can decrease stool volume and slow elimination. The nurse should instruct the client to keep a record of food intake in case of diarrhea, because this helps identify specific foods that irritate the gastrointestinal tract.
What are some of the most common sites of amputation?
shoulder disarticulation Above elbow Below elbow Wrist Hand/finger Above knee Knee disarticulation Below knee Ankle Transmetatarsal Toes
the nurse educated the patient about agravating factors in GERD include all except
smoking, chocolate,alcohol and bland diet
What should be the initial assessment of a pt that just returned from getting an Indiana pouch?
Drainage of urine from the Penrose at the operative site
After an above knee amputation, to diminish swelling to the limb, the action to take would be?
Elevate the foot of the bed on blocks This is a correct answer
For a pt who had replantation of the left thumb, what action should take place post-op?
Elevate the hand but keep it below the level of the heart
if after a week of ostomy surgery you see edema this might indicate?
improper fitting collection device
the most prominent symptom of pyloric obstruction is persistent
vomiting
A client has been experiencing lower GI difficulties that have increased in severity, and the gastroenterologist is concerned that the client's bowel is not functioning properly. What function of the lower GI tract is most likely to be affected by the client's disorder?
water and electrolyte absorption Disorders of the lower GI tract usually affect movement of feces toward the anus, absorption of water and electrolytes, and elimination of dietary wastes.
How does a patient sit down after walking on crutches?
1. With your crutches, back up to the chair or bed until you feel it behind your knees. Take the crutches from under your arms. Put them together, and hold onto both hand grips with one hand. 2. Reach back for the chair or bed with your free hand. 3. Slowly lower yourself onto the chair or bed
The nurse educates a patient about gastric ulcers acute pain occurs when
30 to 60min after a meal
How soon after the onset of compartment syndrome does irreversible muscle damage occur?
8 HOURS
If this heals well, how long until I get a prosthesis
80yo pt with DM and vascular problems had a ↓ leg amputation. What indicates pt understanding?
Which of the following laxatives should be used by a cardiac patient who should avoid straining?
Colace Colace can be used safely by patients who should avoid straining such as cardiac patients and those with anorectal disorders. Milk of Magnesia is a saline agent. Dulcolax is a stimulant. Mineral oil is a lubricant.
Patient with osteoporosis suffers a fall and fracture his wrist, what is the name for this fracture
Colles' fracture
A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling?
Colonoscopy Diverticulosis is typically diagnosed by colonoscopy, which permits visualization of the extent of diverticular disease and biopsy of tissue to rule out other diseases. In the past, barium enema was the preferred diagnostic test, but it is now used less frequently than colonoscopy. CT with contrast agent is the diagnostic test of choice if the suspected diagnosis is diverticulitis; it can also reveal abscesses.
antidiarrheals
Decrease intestinal peristalsis so liquid portion of feces is absorbed
Thermographic findings of cool spots in a certain area of the body indicate?
Decreased blood flow
Increased frequency and water content of stools and vomiting as a result of inflammation
Gastroenteritis
Open fractures have three grades of severity
Grade I: least severe injury, with minimal skin damage Grade II: moderately severe injury, with skin and muscle contusions (bruises) Grade III: most severe injury (wound larger than 6 to 8 cm), with skin, muscle, blood vessel, and nerve damage
what is the cause of most peptic ulcers
H. pylori bacteria
Which of the following is not considered a complication of an amputation? Edema Infection Heart failure Wound dehiscence
Heart failure Rationale: Many complications are associated with amputations, including hemorrhage and hematoma, necrosis, wound dehiscence, gangrene, edema, contracture, pain, infection, phantom limb sensation, and phantom limb pain.
What is the primary symptom of GERD?
Heartburn (pyrosis)
Procedure in which a loop of the ileum is placed through the abdominal wall
Ileostomy
What occurs in bursitis
Inflammation of synovial membrane sac at friction sites
A residual limb is red, edematous, and warm to touch. What should the pt be instructed to do?
Leave the prosthesis off and notify MD This is a correct answer
Which statement is true about drug therapy for CD?
Metronidazole (Flagyl) has been helpful in patients with fistulas and CD.
What teaching should be taught to an older pt with a newly casted Colles fracture?
Move the shoulders to reduce contractures
A pathologic fracture occurs when:
Occurs because of a pathologic condition in the bone, such as a tumor or disease process, that causes a spontaneous break
What term defines an artificial opening into a body cavity?
Ostomy
Fundoplication
This surgical procedure is done to alleviate symptoms of GERD. It is a laparoscopic procedure in which the Lower Esophageal Sphincter is tightened by wrapping and suturing the fundus of the stomach around the esophagus.
In caring for a patient with CD, the nurse observes for which complications?
Peritonitis; Small bowel obstruction; Nutritional and fluid imbalances; Presence of fistulas
Open fractures are graded by severity. Which grade is a moderately severe injury, with skin and muscle contusions? Grade I Grade II Grade III Grade IV
Rationale: Open fractures have three grades of severity: Grade I: least severe injury, with minimal skin damage Grade II: moderately severe injury, with skin and muscle contusions (bruises) Grade III: most severe injury (wound larger than 6 to 8 cm), with skin, muscle, blood vessel, and nerve damage
What is the initial recommended medical intervention for a pt with cancer of the lg intestine?
Surgery
When educating a pt who has IBS, which of the following should lessen their discomfort?
Take small bites and chew well
Why does the nurse position a patient with AKA w, delayed prosthetic fitting PRONE
To prevent flexion contractures
Four-point gait
The right crutch is advanced, then the left foot, then the left crutch, then the right foot Used if weight bearing is allowed and one foot can be placed in front of the other
Open amputations
The severed bone or joint is left uncovered by a skin flap Required when an actual or potential infection exists, as may occur with gangrene or trauma
Why are systemic glucocorticoid medications used as the last choice for the treatment of RA?
They have many side effects
The presence of mucus and pus in the stools suggests which condition?
Ulcerative colitis The presence of mucus and pus in the stools suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption.
What is the most common location of hip fractures?
What is the most common location of hip fractures? The most common types of hip fractures are: Femoral neck fracture. A femoral neck fracture happens 1 to 2 inches from your hip joint. This type of fracture is common among older adults and can be related to osteoporosis
What nutritional suggestion is appropriate for a pt w/a pelvic fx and a risk for constipation?
While immobilized, drink at least 2-3L of fluid daily
When is fat embolism most likely to occur? a. 24 to 48 hours following a fractured tibia b. 36 to 72 hours following a skull fracture c. 4 to 5 days following a fractured femur d. 5 to 6 days following a pelvic fracture
a 24 to 48 hours following a fractured tibi
fluid shift
a rapid water movement between the ECF and the ICF in response to an osmotic gradient
a colostomy is performed by
bringing a loop of the intestine through the wall of the abdomen
What foods does a pt with continent ileostomy should initially avoid
coffe berries nuts fresh fruit
anastasmosis
communication or connection between two organs or parts of organs
Severe or prolonged vomiting puts the patient at risk for
deficient fluid volume
prolapse
falling or dropping down of an organ or internal part
When providing ed to a pt w/a hemorrhoidectomy. Which indicates the need for further teaching?
fluids are restricted
Osteomyelitis:
from contamination of the open wound associated with a fracture or from contamination of indwelling hardware used to repair the broken bone
Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes:
high-fiber diet. A high-fiber diet is prescribed to help control diarrhea and constipation. Foods that are possible irritants, such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, and alcohol, should be avoided. Fluids should not be taken with meals because they cause abdominal distention.
Which kind of hip fracture is repaired with hip prosthesis
intracapsular
transverse colon pasess
liquid to semi solid material
to reduce obstruction in the small bowel risk in a pt with ileostomy what is recommended
low fiber
the new nurse educating about GERD states that
occurs more often in middle age and older adults
sigmoid colon
passes softly formed stool
which food produce thicker stools
pasta and boiled rice
if ofor is a problem with uterestomy
soaked pouch in vinegar and water for 20 to 30 min
Kock pouch
surgical creation of a urinary bladder from a segment of the ileum
ileostomy
surgical opening in the ileum to drain fecal material from the small intestine
Gastrectomy
surgical removal of part or all of the stomach
for stair climbing with crutches
the unaffected leg goes up the step first while the body is supported by the crutches. To descend stairs, the affected leg and the crutches move down one step first, followed by the unaffected leg.
The nurse is taking care of a pt who had colostomy surgery.what does small amount of bleeding around the base of the new stoma indicate
tissue injury
