N2 Exam 3

surgery of choice for colorectal cancer

tumor resection Goal is to preserve anal sphincter and avoid the need for a colostomy Area with tumor removed and remaining bowel anastomosed

management of IBD

- high cal, high protein, low residue diet - lactose free prn - TPN prn - medications - rest - counseling/therapy - surgery

goals of surgery for colorectal CA

- resect tumor - exploratory - find mets - remove lymph nodes that drain area around CA - restore bowel continuity - prevent complications of surgery

IBD postop care

- usual postop concerns - monitor stoma - initial high ileostomy output - 1.5-1.8L in 1st 24h - monitor F&E - monitor for return of bowel - high risk of obstruction in first month

What are the risk factors associated with the development of colorectal cancer

-50 y/o -alcohol -smoking -obesity -fam history -inflammatory bowel disease (IBD) (Disease characterized by the presence of ulcers in the distal portion of the small intestine (Crohn's disease) or mucosal erosions in the large intestine (ulcerative colitis). -diet high in calories, and animal fat -radiation exposure -history of cancer -polyps in colon and rectum

(2) What should a client with GERD avoid

-Acidic foods -Peppermint -Chocolate -Don't eat 3h HS -Alcohol -Tight fitting clothing -3 big meals (instead eat smaller meals throughout the day)

Which kind of meds treat GERD

-Antacids -Proton pump inhibitors - h2 receptor blockers -antiulcer agents -promotility agents

Your client with colorectal cancer will have problems with pain, what are the interventions

-Assess pain level using a rating scale from 0 to 10. -Provide analgesics as prescribed. -Monitor for pain relief. -Assess abdomen for distention, tenderness, and bowel sounds. -Provide analgesics before procedures or activity. -Encourage the use of nonpharmacologic pain relief strategies such as positioning, diversional activities, and relaxation techniques. -If recovering from surgery: -Assess incision for inflammation and edema. -Assess drains for patency. -Teach client to use a pillow to splint abdominal wound when deep breathing and coughing.

(1) Lithium therapy discharge teaching

-Avoid excessive caffeine -Maintain a consistent sodium intake -2500-3000 mL of fluid a day

(1) Why is it difficult to diagnose a child with BPD

-Bipolar symptoms mimic attention deficit-hyperactivity disorder symptoms. -Children are naturally active, energetic, and spontaneous.

What are the tests used to diagnose stomach cancer

-CBC , to identify anemia which is the first indication of stomach cancer -Upper GI x-ray with barium swallow to identify stomach lesion -Gastric ultrasound to identify the stomach mass - upper endoscopy to visualize the stomach mass -biopsy to provide the definitive diagnosis of stomach cancer

(1) A client is diagnosed with bipolar disorder: manic episode. Which nursing intervention would be implemented to achieve the outcome of "Client will gain 2 lbs. by the end of the week?"

1 The nurse should provide the client with high-calorie finger foods throughout the day to help the client achieve the outcome of gaining 2 lbs. by the end of the week. Because of the hyperactive state, the client will have difficulty sitting still to consume large meals.

Differentiate between the clinical manifestations of gastric, duodenal and stress ulcers.

-Gastric Ulcers form on the stomach r/t acid and pepsin (30-55 y/o) -Duodenal Ulcers form on the small intestine r/t acid and pepsin (55-70y/o) -Stress ulcers form because of physiologic stress of illness

A client with PUD will manifest which symptoms

-Gnawing, burning, aching, hunger like pain -Pain is in the epigastric region but radiates to the back -Pain occurs when the stomach is empty, 2-3 hours after a meal and in the middle of the night -The pain is relieved by eating food -They may also experience heartburn, regurgitation or vomitting

What are the risk factors and causes of gastric and duodenal ulcers

-H. Pylori infection -Aspirin and NSAIDs -Smoking cigarettes -H. pylori

What are the risk factors for the development of stomach cancer

-H. pylori infection -Genetics -Chronic gastritis -Pernicious anemia (Autoimmune disease that results in vitamin B12 deficiency because of lack of intrinsic factor production by the body.) -Gastric polyps -Carcinogous foods like nitrates -Achlorhydria- lack of hydrochloric acid in the stomach

(2) What are the manifestations of gastroesophageal reflux (GERD)

-Heartburn after means -Hoarseness -Sore Throat

A client with GERD will manifest which symptoms

-Heartburn that occurs after meals, when bending and reclining - Regurgitation of sour material into the mouth -Difficult and painful swallowing -Atypical, abnormal chest pain -Sore throat -Hoarseness -Aspiration of stomach contents

A complication of PUD is hemorrhage, how is it managed

-IV fluids -Electrolyte replacements -Blood transfusions -NG tube insertion Treatment: endoscopy with clotting or sclerosing agent injected into bleeding vessel; laser photocoagulation therapy to seal bleeding vessels

A complication of PUD is perforation how is it managed

-IV fluids and electrolyte replacement -NG suction -Semi-fowler or fowler position - IV antibiotics to treat bacteral infection and peritonitis Treatment: laparoscopic surgery or open laparotomy to close the perforation may be indicated

education and prevention for colorectal cancer

-Increasing fruits and vegetables in the diet -Reducing saturated fat in the diet -Reducing the intake of red meat in the diet -Engaging in regular exercise -Attaining and maintaining a healthy weight -Stopping smoking -Increasing the intake of fiber -Taking calcium and multiple vitamin supplements -The use of aspirin and NSAIDs are believed to help prevent colorectal cancer.2

preoperative prep colorectal cancer

-Instruct in planned surgical procedure. -Teach in postoperative exercises to reduce complications. -Prepare for surgical procedure by providing medications or bowel preparation as prescribed.

What physiological factors predispose clients to GERD

-It affects 15-20% of adults -Obesity -Pregnancy -Hiatal Hernia -Foods and Meds -Prevalence increases after age 50 -Affects all genders, ethnic and cultural groups

Colostomy intervention (colorectal)

-Pain management -Incision care (infection prevention) -nutrition Ostomy care- Refer client to United Ostomy Association for support. Consult the enterostomal nursing specialist for assistance with instruction.

What are the goals for treatment of GERD

-Reduce the acid reflux -Educate and encourage lifestyle changes

(1) After threatening to jump off of a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first?

"Are you currently thinking about harming yourself?" The nurse should first assess the client for current harmful or suicidal thoughts to minimize risk of harm to the client and provide appropriate interventions. A suicidal client is experiencing a psychiatric emergency. The crisis team's priority is to assess client safety.

For the treatment of PUD what are the lifestyle adjustments that needs to be made

-They must eat balanced meals at regular intervals -there is no need to have a restrictive diet with bland food -mild alcohol is okay and not harmful -if they smoke it will slow down the healing of the ulcer, and increase the frequency of relapses and should be avoided

what are the diagnostic procedures for GI hernias

-ambulatory esophageal ph monitoring -upper endoscopy -barium swallow -esophageal manometry -ct scan -mri

The nurse is providing postoperative care to a client after a total gastrectomy for stomach cancer. Which interventions will assist in caring for this​ client?

-assess color and amount of gastric drainage -maintain iv fluid as prescribed -monitor bowel sounds and abdominal distention -do not reposition NGT because it will affect the sutures -encourage ambulation as soon as suction is discontinued

manifestations of colorectal cancer

-asymptomatic (5-15 yrs to develop) -rectal bleeding -change in bowel movement -abdominal pain -anorexia -weight loss -abdominal or rectal mass -anemia

Symptoms that patient has polyps (colorectal)

-asymptomatic, found in routine exam -painless, rectal bleeding that is bright or dark red -abdominal pain and cramping occur with LARGE polyps -Diarrhea and mucous discharge can occur with a villous polyp

One complication of PUD is hemorrhage, how does it manifest

-blood in the stool (occult) -hematemesis (Vomiting of bright red blood or blood that resembles "coffee grounds.") -fatigue -weakness, dizziness -orthostatic hypotension -hypovolemic shock (type of shock caused by loss of fluid)

What are the complications in surgery for stomach cancer treatment

-dumping syndrome - (The result of a sudden influx of enteral feeding into the GI tract and the creation of a high osmotic gradient within the small intestine.) -anemia (Iron absorption reduced after a gastrojejunostomy Vitamin B12 deficiency common after gastric surgery because cells of the stomach produce intrinsic factor, which is needed for the absorption of vitamin B12) -folic acid deficiency -decreased absorption of calcium and vitamin D -weightloss an inability to eat large meals, insufficient calorie intake, early satiety, decreased stomach size, altered emptying patterns

(3)A nurse is providing care for a client with hypertension. After assessing the​ client, the nurse identifies excess fluid volume as a problem for this client. What nursing interventions would the nurse use in the care of this​ client?

-fluid restriction -calculate I&Os -assess for peripheral edema -weigh daily

What are some complications of PUD if left untreated?

-hemorrhage -obstruction -perforation -bleeding

What are the interventions for colonoscopy preparation

-instruct the pt. on use of meds and solutions to clean the bowel before the procedure -administer NS enemas if indicated to further clean the bowel before the procedure -Teach the ways the polyps will be removed

What are symptoms of PUD in older clients

-poorly localized discomfort -chest pain -dysphagia -weight loss -anemia

The treatment of PUD includes which category of meds

-proton pump inhibitors (90% of ulcer healing in 4 weeks, provides faster pain relief) -h2 receptor blockers (to heal ulcers, they must be taken for 8 weeks or longer) -sucralfate (forms a barrier against acid, bile and pepsin, stimulates secretion of mucus, bicarbonate and prostaglandin) -bismuth compounds (stimulates mucosal bicarbonate and prostaglandin, has an antibacterial action against H. Pylori, causes constipation, harmless dark stools and tongue. it is neurotoxic if high doses are used for a long time -antacids (stimulate mucus and bicarbonate secretions , may cause diarrhea, constipation, interferes with absorption of iron, digoxin, some antibiotics, and other meds) -prostaglandin analogs

what are the diagnostic tests used to diagnose polyps in colorectal cancer

-rectal digital examination(To ID mass if present in rectal area) -Sigmoidoscopy / Colonoscopy (To determine the size, type, and amount of colon involvement with polyps)

One complication of PUD is obstruction, how does it manifest

-sensation of epigastric fullness -nausea and vomiting -electrolyte imbalances -metabolic alkalosis ((bicarbonate excess) A disorder characterized by a high pH (> 7.45) and a high bicarbonate (> 26 mEq/L). It may be caused by loss of acid or excess bicarbonate in the body.)

One complication of PUD is perforation, how does it manifest

-severe abdominal pain that radiates to the shoulder - rigid, board like abdomen -absence of bowel sounds -diaphoresis -tachycardia -rapid and shallow breaths -fever

Intervention for the patient with GERD regarding ongoing care

-teach dietary changes -remain upright after meals and avoid eating for atleast 3h before bed -elevate the head of the bed 6-8 inches on a wooden block -keep scheduled apt and med regimen

A client with stomach cancer will manifest which symptoms (late signs)

-weight loss -cachexia (Weight loss that is comprised of a disproportionate amount of muscle as seen in cancer, HIV infection, and some other chronic diseases; also called "wasting.") -palpable abdominal mass -occult blood in the stool

Screening for colorectal cancer is recommended beginning at the age of 50 years, according to the following schedule

-yearly fecal occult blood every 5 years -double contrast barium enema or CT colonoscopy or flexible sigmoidoscopy or every 10 years get a colonoscopy

The client with coronary artery disease asks the nurse, "Why do I get chest pain?" Which statement would be the most appropriate response by the nurse?

. "Chest pain is caused by decreased oxygen to the heart muscle.", the coronary arteries cannot supply adequate O2 to the heart muscle

(CAD) The client is scheduled for a right femoral cardiac catheterization. Which nursing intervention should the nurse implement after the procedure?

. Assess the client's neurovascular status. for paresthesia, pulses, paralysis ,coldness, pallor right leg should be straight head of the bed not elevated more than 10 degrees and on bed rest, flat

The client is three (3) hours post-myocardial infarction. Which data would warrant immediate intervention by the nurse? . Bilateral peripheral pulses 2+. 2. The pulse oximeter reading is 96%. 3. The urine output is 240 mL in the last four (4) hours. 4. Cool, clammy, diaphoretic skin.

. Cool, clammy, diaphoretic skin. indicates cardiogenic shock

The client with coronary artery disease is prescribed a Holter monitor. Which intervention should the nurse implement?

. Instruct client to keep a diary of activity, especially when having chest pain. should not be removed for any reason even showering continue taking all meds maintain usual activity so physician get accurate account of heart func.

The nurse is administering a beta blocker to the client diagnosed with essential hypertension. Which intervention should the nurse implement?

. Question administering the medication if the BP is <90/60 mm Hg

(1) A college student, who was nearly raped while jogging, completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met?

"I carry mace when I jog. It makes me feel safe and secure." The nurse should evaluate that the client who has developed adaptive coping strategies has achieved the goals of crisis intervention. The final phase of crisis intervention involves evaluating the outcome of the crisis intervention and anticipatory planning.

A nurse prepares a client for coronary artery bypass graft surgery. The client states, "I am afraid I might die." How should the nurse respond?

"Tell me more about your concerns about the surgery." The nurse should discuss the client's feelings and concerns related to the surgery. The nurse should not provide false hope or push the client's concerns off on the chaplain. The nurse should address support systems after addressing the client's current issue.

The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected small intestinal obstruction that is vomiting. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? "The tube will help to drain the stomach contents and prevent further vomiting." "The tube will push past the area that is blocked and thus help to stop the vomiting." "The tube is just a standard procedure before many types of surgery to the abdomen." "The tube will let us measure your stomach contents so we can give you the right IV fluid replacement."

"The tube will help to drain the stomach contents and prevent further vomiting." The NG tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not currently indicated. The location of the obstruction will determine the type of fluid to use, not measure the amount of stomach contents.

The client diagnosed with essential hypertension asks the nurse, "Why do I have high blood pressure?" Which response by the nurse would be most appropriate?

"There is no specific cause for hypertension, but there are many known risk factors."

A nurse cares for a client who has advanced cardiac disease and states, "I am having trouble sleeping at night." How should the nurse respond

"Use pillows to elevate your head and chest while you are sleeping. The client is experiencing orthopnea (shortness of breath while lying flat). The nurse should teach the client to elevate the head and chest with pillows or sleep in a recliner.

initial care for bowel obstruction

*rest* the bowel, *replace* the F&E, *pain* control: - NPO - NGT - IV fluid replacement (GI tract losses are isotonic) - potassium replacement PRN - pain meds - TPN prn

Medications for IBD

*salicylates*: sulfasalazine, mesalamine *antimicrobials*: metronidazole, ciprofloxacin, clarithromycin *immunosuppresants*: methotrexate, cyclosporine, azathioprine *steroids*: prednisone, hydrocortisone *biologics*: mAB drugs - (the ones you see on afternoon TV ads) - Remicade, Humira, Cimzia, Tysabri

What is the sequence of events that could lead to sepsis in a client with an intestinal​ obstruction?

1) Gas and fluid accumulate around the obstruction 2) bowel distention occurs, which interferes with peristalsis and causes atony 3) blood flow to the distended area is compromised which leads to necrosis 4) the bowel can become gangrenous and perforate into the abdominal cavity causing peritonitis

Which interventions should the nurse discuss with the client diagnosed with coronary artery disease? Select all that apply.

1. Instruct the client to stop smoking. 2. Encourage the client to exercise three (3) days a week. 3. Teach about coronary vasodilators

A patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? 7:00 AM

10:00 AM, and 1:00 PM 8:00 AM, 12:00 PM, and 4:00 PM 9:00 AM and 3:00 PM 9:00 AM, 12:00 PM, and 3:00 PM,8:00 AM, 12:00 PM, and 4:00 PM A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.

3. A nurse on an in-patient psychiatric unit receives report at 1500 hours. Which client would need to be assessed first? 1. A client on one-to-one status because of active suicidal ideations. 2. A client pacing the hall and experiencing irritability and flight of ideas. 3. A client diagnosed with hypomania monopolizing time in the milieu. 4. A client with a history of mania who is to be discharged in the morning.

2. A client's behavior of pacing the halls and experiencing irritability should be considered emergent and warrant immediate attention. Most assaultive behavior that occurs on an in-patient unit is preceded by a period of increasing hyperactivity. Because of these symptoms, this client would need to be assessed first.

6. The nurse just received the a.m. shift report. Which client should the nurse assess first? 1. The client diagnosed with coronary artery disease who has a BP of 170/100. 2. The client diagnosed with deep vein thrombosis who is complaining of chest pain. 3. The client diagnosed with pneumonia who has a pulse oximeter reading of 98%. 4. The client diagnosed with ulcerative colitis who has nonbloody diarrhea.

2. The client diagnosed with deep vein thrombosis who is complaining of chest pain. pulm embolism

21. A client prescribed lithium carbonate (Eskalith) is experiencing an excessive output of dilute urine, tremors, and muscular irritability. These symptoms would lead the nurse to expect that the client's serum lithium level would be which of the following? 1. 0.6 mEq/L. 2. 1.5 mEq/L. 3. 2.6 mEq/L. 4. 3.5 mEq/L.

3. The client's symptoms described in the question support a serum lithium level of 2.6 mEq/L.

6. A client diagnosed with bipolar I disorder has a nursing diagnosis of disturbed thought process R/T biochemical alterations. Based on this diagnosis, which outcome would be appropriate? 1. The client will not experience injury throughout the shift. 2. The client will interact appropriately with others by day 3. 3. The client will be compliant with prescribed medications. 4. The client will distinguish reality from delusions by day 6.

4. Distinguishing reality from delusions by day 6 is an appropriate outcome for the nursing diagnosis of disturbed thought process R/T biochemical alterations. Altered thought processes have improved when the client can distinguish reality from delusions.

The unlicensed assistive personnel (UAP) tells the primary nurse that the client diagnosed with coronary artery disease is having chest pain. Which action should the nurse take first? 1. Tell the UAP to go take the client's vital signs. 2. Ask the UAP to have the telemetry nurse read the strip. 3. Notify the client's health-care provider. 4. Go to the room and assess the client's chest pain

4. Go to the room and assess the client's chest pain

20. A client diagnosed with bipolar I disorder is experiencing auditory hallucinations and flight of ideas. Which medication combination would the nurse expect to be prescribed to treat these symptoms? 1. Amitriptyline (Elavil) and divalproex sodium (Depakote). 2. Verapamil (Calan) and topiramate (Topamax). 3. Lithium carbonate (Eskalith) and clonazepam (Klonopin). 4. Risperidone (Risperdal) and lamotrigine (Lamictal).

4. Risperidone (Risperdal), an anti-psychotic, directly addresses the auditory hallucinations experienced by the client. Lamotrigine (Lamictal), a mood stabilizer, would address the classic symptoms of bipolar I disorder.

Differentiates cancer from Barrett's esophagus

A biopsy is used to do this for GERD

A client is receiving an infusion of tissue plasminogen activator (t-PA). The nurse assesses the client to be disoriented to person, place, and time. What action by the nurse is best?

A change in neurologic status in a client receiving t-PA could indicate intracranial hemorrhage. The nurse should stop the infusion and notify the provider immediately

A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important?

A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important?

Outpatient

A colonoscopy for irritable bowel disease is usually this type of procedure

Adenocarcinoma

A common stomach cancer that can develop anywhere on the stomach but is usually found in the distal portion. It starts off as a localized lesion, spreading into the mucosa/submucosa. the lesian may ulcerate, or appear as a polyp like mass Lymph node involvement and metastasis occur early because of the rich blood and lymphatic supply to the stomach.

(1) what is a crisis

A crisis is a sudden event in one's life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem. Crises result in a disequilibrium, from which many individuals require assistance to recover

Back

A deep muscle injection can be given in this location

24 hours

A diagnosis of an upper GI bleed needs to be within this timeframe

Rectal cancer Polyps

A family history of this has an increased risk for colorectal cancer

Infection Inflammation

A fever during acute abdominal pain may indicate this

Identify the cause

A food diary is done for this with irritable bowel disease

A nurse assesses a client who is recovering after a left-sided cardiac catheterization. Which assessment finding requires immediate intervention

A left-sided cardiac catheterization specifically increases the risk for a cerebral vascular accident. A change in neurologic status needs to be acted on immediately Slurred speech and confusion

diagnostics for peritonitis

A paracentesis draws fluid from the peritoneum to test for the presence of protein and WBCs. A WBC count indicates presence of WBCs in the blood. Blood cultures determine the microorganism causing the infection. An abdominal CT is used to determine the location and extent of infection or inflammation.

Gastric stump to the duodenum

A partial gastrectomy connects this structure to this structure

Dumping syndrome

A patient is at risk for this post-op of a gastrectomy

Hoarseness

A person may have this symptom of GERD is they had the syndrome for longer period of time

Enzyme replacement

A person undergoing a Billroth II surgery may need this

Cavities and endocarditis

A person with dental erosion of the can have an increased risk for this

A patient is planned for discharge home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? A nursing assistant on the unit who also has hospice experience A licensed practical nurse that has worked on the unit for 10 years A registered nurse with 6 months of experience on the surgical unit A registered nurse who has floated to the surgical unit from pediatrics

A registered nurse with 6 months of experience on the surgical unit The patient needs ostomy care directions and reinforcement at discharge and should be assigned to a registered nurse with experience in providing discharge teaching for ostomy care. Teaching should not be delegated to a licensed practical/vocational nurse or unlicensed assistive personnel.

2-3 times a day for 10 days

A sitz bath is done this many times for the treatment of hemorrhoids

Rectum and all/some of the colon

A total proctocolectomy removes these parts of the body

A client recently diagnosed with atherosclerosis has joined a weight loss group to reduce the risk of complications such as coronary artery disease. The client reports a weight loss goal of 3 lb a week to the clinic nurse. Which of the following responses would the nurse make to the​ client?

A weight loss of 1 to 1.5 lb per week will lead to sustainable weight​ loss." ​"Ask a dietician to help with​ low-fat diet​ planning." ​"Keep a food diary with entries for each time you eat or drink​ anything." ​"Make lifestyle changes​ gradually." Rapid weight loss may not be sustainable over a long period of time. Many dieters regain their weight loss within 2 years. Sustainable weight loss requires behavior modification and lifestyle changes that are accomplished over a period of time. A food diary will help the client identify eating patterns.

treatment for hemorrhoids

Add fiber to diet Analgesic creams and hot sitz baths Surgical removal for recurrent or very painful hemorrhoids

A nurse is preparing to administer pantoprazole (Protonix) intravenously. What actions by the nurse are most appropriate?

Administer the drug through a separate IV line. Infuse pantoprazole using an IV pump Use an in-line IV filter when infusing

A colectomy is scheduled for a patient with ulcerative colitis. The nurse should plan to include which prescribed measure in the preoperative preparation of this patient? Instruction on irrigating a colostomy Administration of a cleansing enema A high-fiber diet the day before surgery Administration of IV antibiotics for bowel preparation

Administration of a cleansing enema Preoperative preparation for bowel surgery typically includes bowel cleansing with antibiotics, such as oral neomycin and cleansing enemas, including Fleet enemas. Instructions to irrigate the colostomy will be done postoperatively. Oral antibiotics are given preoperatively and an IV antibiotic may be used in the operating room. A clear liquid diet will be used the day before surgery with the bowel cleansing.

After administering newly prescribed captopril (Capoten) to a client with heart failure, the nurse implements interventions to decrease complications. Which priority intervention should the nurse implement for this client?

Administration of the first dose of angiotensin-converting enzyme (ACE) inhibitors is often associated with hypotension, usually termed first-dose effect. The nurse should instruct the client to seek assistance before arising from bed to prevent injury from postural hypotension

The client diagnosed with a myocardial infarction is six (6) hours post-right femoral percutaneous transluminal coronary angioplasty (PTCA), also known as balloon surgery. Which assessment data would require immediate intervention by the nurse?

After balloon surgery the right leg must be kept straight for atleast 6-8h to prevent arterial bleeding from the insertion side in the right femoral artery. a pressure dressing is applied to prevent arterial bleeding. complaining of numbness in the foot is abnormal and may indicate decreased blood supply. internal and external bleeding is the most common complication.

When does the client need to have his first repeat colonoscopy after polyp​ removal?

After polyp​ removal, the client will need to have a repeat colonoscopy at 3​ years, to evaluate if the mass has recurred and then every 5 years if no polyps are found.

A nurse answers a client's call light and finds the client in the bathroom, vomiting large amounts of bright red blood. Which action should the nurse take first? a. Assist the client back to bed. b. Notify the provider immediately. c. Put on a pair of gloves. d. Take a set of vital signs

All of the actions are appropriate; however, the nurse should put on a pair of gloves first to avoid contamination with blood or body fluids

A client is scheduled for a total gastrectomy for gastric cancer. What preoperative laboratory result should the nurse report to the surgeon immediately?

An INR as high as 4.2 poses a serious risk of bleeding during the operation and should be reported.

Diagnostics for appendicitis

An IVP rules out a renal cause of abdominal pain associated with appendicitis. A WBC determines the presence of infection. An abdominal ultrasound reveals an inflamed and enlarged​ appendix, and abdominal​ x-rays diagnose appendicitis.

Healing in the stomach

An NG tube for the treatment of an obstruction from PUD allows for this

Loss of blood

An altered LOC may occur in acute abdominal pain if this occurs

(2) Epigastric Tenderness

An assessment finding that will assist in confirming a diagnosis of GERD.

Looks at outpouching

An endoscopy for esophageal diverticula does this

Chronic esophagitis

An esophageal GI bleed is most commonly due to this

The nurse receives a call from a client with chronic inflammatory bowel disease who underwent a bowel resection with ileostomy 10 days ago. Which information if reported by the client would be of most concern to the​ nurse?

An ileostomy that has not drained in 6 hr could indicate a blockage. This would be the priority concern for the nurse.

For which postappendectomy complication would you assess the​ client's abdominal​ girth?

An increase in abdominal girth postoperatively indicates edema and could indicate infection.

Ruptured appendix

An infection causing acute abdominal pain can be due to this

Rule out what is going out

An occult blood test is done for this in the diagnosis of gastritis

Does not go into the duodenum

An upper GI endoscopy is similar to an EGD except for this

Medical Management of Anal abscess & Fistula:

Anal abscesses are drained immediately Approximately 50% of patients with anal abscess develop a fistula Symptomatic fistulas may be removed surgically High rate of anorectal dysfunction and fecal incontinence

Trauma Local infection Inflammatory

Anal fissures are due to this

Crohn's disease

Anal fistula can occur with this disease

Abscess

Anal fistulas can show this initially

A nurse is teaching a client with heart failure who has been prescribed enalapril (Vasotec). Which statement should the nurse include in this client's teaching?

Angiotensin-converting enzyme (ACE) inhibitors such as enalapril inhibit the excretion of potassium. Hyperkalemia can be a life-threatening side effect, and clients should be taught to limit potassium intake. Salt substitutes are composed of potassium chloride

Your care of the client with stomach cancer will focus on interventions to address postoperative care what are the interventions

Assess position and patency of nasogastric tube, connecting it to low suction. Gently irrigate with sterile normal saline if tube becomes clogged per health care provider's direction. Avoid dislodging nasogastric tube because it is used to maintain the gastric suture lines. Assess color, amount, and odor of gastric drainages; initial drainage is bright red but becomes dark and then clear or greenish-yellow clear over the first 2 to 3 days. Maintain intravenous fluid infusions as prescribed. Provide prescribed medications. Monitor bowel sounds and abdominal distention. Resume oral food and fluids as prescribed beginning with clear liquids, progressing to full liquids, and ending with frequent small feedings of regular foods. Encourage ambulation.

The client is one (1) day postoperative coronary artery bypass surgery. The client complains of chest pain. Which intervention should the nurse implement first?

Assess the client's chest dressing and vital signs.

Which intervention should the nurse implement when administering a loop diuretic to a client diagnosed with coronary artery disease?

Assess the client's serum potassium level., loop diuretics cause potassium to be lost in urine. if pt. is hypokalemic dont give the med

colostomy interventions colorectal

Assess the location of the stoma and type of colostomy created. Monitor stoma appearance and surrounding skin. Ensure drainage collection device firmly attached over the stomal opening. Assess type of fecal output and if consistent with location of the ostomy. Provide ostomy care.

Microorganisms Burns/Renal failure/sepsis Stress Autoimmune

Causes of gastritis

Structural changes Age Trauma Congenital weakness Recumbent position

Causes of hiatal hernias

Asities Tumors Intense physical exertion (heavy lifting) Pregnancy

Causes of increased abdominal pressure

Falling Car accidents Ruptured organs AAA

Causes of internal bleeing

Genetic Diet Hygiene Stress Smoking NSAIDs

Causes of irritable bowel disease

Food intolerance GI infections Psychological stressors

Causes of irritable bowel syndrome

General anesthesia Chemo Opioids Digoxin Stress Fear Over-irritation of the GI

Causes of nausea and vomiting

Removal of 50% or more of resection Damage to the intestinal mucosa

Causes of short bowel syndrome

Nonspecific mucosal injury Diet Other

Causes of stomach cancer

Nerve damage Autoimmune

Causes of the absence of esophageal peristalsis

which antibiotics treat appendicitis

Cefoperazone (Cefobid), cefotaxime (Claforan), ceftazidime (Fortaz), or ceftriaxone (Rocephin) to reduce inflammation and infection is given before surgery and continued for 48 hrs postoperatively

Used to treat inflammation caused by a specific bacterium in diverticular

Cefoxitin (Mefoxin) Piperacillin-tazobactam (Zosyn) Ticarcillin-clavulanate (Timentin)

Gluten

Celiac disease is an intolerance of this

Immune-mediated

Celiac disease is this type of response in the body

Europeans

Celiac disease usually occurs in this demogrpahic

Intermittent burning and tightness at the sternum radiating to the jaw

Characteristics of GERD pyrosis

The nurse is preparing to administer a scheduled dose of docusate sodium when the patient reports an episode of loose stool and does not want to take the medication. What is the appropriate action by the nurse? Write an incident report about this untoward event. Attempt to have the family convince the patient to take the ordered dose. Withhold the medication at this time and try to administer it later in the day. Chart the dose as not given on the medical record and explain in the nursing progress notes.

Chart the dose as not given on the medical record and explain in the nursing progress notes. Whenever a patient refuses medication, the dose should be charted as not given with an explanation of the reason documented in the nursing progress notes. In this instance, the refusal indicates good judgment by the patient, and the patient should not be encouraged to take it today.

Antacids

Chest pain from GERD is relieved by this

Reduces the incidence of diarrhea

Cholestyramine (Question) does this for the treatment of short bowel syndrome

Opioid constipation

Cholestyramine helps with this when not given for short bowel syndrome

H2- Receptor blockers that treat GERD. How do they do so

Cimetidine (Tagamet) Famotidine (Pepcid0 Ranitidine (Zantac) Nizatidine (Axid) They work by blocking the ability of histamine to stimulate acid secretion by the gastric parietal cells The volume and concentration of hydrochloric acid is reduced and they are prescribed twice a day

A nursing student is caring for a client who had a myocardial infarction. The student is confused because the client states nothing is wrong and yet listens attentively while the student provides education on lifestyle changes and healthy menu choices. What response by the faculty member is best?

Clients are often in denial after a coronary event. The client who seems to be in denial but is compliant with treatment may be using a healthy form of coping that allows time to process the event and start to use problem-focused coping. The student should not discourage this type of denial and coping, but rather continue providing education in a positive manner

A nurse prepares a client for a pharmacologic stress echocardiogram. Which actions should the nurse take when preparing this client for the procedure

Clients receiving a pharmacologic stress echocardiogram will need peripheral venous access and continuous blood pressure and pulse monitoring. The client must be NPO 3 to 6 hours prior to the procedure. Education about dobutamine, which will be administered during the procedure, should be performed. Beta blockers are often held prior to the procedure.

(1) Crisis long term goal

Clients return to original baseline behavior or better

9. A client had an upper gastrointestinal hemorrhage and now has a nasogastric (NG) tube. What comfort measure may the nurse delegate to the unlicensed assistive personnel (UAP)?

Clients with NG tubes need frequent oral care both for comfort and to prevent infection

A nurse teaches a client who has a history of heart failure. Which statement should the nurse include in this client's discharge teaching? a

Clients with heart failure are instructed to weigh themselves daily to detect worsening heart failure early, and thus avoid complications. Other signs of worsening heart failure include increasing dyspnea, exercise intolerance, cold symptoms, and nocturia. Fluid overload increases symptoms of heart failure. The client should be taught to eat a heart-healthy diet, balance intake and output to prevent dehydration and overload, and take medications as prescribed. The most important discharge teaching is daily weights as this provides the best data related to fluid retention

Dark red for 12 hours Yellow/ brown/green color afterward

Color of the output of an NG post-op of a laparascopic surgery

Males OVer the age of 50

Colorectal cancer is more common in this demographic

Rectum-sigmoid colon

Colorectal cancer mostly occurs in this location

Intestines

Columnar cells are normal in this part of the GI

Lactose High fat Cold temperature foods Fruits that have peels

Common causes of irritable bowel disease

Esophagus rupture with staple

Complication of esophageal diverticula

Local problem Nutritional problem Systemic probelm Toxic megacolon

Complication of irritable bowel disease

A nurse cares for a client who is recovering from a right-sided heart catheterization. For which complications of this procedure should the nurse assess?

Complications from a right-sided heart catheterization include thrombophlebitis, pulmonary embolism, and vagal response. Cardiac tamponade is a risk of both right- and left-sided heart catheterizations. Stroke and myocardial infarction are complications of left-sided heart catheterizations.

Hemorrhage Perforation Obstruction

Complications of PUD

Dumping syndrome

Complications of a vagotomy

Stool can get stuck and cause pain and infection

Complications of an anal fistula

Hemorrhagic shock Internal bleeding

Complications of an upper GI bleed

Aspiration Malnutrition Perforation (rupture)

Complications of esophageal diverticula

GERD Esophagitis Hemorrhage Stenosis Strangulation Ulcerations of herniated portion

Complications of hiatal hernias

Infections Hypovolemic shock Sepsis Intraabdominal abscess Paralytic ileus ARDS

Complications of peritonitis

Sulfa allergy Aspirin allergy

Contraindications for Sulfasalazine

Chemo-induced emesis

Dexamethasone is used for this type of vomiting

Endoscopy H. pylori testing Barium swallow Labs

Diagnosis of PUD

Barium swallow (esophagram) Endoscopy

Diagnosis of achalasia

H&P Assessment Labs

Diagnosis of acute abdominal pain

CT/Abdomen X-ray Colonoscopy CBC

Diagnosis of an intestinal obstruction

Endoscopy Labs

Diagnosis of an upper GI bleed

Physical exam

Diagnosis of anal fissure

H&P WBC UA CT

Diagnosis of appendicitis

History and family history Screening CT/MRI

Diagnosis of colorectal cancer

CT with PO contrast Abdominal X-ray

Diagnosis of diverticulitis and diverticulosis

History of symptoms Endoscopy Biopsy Allergy skin testing

Diagnosis of eosinophilic esophagitis

Endoscopy Barium studies

Diagnosis of esophageal diverticula

Endoscopy with biopsy Samples CBC Occult blood test

Diagnosis of gastritis

Investigate the restaurant

Diagnosis of gastroenteritis

Digital exam (for internal) Visual exam (for external)

Diagnosis of hemorrhoids

CBC Stool samples Small bowel study US CT/MRI Colonoscopy

Diagnosis of irritable bowel disease

Food diary Patient history

Diagnosis of irritable bowel syndrome

CBC PERitoneal aspiration Abdominal X-ray US/CT

Diagnosis of peritonitis

Endoscopy and biopsy CT PET Labs

Diagnosis of stomach cancer

Barium swallow Endoscopy

Diagnostic tests for hiatal hernias

Increase fiber Decrease fats and red meats Give clear liquids to give the colon rest

Diet for the treatment of diverticulitis and diverticulosis

High fiber diet Increase fluids

Diet for the treatment of hemorrhoids

TPN 6 small meals/day

Diet for the treatment of short bowel syndrome

local manifestation of peritonitis symptoms

Diffuse or localized abdominal pain Abdominal rebound tenderness Board-like rigidity of the abdomen Diminished or absent bowel sounds Abdominal distention Anorexia Nausea and vomiting

(1) What is the best nursing rationale for holding a debriefing session with clients and staff after a take-down intervention has taken place in an inpatient unit?

Discuss the situation that led to inappropriate expressions of anger. The nurse should determine that the purpose for holding a debriefing session with clients and staff after a take-down intervention is to discuss the situation that led to inappropriate behavior. It is important to determine the factors leading to the inappropriate behavior in order to develop future intervention strategies. It is also important to help clients and staff process feelings about the situation.

hartmann procedure (colorectal)

Distal portion of colon left in place and closed with sutures Used for bowel rest or healing after traumatic injury 3 to 6 months after creation, ostomy is closed and colon resected

Anywhere in the bowel

Diverticula can occur at this location

High intraluminal pressure

Diverticula is due to this

A nurse teaches a client who is prescribed digoxin (Lanoxin) therapy. Which statement should the nurse include in this client's teaching?

Do not take this medication within 1 hour of taking an antacid." Gastrointestinal absorption of digoxin is erratic. Many medications, especially antacids, interfere with its absorption

Used to soften stool Laxatives are avoided in diverticular

Docusate sodium (Colace)

The nurse is admitting a patient with severe dehydration and frequent watery diarrhea. A 10-day outpatient course of antibiotic therapy for bacterial pneumonia has just been completed. What is the most important for the nurse to take which action? Wear a mask to prevent transmission of infection. Wipe equipment with ammonia-based disinfectant. Instruct visitors to use the alcohol-based hand sanitizer. Don gloves and gown before entering the patient's room.

Don gloves and gown before entering the patient's room. Clostridium difficile is an antibiotic-associated diarrhea transmitted by contact, and the spores are extremely difficult to kill. Patients with suspected or confirmed infection with C. difficile should be placed in a private room, and gloves and gowns should be worn by visitors and health care providers. Alcohol-based hand cleaners and ammonia-based disinfectants are ineffective and do not kill all of the spores. Equipment cannot be shared with other patients, and a disposable stethoscope and individual patient thermometer are kept in the room. Objects should be disinfected with a 10% solution of household bleach.

Smooth muscle relaxants Botulinum toxin injection

Drug therapy for achalasia

Proton pump inhibitors H2 receptor blockers Acid protecting Antacids

Drug therapy for the treatment of GERD

Cause and severity of the disease

Drugs are given for the treatment of irritable bowel disease based on this

PPI blood transfusion

Drugs for an upper GI bleed

H2 blockers PPI Antacids Cytoprotective Antibiotics

Drugs for the treatment of PUD

Antacids H2 receptor blockers Proton pump inhibitor Combination of drugs

Drugs for the treatment of gastritis

High acid secretion

Duodenal PUD is due to this

35-45 years

Duodenal PUD usually occurs with this demographic

(1) what is the difference between a manic episode and hypomania

During a manic episode, clients may experience psychosis, and this symptom is absent in hypomania.

Nursing process for GERD (assessment and physical examination)

During the health history assess frequent heartburn, or atypical chest pain. discover if there is an intolerance to foods that are acidic, spicy, fatty. Discover if they are regurgitating acidic gastric juice, if they have increased symptoms when bending over, lying down or wearing tight clothing. If they have difficulty swallowing or hoarseness in their voice. Assess if they have epigastric tenderness during their physical examination

An emergency room nurse obtains the health history of a client. Which statement by the client should alert the nurse to the occurrence of heart failure?

Dyspnea on exertion is an early manifestation of heart failure and is associated with an activity such as stair climbing.I get short of breath when I climb stairs."

(1) what do anticholinergic and antihistamine prevent

EPS while taking antipsychotics

Untwist the intestines

Early ambulation is done to do this post-op of a laparascopic surgery

It will relieve complications but will not cure

Education about surgery with Crohn's disease

No immunization without MD approval Report temperature over 100.4 immediately Passes through body fluid Wear gloves

Education for Capecitabine (Xeloda)

Positioning Avoidance Frequent small meals Weight loss for obesity Medication information Call MD if continuing to have problems

Education for the treatment of GERD

Before treatment is started, the following diagnostic tests are done: HTN

Electrocardiogram Urinalysis Blood glucose Hematocrit Serum potassium, creatinine, and calcium Cholesterol and lipid panel to include high-density lipoprotein, low-density lipoprotein, and triglycerides

Your client with colorectal cancer will have problems with grieving, what are the interventions

Encourage client to express fears and concerns over diagnosis of cancer and prognosis. Assist to identify coping mechanisms. Offer to contact support groups, spiritual counselors, or social services for support. Refer client to support groups and counselors as requested.

A client has hemodynamic monitoring after a myocardial infarction. What safety precaution does the nurse implement for this client?

Ensure the balloon does not remain wedged

Older adults

Epiphrenic diverticulum is usually seen in this demographic

Most clients with diverticulosis have no symptoms but when they do it manifests as

Episodic left-sided abdominal pain Constipation alternating with diarrhea Cramps Stools that are narrow in diameter Blood in stools Weakness Fatigue

Bacteria known to cause peritonitis include

Escherichia coli and Klebsiella, Proteus, and Pseudomonas organisms

Mallory-Weiss tear

Esophageal GI bleeds can be due to this

Esophageal varicies

Esophageal GI bleeds can lead to this

Poor prognosis because it is usually caught late

Esophageal cancer has this type of prognosis

perforated appendicits

Evidence of gross perforation and contamination of the peritoneal cavity

risk factors for essential htn

Excess alcohol intake High sodium intake Low potassium, calcium, and magnesium intake Insulin resistance Obesity Stress Age Family history Genetics Race

A patient after a stroke who primarily uses a wheelchair for mobility has developed diarrhea with fecal incontinence. What is a priority assessment by the nurse? Fecal impaction Perineal hygiene Dietary fiber intake Antidiarrheal agent use

Fecal impaction Patients with limited mobility are at risk for fecal impactions caused by constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

systemic manifestation of peritonitis symptoms

Fever Malaise Tachycardia Tachypnea Restlessness Confusion Disorientation Oliguria

Syndrome

GERD is not a GI disease but is this

Signs and symptoms

GERD is usually just diagnosed with this

Obstruction → perforation

Gastric PUD can cause this which leads to a high fatality chance

Anywhere

Gastric PUD can occur at this location

The nurse is reviewing the chart of a client diagnosed with peritonitis. The nurse recognizes that which comorbidities could have contributed to the​ client's diagnosis?

Gastrointestinal bleed from a gastric ulcer Peritoneal dialysis A history of pelvic inflammatory disease

Flattened (microwave or stir it)

Ginger ale should be this when giving for nausea or vomiting

Tubular polyps

Globelike mass that is pedunculated Incidence increases with age Occurs in all age groups and both genders Those larger than 1 cm have an increased risk of becoming dysplastic or malignant

What is H-pylori and what is the significance of H-pylori in peptic ulcer disease?

H. pylori is a bacteria that produces enzymes the reduce the way mucous gel works, because the efficacy is lessened the gastric mucosa is not protected when the infection occurs, a inflammatory response follows, that leads to more gastric cell damage that does not even provide in immunity of the infection H. pylori is a risk factor for PUD

8-12 weeks

HALO treatment allows for complete healing in this amount of time

3-4 weeks

HALO treatment allows of the growth of healthy tissue in this time

Support tissue weakens leading to vein dilation

Hemorrhoids are due to this

Abdominal wall

Hernias is usually through this wall

Reducible

Hernias need to be this

COPD Liver cirrhosis Chronic pancreatitis CKD Hyperparathyroidism Zllinger-ellison syndrom

High risk population for duodenal PUD

The nurse is caring for a patient admitted with a suspected bowel obstruction. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? Low-pitched and rumbling above the area of obstruction High-pitched and hypoactive below the area of obstruction Low-pitched and hyperactive below the area of obstruction High-pitched and hyperactive above the area of obstruction

High-pitched and hyperactive above the area of obstruction Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling," above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

The nurse is developing a plan of care for a patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history does the nurse recognize as increasing the patient's risk for colorectal cancer? Osteoarthritis History of colorectal polyps History of lactose intolerance Use of herbs as dietary supplements

History of colorectal polyps A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

What information would have the highest priority for the nurse to include in preoperative teaching for a patient scheduled for a colectomy? How to care for the wound How to deep breathe and cough The location and care of drains after surgery Which medications will be used during surgery

How to deep breathe and cough Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively but will be done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

No fluid absorption

Hypotension and hypovolemic shock can occur due to this in an intestinal obstruction

Easily dehydrated

I&Os are done for the treatment of an obstruction from PUD because of this

A client has a recurrence of gastric cancer and is in the gastrointestinal clinic crying. What response by the nurse is most appropriate?

I'd like to know what you are feeling now. The nurse assesses the client's emotional state with open-ended questions and statements and shows a willingness to listen to the client's concern

Monthly

IM and SQ cobalamin is given at this frequency

Dehydration can occur rapidly

IV fluids are done for the treatment of gastritis because of this

Peritonitis

If perforation occurs with esophageal diverticula, this can occur

Perforation

If stool goes around an obstruction in colorectal cancer, this will occur

Vein

If the bleeding location from an upper GI bleed is through this, it will be mild

Artery

If the bleeding location from an upper GI bleed is through this, it will be more severe

in appendicitis what is the iliopsoas sign and obturator sign

Iliopsoas Sign Indicates inflammation of the psoas muscle Obturator Sign Indicates inflammation along obturator internus muscle

nurse assesses an older adult client who is experiencing a myocardial infarction. Which clinical manifestation should the nurse expect?

In older adults, disorientation or confusion may be the major manifestation of myocardial infarction caused by poor cardiac output.

ongoing care for colorectal care

Instruct on the importance of having follow-up colonoscopies as prescribed as a form of early detection should the polyps recur. Teach on the manifestations of complications to report to the health care provider, including diarrhea or rectal bleeding. Remind client to keep all scheduled follow-up appointments with the health care provider.

(2) How is aspirin a risk factor for peptic ulcers

Intake of aspirin is a risk factor for peptic​ ulcers, Aspirin interrupts prostaglandin synthesis by disrupting the action of the enzyme cyclooxygenase.

The client comes to the clinic complaining of muscle cramping and pain in both legs when walking for short periods of time. Which medical term would the nurse document in the client's record?

Intermittent claudication. . This is the classic symptom of arterial occlusive disease.

what is responsible for the pain that is associated with diverticular disease

Intestinal inflammation and edema. The inflammation and edema result from the herniation of the intestinal mucosa into the muscular wall of the intestines

Helps with absorption of nutrients Reduces the volume of parenteral nutriton

MOA for Teduglytide

Inhibits the production of making new blood vessels

MOA of angiogenesis inhibitors

Which antacids treat GERD and how do they work

Maalox Mylanta Gaviscon Aludrox Gelusil Riopan Tums Amphojel They work by buffering or neutralizing gastric acid. They also relieve pain and prevent further damage to the esophageal gastric mucosa

A nurse is teaching a client about magnesium hydroxide with aluminum hydroxide (Maalox). What instruction is most appropriate?

Maalox can cause hypermagnesemia, which causes diarrhea, so the client should be taught to report this to the provider

The nurse is administering a cathartic agent to a patient with renal insufficiency. Which order will the nurse question? Bisacodyl Lubiprostone Cascara sagrada Magnesium hydroxide

Magnesium hydroxide Milk of Magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not currently dehydrated.

(1) Which of the following interventions should a nurse use when caring for an inpatient client who expresses anger inappropriately?

Maintain a calm demeanor. Clearly delineate the consequences of the behavior. Set limits on the behavior.

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation? Maintain a high intake of fluid and fiber in the diet. Discontinue intake of medications causing constipation. Eat several small meals per day to maintain bowel motility. Sit upright during meals to increase bowel motility by gravity.

Maintain a high intake of fluid and fiber in the diet. Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be discontinued. Eating several small meals per day and position do not facilitate bowel motility.

(1) Bipolar depression education to patient

Maintain therapeutic range for lithium that is 0.5-1.2 mEq/L and for valproic acid it is 50-150 mcg Keep a normal balanced sodium diet If vomiting and diarrhea present consult physician as it is first sign of Lithium toxicity Carry an ID card that has dose and frequency Take meds with meals to avoid GI upset

pain management and ongoing care for pt with diverticular disease

Maintaining bed rest Providing a diet that reintroduces foods, beginning with clear liquids and progressing as tolerated to a soft low-fiber diet with bulk-forming agents Teaching on the prescribed high-fiber diet, including the reasons why the diet needs to be followed for life Instructing on the manifestations and complications of diverticular disease Teaching on colostomy care if indicated Referring client to enterostomal nurse if needed for ostomy instruction Referring client to home care if needed Instructing client to plan for surgery to reverse the colostomy if indicated

(1) What are depot Antipsychotics

Med that is not PO, it is not a tab/cap. it is an injection that is given every 2-4 weeks. Good for those who cant take PO meds and are uncompliant with regimen Extended release and has same effects as the PO version. use 1 to 1 1/2 inch needle (large needle) Z Track method

Liver and lung

Metastasis of esophageal cancer usually goes here

Liver

Metastasis usually occurs to this with colorectal cancer

promotility agent that treats GERD. How does it do so

Metoclopramide (Reglan) it works by stimuating the upper GI's motility and gastric emptying the long term use is not reccommended for the treatment of GERD

which GERD med is not recommended for long term use

Metoclopramide (Reglan) The promotility agent

Used for mild symptoms Reduces inflammation caused by bowel flora in diverticular

Metronidazole (Flagyl) Ciprofloxacin (Cipro) Trimethoprim-sulfamethoxazole (Septra, Bactrim)

Your client with diverticulitis may experience the following manifestations:

Mild to severe, steady or cramping, left-sided abdominal pain Constipation or diarrhea Nausea Vomiting Low-grade fever Abdominal distention Abdominal tenderness Palpable mass in the left lower abdominal quadrant

(2) When a patient with a perforated peptic ulcer that is at risk for bleeding what are the proper interventions

Monitor abdominal girth for distention Insert an NG tube and maintain patency Assess stools, gastric drainage for blood and review hGb and HCt levels Maintain bedrest with the head of the bed elevated

sigmoid colostomy

Most common permanent ostomy performed Stoma located on the lower left abdominal quadrant

Tense muscles in response to touch

Muscle guarding shows this

imaging May not have sx if mild case or poor sx candidate - just get abx

NGT, pain meds, IV fluids.

A pt experiencing acute bout of diverticulitis they will get what dietary treatment

NPO, IV fluids and possible parenteral nutrition clear liquids introduced first Diet changed to soft, low-roughage foods with psyllium seeds to soften stool and add bulk avoid wheat, corn bran, vegetables and fruit skins, nuts and dry beans when the episode is resolved they may eat cereals, grains, fruits and vegetables

s/s of colorectal CA

Nonspecific s/s - fatigue, wt loss. Fe-def anemia, rectal bleed, bowel pattern change, bowel obstruction/perforation. Late s/s include abd pain, palpable abd mass, ascites, hepatomegaly (liver = common site for mets)

Initially bright red Dark red within 24 hours Yellow-green after 36-48 hours

Normal colors for a vagotomy NG drainage

A nurse assesses a client who is recovering from a myocardial infarction. The client's pulmonary artery pressure reading is 25/12 mm Hg. Which action should the nurse take first?

Normal pulmonary artery pressures range from 15 to 26 mm Hg for systolic and from 5 to 15 mm Hg for diastolic. Although this client's readings are within normal limits, the nurse needs to assess any trends that may indicate a need for medical treatment to prevent complication

Pouches in the colon, or diverticula, develop when the pressure inside of the bowel lumen causes bowel mucosa to herniate through the bowel wall

Normally, fecal material moves through the bowel lumen after meals as a part of digestion. When the fecal matter is lacking in fiber or bulk, pressure within the bowel increases. This increased pressure causes the bowel mucus layer to push through or herniate through the muscle wall, causing a pouch.

Children Elderly Immunocompromised

Norovirus can be deadly for these demographics

Contaminated food or water

Norovirus is due to this

(1) Lamotrigine (Lamictal)

Not for adolescents, children under 16 should not use! Treats BIPOLAR DISORDER ,epilepsy

Which assessment data would warrant immediate intervention in the client diagnosed with arterial occlusive disease?

Numbness and tingling are paresthesia, which is a sign of a severely decreased blood supply to the lower extremities.

Fat malabsorption

Nutritional problem with irritable bowel disease

Edema around the ulcer

Obstruction from PUD is due to this

Bowel obstruction BIliary obstruction (gallstone) Strangulation Internal bleeding

Obstructions that can lead to acute abdominal pain

A client is admitted to a​ medical-surgical floor with a diagnosis of peritonitis. The nurse knows that which treatment measure is consistent with this​ diagnosis?

Oxygen is prescribed for a client with peritonitis to facilitate cellular metabolism and healing. Food and fluids are withheld until bowel function is restored. The Fowler or​ semi-Fowler position is ordered rather than​ flat-lying position to help localize the infection and promote lung ventilation. they will have a nasogastric tube connected to suction for gastric decompression.

Hydrochloric acids and pepsin

PUD is due to this in the stomach

A nurse assesses an older adult client who has multiple chronic diseases. The client's heart rate is 48 beats/min. Which action should the nurse take first

Pacemaker cells in the conduction system decrease in number as a person ages, resulting in bradycardia. The nurse should check the medication reconciliation for medications that might cause such a drop in heart rate, then should inform the health care provider.

Apendicitis Peritonitis

Pain while standing may be a sign of these complications

Chemo Surgery

Palliative care can be done through these methods for colorectal cancer

Peritonitis

Perforation can lead to this with irritable bowel disease

Peritonitis

Perforation of PUD causes a risk for this

Deep PUD

Perforation usually occurs with this type of PUD

local excision surgery (colorectal)

Performed during endoscopy Eliminates the need for abdominal surgery Used for small localized tumors

Causes N/V

Phenothiazines block dopamine because dopamine causes this

22. The client diagnosed with a myocardial infarction is on bedrest. The unlicensed assistive personnel (UAP) is encouraging the client to move the legs. Which action should the nurse implement?

Praise the UAP for encouraging the client to move legs. b/c they risk DVT

(3) A client newly diagnosed with hypertension asks the clinic nurse about a urinalysis report the client just received from the health care provider. The client asks the nurse what protein in the urine means. What is the best response by the​ nurse?

Protein in the urine indicates a degree of kidney damage. In this​ case, the damage is most likely from untreated hypertension. The client is newly diagnosed with hypertension and may already have kidney damage. Protein in the urine is an abnormal finding. The client may need additional testing to determine how much damage has occurred

Before the first meal of the day

Proton pump inhibitors should be taken at this time of the day for the treatment of GERD

A nurse assesses a client after administering a prescribed beta blocker. Which assessment should the nurse expect to find?

Pulse decreased from 100 beats/min to 80 beats/min Beta blockers block the stimulation of beta1-adrenergic receptors. They block the sympathetic (fight-or-flight) response and decrease the heart rate (HR). The beta blocker will decrease HR and blood pressure, increasing ventricular filling tim

Signs of systemic congestion occur with right-sided heart failure. Fluid is retained, pressure builds in the venous system, and peripheral edema develops. Left-sided heart failure symptoms include respiratory symptoms. Orthopnea, coughing, and difficulty breathing all could be results of left-sided heart failure.

R/L failure

Post-op Adjunct Palliative

Radiation is used for this with colorectal cancer

how is radiation and chemotherapy used to treat colorectal cancer

Radiation is used preoperatively to shrink large rectal tumors before the surgical resection. Postop radiation is used to reduce the recurrence of pelvic tumors the radiation can be external or implanted for small rectal cancers chemo reduces the rate of tumor reoccurence and reduces the spread to the liver (Fluorouracil (5-FU) Folinic acid (Leucovorin) Irinotecan (CPT-11))

(1) 1st stage crisis intervention

Rapid biopsychosocial assessment (precipitating event)

(1) 2nd stage crisis intervention

Rapport

Medical/Surgical Management of anal fissures

Relaxation of internal sphincter Prevention of traumatic passage of stool by introducing fiber therapy Pain control with topical anesthetic creams Lateral internal sphincterotomy to relax internal anal sphincter Main complication: development of fecal incontinence

NSAIDS Digoxin Steroids Fosamax Alcohol Radiation/smoking Reflux Psychological stress Diet Environment

Risk factors for gastritis

Women Pregnancy Obesity

Risk factors for umbilical hernias

PO IV IM

Routes for iron

(1) What are nursing intervention education

SAFETY first! Search for contraband classify the state of person (are they suicidal, have they been assaulted, are they combative?) reduce stimuli in environment exercise (minimalize, no IVS, bolted down furniture, less is more) therapeutic communication (have a calm attitude) medications therapy emergency treatment orders (one-time order, too agitated, combative use benzo, 1st gen AP, anticholinergic and antihistamine to prevent EPS)

HA Nausea Fever Photosensitivity

Side effects for Sulfasalazine

Lowered the RBCs Lowered platelets

Side effects of Capecitabine (Xeloda)

Anxiety Hallucination Tremors

Side effects of Metclopramide

Constipation

Side effects of acid protective drugs

Dry mouth Hypotension Sedative effect Constipation

Side effects of promethazine

Leaks out of veins and causes tissue necrosis May cause microemboli

Side effects of promethazine through IV push

diagnostics for colorectal cancer

Sigmoidoscopy Colonoscopy- To detect and visualize bowel tumors Tissue biopsy-To confirm cancerous cells and cell differentiation Chest x-ray-To detect tumor metastasis to the lung Carcinoembryonic antigen (CEA) -To estimate prognosis, monitor treatment, and detect cancer recurrence Fecal occult blood test (guaiac test or hemoccult)-To detect blood in the feces CBC- Anemia

Dysphagia Regurgitation Chronic cough Aspiration Weight loss

Sign and symptoms of esophageal diverticula

Diarrhea with N/V Abdomen cramping Dehydration Tachycardia Low blood pressure

Signs and symptom of gastroenteritis

Diarrhea Bloody stools Weight loss Abdominal pain Fever Fatigue

Signs and symptom of irritable bowel disease

Progressive dysphagia

Signs and symptoms of Barrett's esophagus

Heartburn Dyspepesia Regurgitation Hoarseness Sore throat/lump in the throat Chest pain Dental erosion Wheezing/coughing/dyspnea Nocturnal coughing with loss of sleep

Signs and symptoms of GERD

Hematemesis Burning/gaseous pain aggravated by food

Signs and symptoms of PUD

Dysphagia Substernal chest pain Halitosis Cannot burp C/O symptoms of GERD

Signs and symptoms of achalasia

Pain N/V/D Constipation Flatulence Bloating Fatigue Fever

Signs and symptoms of acute abdominal pain

N/V Feeling of fullness Epigastric tenderness Weight loss Hemorrhage Coffee ground emesis Drug or alcohol abuse

Signs and symptoms of acute gastritis

Fever Incisional drainage

Signs and symptoms of an infection post-op ion a laparascopic surgery

Gradual onset Rarely vomit Less pain Increased abdominal distension Less gas

Signs and symptoms of an intestinal obstruction in the large intestines

Rapid onset Vomiting Colic pain Abdominal distention

Signs and symptoms of an intestinal obstruction in the small intestines

Anal pain Bleeding Constipation

Signs and symptoms of anal fissure

Peri-umbilical pain Anorexia N/V McBurney's sign Rebound tenderness Muscle guarding Fever Cough

Signs and symptoms of appendicitis

Foul-odor diarrhea Steatorrhea Flatulence Abdomen distention Malnutrition Dermatitis herpetiformis

Signs and symptoms of celiac disease

Similar to acute gastritis Loss of instrinsic factor Low cobalamin (B12) Pernicious anemia Neurological problems

Signs and symptoms of chronic gastritis

Rigid abdomen

Signs and symptoms of internal bleeding

Intermittent Constipation Diarrhea Cramping Gas

Signs and symptoms of irritable bowel syndrome

Bloating Flatulence Severe abdominal cramping Diarrhea

Signs and symptoms of lactase deficiency

Increased salivation Dehydration Weakness Metabolic alkalosis Metabolic acidosis

Signs and symptoms of nausea and vomiting

Pain that gets worse at night Relief from burping or vomiting Projectile vomiting Constipation

Signs and symptoms of obstruction from PUD

Abdomen pain Tenderness at site Rebound tenderness Muscle rigidity Spasms

Signs and symptoms of peritonitis

Diarrhea Steatorrhea Malnutrition/mineral defiency

Signs and symptoms of short bowel syndrome

Hepatotoxicity Hypersensitivity

Signs of this should be looked for with Tysabri

arbs in HTN

Similar action to ACE inhibitors but block the angiotensin II receptors

hypertensive crisis

Some clients with hypertension may develop a rapid elevation in either the systolic or diastolic blood pressure. The most common cause of this type of hypertension is suddenly not taking prescribed medication. Nocturia Confusion Nausea Vomiting Visual disturbances Papilledema

Sodium retention Hypokalemia Toxic megacolon

Steroids and irritable bowel disease may cause this

Stomach ulcers NSAIDs

Stomach and duodenal GI bleeds can be due to this

The nurse is discussing angina with a client who is diagnosed with coronary artery disease. Which action should the client take first when experiencing angina?

Stop the activity immediately and rest

Bowel obstructions

Strictures can lead to this with irritable bowel disease

Increased abdominal pressure

Structural changes that cause hiatal hernias are due to this

(1) concomitant disorders of bipolar depression

Substance abuse, Diabetes, Seizures, Hypertension,

During or immediately after the meal

Substernal chest pain occurs at this time or achalasia

Antiulcer agent that treats GERD. How does it do so

Sucralfate (Carafate) reacts with gastric acid thus forming a thick oaste that adheres to damaged gastric mucosal tissue. It protects the gastric mucosa and promotes healing

The nurse is preparing to administer a daily dose of docusate sodium to a patient that will continue taking it after discharge. What information should the nurse provide to the patient to optimize the outcome of the medication? Take a dose of mineral oil at the same time. Add extra salt to food on at least one meal tray. Ensure a dietary intake of 10 g of fiber each day. Take each dose with a full glass of water or other liquid.

Take each dose with a full glass of water or other liquid. Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fiber intake should be a minimum of 20 g daily to prevent constipation. Mineral oil and extra salt are not recommended.

Your care of the client with stomach cancer will focus on interventions to address ongoing care what are the interventions

Teach care of the incision and feeding tube if present. Instruct on ways to maintain nutritional intake and prevent complications. Teach pain management approaches. Refer client to home care or hospice as needed and when appropriate. Remind client to keep all scheduled follow-up appointments with the health care provider.

MRI (It has metal)

The LINX system does not use this test

Closes the esophageal sphincter with a band but allows for food to pass on

The LINX system does this

A nurse cares for a client who has an 80% blockage of the right coronary artery (RCA) and is scheduled for bypass surgery. Which intervention should the nurse be prepared to implement while this client waits for surgery?

The RCA supplies the right atrium, the right ventricle, the inferior portion of the left ventricle, and the atrioventricular (AV) node. It also supplies the sinoatrial node in 50% of people. If the client totally occludes the RCA, the AV node would not function and the client would go into heart block, so emergency pacing should be available for the client

Ischemia from poor blood supply

The anal pain from anal fissure is due to this

(1) The basic premise of a recovery model used to treat clients diagnosed with BPD

The basic premise of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care and to enable a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

(1) An inpatient client with a known history of violence suddenly begins to pace. Which additional client behavior should alert a nurse to escalating anger and aggression?

The client has a tense facial expression and body language may indicate that a clients anger is escalating

. The nurse is preparing to administer a beta blocker to the client diagnosed with coronary artery disease. Which assessment data would cause the nurse to question administering the medication?

The client has an apical pulse of 56. it is too low, lower than 60. it would decrease it yet its already low

A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be most helpful?

The client with dumping syndrome after a gastrectomy has multiple dietary needs. A referral to the registered dietitian will be extremely helpful.

The nurse is administering a calcium channel blocker to the client diagnosed with a myocardial infarction. Which assessment data would cause the nurse to question administering this medication?

The client's blood pressure is 90/62. the bp is too low and could cause the BP to bottom out

Explain the incidence and pathophysiology of chronic inflammatory bowel disease.

The disease occurs more frequently in the United States and northern European nations. The peak incidence of the disease is in adolescence and young adulthood The disease is often linked to heredity. Physiological or psychological stress can exacerbate the disease.

A client received tissue plasminogen activator (t-PA) after a myocardial infarction and now is on an intravenous infusion of heparin. The client's spouse asks why the client needs this medication. What response by the nurse is best?

The heparin keeps that artery from getting blocked again. After the original intracoronary clot has dissolved, large amounts of thrombin are released into the bloodstream, increasing the chance of the vessel reoccluding

(1)What are the signs of lithium carbonate toxicity

The initial signs of toxicity include ataxia, blurred vision, severe diarrhea, nausea and vomiting, and tinnitus. Lithium levels should be monitored monthly with maintenance therapy to ensure proper dosage. toxicity.

heart catheterization

The insertion of a tube into the heart to examine the cardiac muscles. is performed for clients who have the symptoms of coronary artery disease

A nurse cares for a client who is prescribed magnetic resonance imaging (MRI) of the heart. The client's health history includes a previous myocardial infarction and pacemaker implantation. Which action should the nurse take?

The magnetic fields of the MRI can deactivate the pacemaker. The nurse should call the health care provider and report that the client has a pacemaker so the provider can order other diagnostic tests.

The nurse needs to include information on colostomy management and the plan to reverse the colostomy when educating the client about ongoing​ care.

The nurse also needs to include information on how to contact the enterostomal nurse and the importance of keeping all​ follow-up appointments when educating the client about ongoing care. The nurse would not provide education about the need to follow a​ high-fiber diet for 6 months because this client needs to follow this diet for life.

(1) A client refuses to take lithium carbonate (lithobid) because theyre afraid to gain weight for adherence what may the physician prescribe

The nurse should anticipate that the physician may prescribe valproic acid in order to increase this client's medication adherence. Valproic acid is an anticonvulsant medication that can be used to treat bipolar disorder. One of the side effects of this medication is weight loss.

(1) A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, "I can't function any longer under all this stress." Which type of crisis is the client experiencing?

The nurse should determine that the client is experiencing a psychiatric emergency crisis. Psychiatric emergencies occur when crisis situations result in severe impairment, incompetence, or an inability to assume personal responsibility.

(1) A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior?

The nurse should document that this client's behavior is "Agitated and pacing. Exhibiting grandiosity. Mood labile." The client is exhibiting mood swings from euphoria to irritability. Grandiosity refers to the attitude that one's abilities are better than everyone else's.

(1) lithium carbonate (Eskalith) and olanzapine (Zyprexa) How does Zyprexa work

The nurse should explain to the client's spouse that olanzapine can calm hyperactivity until the lithium carbonate takes effect. Lithium carbonate may take 1 to 3 weeks to begin to decrease hyperactivity. Monotherapy with the traditional mood stabilizers like lithium carbonate, or atypical antipsychotics like olanzapine, has been determined to be the first-line treatment for bipolar I disorder.

(1) How should nurse prioritize bipolar disorder outcomes

The nurse should order client outcomes based on priority in the following order: Remains free of injury, maintains nutritional status, sleeps 6 to 8 hours a night, and interacts appropriately with peers. The nurse should prioritize the client's safety and physical health as most important

(1) A new mother is concerned about her ability to perform her parental role. She is quite anxious and ambivalent about leaving the postpartum unit. To offer effective client care, a nurse should be familiar with what information about this type of crisis?

The nurse should understand that this type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. Reassurance and guidance should be provided as needed, and the client should be referred to services that can provide assistance.

30. A client thought to be cheeking medications is prescribed Lithium syrup 900 mg bid. The syrup contains 300 mg of lithium per 5 mL. At 0800, how many milliliters would the nurse administer? _____ mL.

The nurse would administer 15 mL.

The nurse is providing education to a client newly diagnosed with diverticulosis about diverticulitis. About which manifestations of diverticulitis would the nurse educate this​ client?

The nurse would provide education about a​ low-grade fever, abdominal​ tenderness, nausea,​ vomiting, and abdominal distention,.​ Left-sided abdominal​ pain

0-2 hours

The pain in a perforation of PUD lasts for this long

(1) A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the priority nursing diagnosis for this client?

The priority nursing diagnosis for this client is risk for self-directed violence R/T hopelessness. Nurses should prioritize diagnoses and outcomes based on potential safety risk to the client or others.

(1) A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize?

The priority nursing diagnosis for this client should be risk for suicide R/T hopelessness. The nurse should always prioritize client safety. This client is at risk for suicide because of his or her recent suicide attempt.

TNM Depth

The prognosis of colorectal cancer is based on this

Summarize the pathophysiology of GERD

The stomach contents/juices flow backward into the esophagus, Exposing it to corrosive elements like pepsin, acid and bile that causes inflammation and eventual ulceration of the esophagus. If left untreated, the cells become inflamed and scarred, constricting the lumen leading to painful swallowing the reflux can reach the pharynx and mouth allowing aspiration which occurs mostly during sleep in the recumbent position

(1) cyclothymic disorder. DSM-5 diagnostic criteria would the nurse expect this client to meet?

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Depressive symptoms that do not meet the criteria for a major depressive episode.

(1) Least Restrictive method for de-escalation

Therapeutic communication, redirection

A client with peptic ulcer disease asks the nurse about taking slippery elm supplements. What response by the nurse is best?

There are several complementary and alternative medicine regimens that are used for gastritis and peptic ulcer disease. Most have been tested on animals but not humans. Slippery elm is a common supplement used for this disorder

Hemorrhage

There is an increased risk for this due to the loss of plasma in the stomach in chronic gastritis

Infection

There is an increased risk for this with Tysabri

Hiatal hernia Incompetent LES Delayed gastric emptying Obesity Cigarette/cigar use

These are causes of GERD

Abdominal surgery Inflammatory response Electrolyte abnormality Thoracic/lumbar spinal fracture

These are causes of a paralytic ileus

Surgical adhesions Cancer Hernias Strictures Intussusception

These are come causes of mechanical intestinal obstruction

Esophagitis Bronchitis Pneumonia Barett's esophagus

These are complications of GERD

Fish Meal Poultry

These are food sources of cobalamin

High fructose Milk

These are foods that can precipitate symptoms of irritable bowel syndrome

(Almost the same as phenothiazines) Dry mouth Hypotension Sedative effect Constipation Rash

These are side effects of antihistamines

Nitrates CCBs

These are smooth muscle relaxants for achalasia

Smells Taste Hearing Vision

These are stimuli to nausea and vomiting

Squamous

These are the normal cells in the esophagus

Cannot fully see down the lesion Narrowing Malignancy

These are the problems with Barrett's esophagus

Sliding Rolling

These are the types of hiatal hernia

Drug therapy Nutritional therapy Non-drug therapy

These are treatments for nausea and vomiting

Milk Egg Wheat/rye Beef

These are triggers for eosinophilic esophagitis

Caffeine Chocolate Anticholinergics

These are triggers of an incompetent LES

Medications Preservatives Wheat/barley/rye

These are triggers to celiac disease

Cimetidine (Tagemet) Ranitidine (Zantac) Famotidine (Pepcid)

These are types of H2 receptor blockers

Tomato Orange juice Red wine

These are types of acidic foods

Hemorrhoids Anal fissure Anal fistula

These are types of analrectal problems

Metoclopramide (Reglan) Ondansetron (Zofran) Dexamethasone (Decadron) Marinol (Dromaderol)

These are types of anti-emetics

Dimenhydrinate (Dramamine) Meclizine (Antivert) Hydroxyzine (Vitaril)

These are types of antihistamines

(essential oils) Ginger Peppermint oil

These are types of botanicals

Blood in stool Loose stool

These are types of changes in the bowel that can occur with colorectal cancer

Appenivitis Peritonitis Gastroenteritis Irritable bowel syndrome

These are types of inflammatory GI disorders

Crohn's disease Ulcerative colitis

These are types of irritable bowel syndromes

Lactose intolerance IBD Celiac disease

These are types of malabsorption syndromes

Acupuncture Acupressure Botanicals Relaxation breathing exercises Mouthwash

These are types of non-drug therapy for nausea and vomiting

Billroth I (Gastro-duoden-ostomy) Billroth II (Gastro-jajun-ostomy)

These are types of partial gastrectomy

Breath test Urine Serum Stool Gastric tissue

These are types of samples that can be used for the diagnosis of gastritis

Partial gastrectomy Vagotomy

These are types of surgery used for the treatment of PUD

Phenothiazines Antiemetics Anticholinergics Antihistamines

These are used for drug therapy for nausea and vomiting

Stomach flu Norovirus

These are viral causes of gastroenteritis

Bronchitis Pneumonia

These complications of GERD are due to aspiration

NSAIDs Digoxin Steroids Fosamax

These drugs have a direct irritating effect on the gastric mucosa

Infection Bleeding

These is a higher risk for this with Capecitabine (Xeloda)

NSAIDs Corticosteroids Anticoagulants SSRIs

These medications can cause PUD

Mycobacterium Cytomegalic virus Syphilis

These microorganisms lead to chronic gastritis

Cobalamin Calcium Zinc

These minerals are deficient in short bowel syndrome

Age Alaskan Male Caucasian

These people are at an increased risk for esophageal cancer

Diarrhea Bloody stools

These symptoms are more common with ulcerative colitis

Antimicrobials Corticosteroids Immunosuppressants

These types of drugs are used for the treatment of irritable bowel disease

Smoked Salted Pickled

These types of foods can cause stomach cancer

Step-up/step-down units

This affects the type dosage of the drug with irritable bowel disease

6-8 liters

This amount of fluid enters the intestines everyday

Complications

This can be the earliest sign of PUD

Cold compress

This can be used if scrotal edema occurs after a herniorrhaphy

Anemia Osteoporosis

This can develop is a person with celiac disease does not avoid gluten

Vomiting

This can lead to fatality in a severe intestinal obstruction

Lying flat

This can precipitate nocturnal coughing with loss of sleep in GERD

Adenocarcinoma

This cancer forms from the glands in the lining of the esophagus

Alcohol and smoking

This causes high acid secretion

The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the client's abdomen is tense and rigid. What action takes priority?

This client has manifestations of a perforated ulcer, which is an emergency. The priority is to get the client medical attention

A client is in the hospital after suffering a myocardial infarction and has bathroom privileges. The nurse assists the client to the bathroom and notes the client's O2 saturation to be 95%, pulse 88 beats/min, and respiratory rate 16 breaths/min after returning to bed. What action by the nurse is best?

This client's physiologic parameters did not exceed normal during and after activity, so it is safe for the client to continue using the bathroom.

Jewish descent

This demographic is higher for irritable bowel disease

Elderly

This demographic may not show signs of an infection with diverticulitis

Barium swallow

This diagnostic test has the patient eat food with barium which shows how the person is eating

PUD

This disease causes the erosion of the GI mucosa

When the fecal matter is lacking in fiber or​ bulk, pressure within the bowel increases.

This increased pressure causes the bowel mucus layer to push through or herniate through the muscle​ wall, causing diverticula to occur.

Achalasia

This increases the risk for esophageal diverticula

Melena

This is a black tarry stool that is almost jelly-like

Paralytic ileus

This is a cause of a non-mechanical intestinal obstruction

Tumor on the spinal cord or brain

This is a cause of projectile vomiting

N/V

This is a common post-op symptom

Short bowel syndrome

This is a complication if too much of the bowel is removed with surgery

Carafate

This is a cytoprotective drug

Irritable bowel syndrome

This is a disorder causing episodes of constipation and diarrhea in the intestines

Ascites

This is a poor prognosis sign of stomach cancer

Zllinger-ellison syndrome

This is a rare, chronic condition that causes severe peptic ulcers and hypersecretion of HCL

Pyritic rash

This is a rash that has bumps and blisters

Esophageal diverticula

This is a sac-like outpouching of one or more layers of the esophagus (like a hernia)

No bowel sounds even after the bowel problem is fixed

This is a sign of a paralytic ileus

Bleeding

This is a sign of polyps

No bowel sounds initially but it will return when adhesions develop

This is a sign of surgical adhesions

Blood in stool

This is a signs and symptom of anemia with stomach cancer

Isosorbide nitrate

This is a smooth muscle relaxant/nitrate given for intermittent chest pain and achalasia

Carafate (Sucrolfate)

This is a type of acid protective drug

Promethazine (Phenergan)

This is a type of phenothiazine

Omeprazole

This is a type of protein pump inhibitor

Barium study test

This is a type of small bowel study

LINX system

This is a type of surgery for the treatment of GERD

Partial/total gastrectomy

This is a type of surgery used for stomach cancer

Aspiration

This is a very common sign and symptom of esophageal diverticula

Irriducibile (incarcerated)

This is a very dangerous hernia that can cause poor intestinal flow

Stomach cancer

This is an adenocarcinoma of the stomach

Diverticulitis

This is an inflamed diverticula

Anal fissure

This is an ulcer/crack in the lining of the anal wall

Occult bleeding

This is blood given in the stool or vomit

Pre-cancer lesion

This is developed in Barrett's esophagus

Tissue edema Disruption of capillary walls in the stomach Lose plasma in the stomach

This is developed in chronic gastritis

Semi-soft bland diet Eat slowly Drink with meals Sleep with HOB elevated

This is done for diet in achalasia

TPN Feeding tube 30-60mL of water/hr Check if they have reflux

This is done for nutritional therapy for esophageal cancer

Diet Drug therapy

This is done for symptomatic relic for achalasia

Surgery Chemotherapy Palliative care Targeted therapy Radiation

This is done for the treatment of colorectal cancer

Untwist strangulated intestine Tumor removal Cutting an adhesion

This is done is surgery for an intestinal obstruction

NG tube to low suction Early ambulation No lifting more than 3-5 pounds Report sign and symptoms of infection

This is done post-op of a laparoscopy surgery for acute abdominal pain

GERD

This is due to the reflux of gastric contents into the lower esophagus

Dyspepsia

This is epigastric pain/discomfort

Halitosis

This is foul smelling breath

Muscle guarding

This is indicative of peritonitis and appendicitis

Regurgitation

This is the event when food is slowly brought of from the stomach and into the oral space

Endoscopy

This is the first line management for an upper GI bleed

Projectile vomiting

This is the forceful expulsion of food contents

Put into remission and maintain it

This is the goal of drug therapy with irritable bowel disease

Remove as much of the stomach to get rid of the cancer and surrounding cells

This is the goal of surgery in stomach cancer

Intestinal obstruction

This is the inability of the intestinal contents to pass through the GI tract

Ulcerative colitis

This is the inflammation and ulceration of the *colon and rectum*

Gastritis

This is the inflammation of the gastric mucosa

Gastroenteritis

This is the inflammation of the mucosa in the stomach and small intestine

Peritonitis

This is the local/generalized inflammation of the peritoneum

Halfway between the umbilicus and iliac crest

This is the location for McBurney's point

Esophageal cancer

This is the malignant neoplasm of the esophagus

Short bowel syndrome

This is the minimal surface area for the small intestines to absorb nutrients

Acid is produced but anything that interacts with the acid is blocked

This is the mode of action for H2 blockers

Blocks the dopamine receptors

This is the mode of action for phenothiazines

Increases gastric emptying by decreasing GI motility and decreasing the action of dopamine

This is the mode of action of Metclopramide

Covers and protects the ulcers

This is the mode of action of acid protective drugs

Blocks the cholinergic pathway

This is the mode of action of anticholinergics

Block histamine receptors

This is the mode of action of antihistamines

Metabolic alkalosis

This is the more common metabolic symptom of nausea and vomiting

Upper (Zenker's diverticulum)

This is the most common area for esophageal diverticula

H. pylori

This is the most common cause of duodenal PUD

Progressive dysphagia

This is the most common sign and symptom of esophageal cancer

Progressive dysphagia

This is the rapidly declining ability to swallow

Partial gastrectomy

This is the removal of the distal 2/3rds of the stomach

Barrett's esophagus

This is the replacement of normal squamous epithelium with columnar epithelium

Diverticula

This is the saccular dilation/out-pouching of mucosa in the colon

Intussusception

This is when the bowel squeezes and a small part goes into a larger part

Malabsorption syndrome

This is when the intestine cannot correctly absorb nutrients into the blood stream

Tiny changes are not seen

This is why a CXR is not useful for the diagnosis of gastritis

Hypersalivation

This may occur with regurgitation

Loperamide (Imodium)

This medication can be given for the treatment of irritable bowel syndrome

PPI

This medication works the fastest for PUD

H. pylori

This microorganism can cause PUD

Surgery

This needs to be down if if an intestinal obstruction is severe

Frequency of pain Timing DUration of pain Location Aggravating/alleviating Level of pain Non-verbal behaviors

This needs to be known about the H&P for acute abdominal pain

Brainstem

This part of the brain tells a person to vomit

Posterior teeth

This part of the teeth are usually eroded with GERD

75%

This percent of gas is due to swallowing it

Puts patients at a higher risk with concurrent use of NSAIDs

This s how anticoagulants can cause PUD

Late night eating Smoking Caffeine Acidic foods

This should be avoided with GERD

Treat root cause

This should be done before medications are given for irritable bowel syndrome

Liquid diet (no milk) Enteral feedings (to maintain adequate calorie intake)

This should be done for acute IBD exacerbations

May not have a lot of output

This should be noted about an NG tube gastrectomy post-op

Placed near the abdominal cavity to drain surrounding fluid

This should be noted about chest tubes gastrectomy post-op

Tarditive dyskinesia

This should be ruled out for side effects when giving Metclopramide

Heart attack

This should be ruled out when it comes to GERD

Side effects When to take it

This should be taught when giving medications for the treatment of GERD

What they ate What symptoms displayed

This should be written down with a food diary for irritable bowel disease

Weight loss

This symptom is more common with Crohn's disease

Hemoccult Guaiac test Occult stool

This test has multiple name and is used to check for blood in the stool or vomit

Tysabri (Aralizumab)

This type of Anti-TNF agent is used for irritable bowel disease

Pepcid complete

This type of H2 receptor blocker may cause constipation

Acute PUD

This type of PUD is a superficial erosion develops in the presence of an acidic environment for a short duration

Chronic PUD

This type of PUD is an erosion of the muscular wall causes fibrous tissue to be formed

Scopolamine

This type of anticholinergic is usually placed behind the ear

Sulfasalazine (Azylfidine)

This type of antimicrobial (antibiotic) is used for the treatment of irritable bowel disease

High fats and meat

This type of diet can cause irritable bowel disease

High in red or processed meats Low in fruits and vegetables

This type of diet has an increased risk for colorectal cancer

Soft food

This type of diet is used for esophageal diverticula

Diffuse

This type of gastritis is in multiple places

Localized

This type of gastritis is in one specific sport

Inguinal

This type of hernia is more common in males

Umbilical

This type of hernia is more common in women

Rolling

This type of hiatal hernia gets stuck at the diaphragm

Sliding

This type of hiatal hernia goes through the diaphragm and it goes back

Anti-TNF agent

This type of immunosuppressant is used for irritable bowel disease

Non-mechanical intestinal obstruction

This type of intestinal obstruction occurs when something other than the physical bowel has a problem

Mechanical intestinal obstruction

This type of intestinal obstruction occurs when the physical bowel has a problem

Stapling

This type of surgery is done for esophageal diverticula

Total proctocolectomy

This type of surgery is used to *cure* ulcerative colitis

SRMD

This type of upper GI bleed is usually found after surgery

Virus

This type pathogen causes gastroenteritis

(1) DSM-5 Characteristics for manic and hypomanic episodes

Three or more of the following symptoms may be experienced in both hypomanic and manic episodes: Inflated self-esteem or grandiosity, decreased need for sleep (e.g., feels rested after only 3 hours of sleep), more talkative than usual or pressure to keep talking, flight of ideas and racing thoughts, distractibility, increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation, excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments). If there are psychotic features, the episode is, by definition, manic.

Endoscopy Treat shock sign and symptoms Drugs

Treatment for an upper GI bleed

(Conservative) Fiber in diet Sitz bath Fluids

Treatment for anal fissure

Avoid the triggers

Treatment for celiac disease

Lifestyle changes Diet Alcohol Smoking

Treatment for chronic gastritis

Diet Weight loss Surgery

Treatment for diverticulitis and diverticulosis

Antacids Corticosteroids

Treatment for eosinophilic esophagitis

(Non-specific) Pressure Diet Surgery

Treatment for esophageal diverticula

Supportive care Acute treatment Chronic treatment Drugs

Treatment for gastritis

Epinephrin injection Thermal coagulation therapy

Treatment for hemorrhage in PUD

Increased HR Weak pulse Decreased BP Vitals every 15 mins Bolus/fluids

Treatment for hemorrhagic shock

Diet anti-infalmatory ointment Rubber band ligation Sitz bath

Treatment for hemorrhoids

Lifestyle modifications Surgery

Treatment for hiatal hernias

Prevent fluid and electrolyte imbalances Strict I&O Surgery

Treatment for intestinal obstruction

Drugs Bowel rest Hospitalization Surgery Nutrition

Treatment for irritable bowel disease

Lifestyle changes Probiotics Medications

Treatment for irritable bowel syndrome

Diet Supplement Lactase enzymes

Treatment for lactase deficiency

NG tube on continuous decompression CBC Surgery

Treatment for perforation of PUD

Antibiotics Analgestics NG tube to suction Antiemetic Drain

Treatment for peritonitis

Diet Medications Intestinal transplant

Treatment for short bowel syndrome

Surgery Chemo Radiation

Treatment for stomach cancer

(1) Verapamil (Calan) Calcium channel blocker

Treats: Bipolar Mania! Angina, arrhytmias, HTN, migraine It is contraindicated in those who are hypersensitive to the class, the elderly, those with liver, renal, cardiac disease. Is pregnant, lactating and has INTRACRANIAL PRESSURE.

double barrel colostomy

Two stomas are created Used for trauma, tumors, or inflammation May be temporary or permanent Proximal ostomy used to expel feces Distal stoma used to expel mucous from the distal colon

Fistulotomy

Type of surgery for the treatment of an anal fistula

Naproxen Motrin

Types of NSAIDs

Acute/Chronic Gastric/Duodenal

Types of PUD

Bevacizumab (Avastin) Ziv-aflibercept (Zeltrap)

Types of angiogenesis inhibitors

5-Fluoroacil (5FU) + Folinic acid (Leucovorin) Capecitabine (Xeloda)

Types of chemotherapy

Acute/chronic Diffuse/localized

Types of gastritis

Inguinal Femoral Umbilical Ventral/incisional

Types of hernias

Mechanical Non-mechanical

Types of intestinal obstructions

Ulcerative colitis Crohn's disease

Types of irritable bowel disease

(1) Emergency treatment for bipolar disorder

Typical Gen 1 + Antipsychotic + Antihistamine(EPS prevention)

Laboratory and Diagnostic Procedures Cholelithiasis

Ultrasound of the gallbladder Nuclear studies

Which tests are used to diagnose PUD

Upper GI series (detects 80-90% ulcers) Endoscopy (To visualize esophageal, gastric, and duodenal mucosa to inspect ulcers and obtain tissue for biopsy) Biopsy urease test (to diagnose H. Pylori) Fecal H Pylori (to detect the presence of H. Plyori in the stool) Urea Breath Test (to measure the presence of H. Pylori) Gastric analysis ( To evaluate gastric acid secretion in suspected Zollinger-Ellison syndrome) ***testing for organism ***direct visualization

(1) What are deescalation techniques

Use less restrictive measures first! Move in a low stimuli environment, stay with the patient, keep calm voice non threatening posture, offer food/drink as a distraction, allow a phone-call, see S/O, decrease wait time, identify consequences administer PRN meds, and tell them they will face consequences Give them a timeout, unlocked seclusion

what is a laparotomy

Used to inspect the bowel tissue Removes infarcted or gangrenous tissue

transverse loop colostomy

Used to relieve an intestinal obstruction or perforation Loop of transverse colon brought to the skin surface and looped over a structure to prevent the loop from going back into the abdominal cavity Stoma is made in the loop of colon Are considered temporary ostomies

what is a bowel resection

Used to remove large tumors obstructing the bowel lumen Stents may be placed to keep the bowel lumen open Obstruction dissected, and the remaining bowel segments anastomosed Temporary or permanent colostomy may be needed

Tumor shrinkage before surgery Adjunct therapy with medications

Uses for chemotherapy with colorectal cancer

Weak surgical area

Ventral-Incisional hernias are due to this

STAT and frequent

Vital signs for the treatment of acute abdominal pain is done at this frequency

Fever Low blood pressure

Vital signs for the treatment of acute abdominal pain looks for these things

The nurse is teaching the client recently diagnosed with essential hypertension. Which instruction should the nurse provide when discussing exercise?

Walk at least 30 minutes a day on flat surfaces.

Anemia

Weakness and fatigue is due to this in colorectal cancer

the health history of a client who is newly admitted to the medical unit. Which statement by the client should alert the nurse to the presence of edema?

Weight gain can result from fluid accumulation in the interstitial spaces. This is known as edema. The nurse should note whether the client feels that his or her shoes or rings are tight, and should observe, when present, an indentation around the leg where the socks end.

Poor nutrition

Weight loss from esophageal cancer is due to this

dumping syndrome

When the volume of the gastric contents is​ large, motility is enhanced into the intestines. The hypertonic gastric contents will pull water from the blood to balance the​ osmolality, resulting in the symptoms of Clients should lie down to reduce the effect of gravity on gastric motility.

(1) An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which nursing intervention should a nurse implement to address this behavior?

With staff support and a show of solidarity, set firm limits on the behavior.

A​ 63-year-old female client asks the clinic nurse about her risk for developing coronary artery disease compared with that of a man. What is the most accurate response by the​ nurse?

Women have a lower risk of developing coronary artery disease until the age of menopause. After​ menopause, the risk is the same for men and women. This is because of the presence of​ estrogen, which is protective against coronary artery disease. Estrogen levels decline after menopause.

An emergency room nurse assesses a female client. Which assessment findings should alert the nurse to request a prescription for an electrocardiogram

Women may not have chest pain with myocardial infarction, but may feel discomfort or indigestion. They often present with a triad of symptoms—indigestion or feeling of abdominal fullness, feeling of chronic fatigue despite adequate rest, and feeling unable to catch their breath. Frequently, women are not diagnosed and therefore are not treated adequately.

(3) weight control in waist per women and men, which circumference can increase risk for HTN

Women: 35 or more Men: 40 or more

diagnostic tests for intestinal obstruction

X-rays, CT scan, complete blood count with differential WBC Barium swallow or barium edema Careful history and physical examination

behavioral and mind-body therapies may be used to help some clients reduce blood pressure. Therapies used include:

Yoga Tai chi Meditation Guided imagery Physical exercise

Which client teaching should the nurse implement for the client diagnosed with coronary artery disease? Select all that apply

a low fat, low cholesterol to decrease buildup of atherosclerosis instruct client to walk 30 minutes a day walking will help increase collateral circulation Refer to counselor for stress reduction techniques reduce stress increase fiber to remove excess cholesterol

(1) Treatment for Bipolar disorder should have which approach

a multi modality approach that includes med evaluation, psychotherapy, family therapy, group therapy, and support groups multidisciplinary interventions: alternative therapy, yoga/meditation and exercise they should also be referenced to relapse prevention, community and spiritual resources that can help them

After an exploratory laparotomy

a patient on a clear liquid diet reports severe gas pains and abdominal distention. Which action by the nurse is most appropriate? Return the patient to NPO status. Place cool compresses on the abdomen. Encourage the patient to ambulate as ordered. Administer an as-needed dose of IV morphine sulfate,Encourage the patient to ambulate as ordered. Swallowed air and reduced peristalsis after surgery can result in abdominal distention and gas pains. Early ambulation helps restore peristalsis and eliminate flatus and gas pain. Medications used to reduce gas pain include metoclopramide, which stimulates peristalsis. A heating pad can help to alleviate some of the pain and help make the patient more comfortable. There is no need for the patient to return to NPO status. Drinking ginger ale may be helpful.

Two days after a colectomy for an abdominal mass

a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result what event? Impaired peristalsis Irritation of the bowel Nasogastric suctioning Inflammation of the incision site,Impaired peristalsis Until peristalsis returns to normal after anesthesia, the patient may experience slowed gastrointestinal motility, leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

The treatment of choice for polyp removal is

a polypectomy that is done during a colonoscopy.

what class is metoclopramide (reglan)

a promotility agent

(1) bipolar I severe

a single manic episode to hypomania or depression, the social and occupational functioning is impaired

How to manage celiac disease

a totally gluten free diet, no oats and corn

What is a hernia and what it is caused by

a weakness in the abdominal wall that permits abdominal contents to move out of the abdominal cavity, caused by an increase in intra-abdominal pressure, trauma, or as a complication of surgery

A nurse is caring for a client with a history of renal insufficiency who is scheduled for a cardiac catheterization. Which actions should the nurse take prior to the catheterization?

a. Assess for allergies to iodine. b. Administer intravenous fluids. c. Assess blood urea nitrogen (BUN) and creatinine results. If the client has kidney disease (as indicated by BUN and creatinine results), fluids and Mucomyst may be given 12 to 24 hours before the procedure for renal protection. The client should be assessed for allergies to iodine, including shellfish; the contrast medium used during the catheterization contains iodine.

symptoms for crohns disease

abdominal pain and distention tenderness in RLQ severe diarrhea low grade fever bloody stool weight loss severe malabsorption later on dehydration occurs, electrolyte imbalance and anemia

What would nurse assess during the physical examination of a client with colorectal cancer

abdominal tenderness

A client admitted to the emergency department for diverticulitis has a​ low-grade fever and abdominal distention. The nurse would anticipate that the health care provider will order what test to rule out bowel​ perforation?

abdominal x-ray

(3) what causes angioedema and what treats it

ace and arbs epinephrine

gastric tube placement is confirmed with an

acid pH reading which is less than 7

Anal abscess:

acute manifestation of infectious process Fistula: chronic manifestation of same perirectal process

Tear in the lining of the anal canal Most caused by trauma to the canal Internal sphincter muscle beneath spasms and causes severe pain Patient complaints of tearing pain with bowel movements May have small amount of bright blood Diagnosed from history and direct visualization of rectum

anal fissure

A patient is scheduled to receive "Colace 100 mg PO." The patient asks to take the medication in liquid form

and the nurse obtains an order for the change. The available syrup contains 150 mg/15 mL. Calculate how many milliliters the nurse should administer. ___ mL,10

Broad-spectrum antibiotics such as imipenem (Primaxin) or meropenem (Merrem) are used until the offending bacterium is identified in peritonitis and then when it is identified

antibiotics such as ampicillin (Polycillin), metronidazole (Flagyl), ciprofloxacin (Cipro), clindamycin (Cleocin), ceftriaxone (Rocephin), gentamicin (Garamycin), or amikacin (Amikin) will be prescribed.

(1) Medications to treat EPS

anticholinergics

(3) medical management and surgeries for DVT

anticoagulants heparin thrombin inhibitorrs oral warfarin the surgeries are venous thrombectomy it is not commonly performed or interruption of vena cava

(1) renders contraceptives ineffective

anticonvulsants

(1) not approved by FDA to treat mania

antidepressants

(1) emergency meds for bipolar

antipsychotics, benzos, anticholinergics

(1) What are concomitant disorders that can occur along with bipolar depression

anxiety disorders substance abuse diabetes HTN Seizures --- People with other mental issues like anxiety, substance abusers. Those who have diabetes, HTN and seizures.

what is the Tx for appendicitis

appendectomy, preferably before it ruptures, and abx (usually start IV abx before sx)

Purulent exudate forms. Within 24 to 36 hrs, tissue necrosis and gangrene result. This can lead to perforation and bacterial peritonitis unless treatment is initiated.

appendicitis

What is the most common reason for emergency abd surgery?

appendicitis

Nursing process for Stomach cancer (assessment and physical examination)

assess anorexia, early satiety, indigestion, or vomiting epigastric pain after meals recent and unintentional weight loss examine their general appearance, height and weight abdominal distention, palpable mass , occult blood in stool or vomitus

(3) management of raynauds disease

assess hands and toes smoking cessation maintain warmth avoid stress and avoid meds

A client admitted to the emergency department for diverticulitis has a​ low-grade fever and abdominal distention. The nurse would anticipate that the health care provider will order what test to rule out bowel​ perforation? in a patient with diverticulitis

assessing the abdominal girth every 4 hours monitor temp every 4 hours monitor for abdominal pain every 4-8 hours monitor I and Os Administering intravenous fluids or parenteral nutrition (or both) as prescribed Monitor stool for occult blood

manifestations of primary htn

asymptomatic blood pressure elevations are transient but eventually become permanent The onset of symptoms is usually vague and includes a headache in the back of the head and neck that is present upon waking from sleep and subsiding during the day. The client may also experience symptoms associated with target organ damage,

(1) antipsychotic maintenance with a delayed onset

atypical 2nd generation

(3) Mean Arterial Pressure

avg arterial pressure in the arteries to indicate perfusion in the vital organs Good - in the 90s Bad- in the 70s

tests used in the diagnosis of diverticular disease

barium enema-To identify colon spasm, muscle wall thickening, and narrow bowel lumen abominal xrays-To identify free abdominal air indicating perforation sigmoidoscopy/colonoscopy-To detect diverticula, assess for strictures and bleeding, and rule out tumors abdominal ct scan- To detect abscesses, fistulas, and areas of inflammation Hemoccult or guaiac testing of stool- to determine occult blood in the stool WBC- to detect elevations because of bowel inflammatioon Ultrasound- to detect an abscess or bowel thickening

(3) management of varicose veins

bed rest with elevation compression stockings incision and skin care avoid activities that could cause venous pooling develop walking program and lose weight

When providing education to a client with diverticular​ disease, the nurse would encourage the client to consume​ broccoli, apples, and brown rice. When providing education to a client with diverticular​ disease, the nurse needs to tell the client to avoid

berries and popcorn because their seeds can catch in the diverticula.

(3) A client is diagnosed with hypertension. The client also has a diagnosis of chronic obstructive pulmonary disease​ (COPD). Of the following​ medications, which medication would the health care provider avoid prescribing for this​ client?

betablockers! cause bronchial constriction and are contraindicated in clients with COPD or asthma.

(1) Mania can occur as a

biological (organic) or psychological disorder, or as a response to substance use or a general medical condition

The nurse is educating a client with peptic ulcer disease about home medications. What medication will cause stools and the tongue to​ darken?

bismuth compounds

What is the transcultural incidence of hypertension in the U.S.?

black women and lower in asians

low bp high pulse indicate

blood loss

causes of peritonitis - primary:

blood-borne MOs genital tract MOs cirrhosis c ascites

Diverticular disease manifests as changes in.

bowel elimination​ patterns, which include episodes of constipation alternating with​ diarrhea, narrower diameter of​ stools, and blood in the stools

A client with persistent diverticulitis may have

bowel resection surgery,affected bowel is removed and the remaining segments are ansatomosed. if the inflammation is severe a temp colostomy may be created to promote healing. the anastomosis is delayed until the bowel is healed

what is a volvulus

bowel twists like it's trying to be a balloon animal

Your client with peritonitis will be treated with medications, nutritional alterations, comfort measures, intestinal decompression, and possibly surgery. what are they

broad spectrum antibiotics before offending bacteria is found, then RX for antibiotics Iv fluid, electrolyte replacement parenteral nutrition until eating orally o2 for healing fowler position to help localize the infection and promote lung ventilation intestinal decompression-Used to relieve abdominal distention and minimize postoperative respiratory problems Nasogastric or long intestinal tube is inserted and connected to continuous drainage Suction is maintained until peristalsis resumes, bowel sounds are present, and the client is passing flatus. Food and fluid is withheld until intestinal motility returns and suction is discontinued. lapratomy surgery then isotonic lavage

A patient with an intestinal obstruction has a nasogastric (NG) tube to suction but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered

but the irrigating fluid does not return. What should be the priority action by the nurse? Notify the physician. Auscultate for bowel sounds. Reposition the tube and check for placement. Remove the tube and replace it with a new one.,Reposition the tube and check for placement. The tube may be resting against the stomach wall. The first action by the nurse is to reposition the tube and check it again for placement. The physician does not need to be notified unless the nurse cannot restore the tube function. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

(3) Medical management of angina pectoris

calcium channel blockers nitrates beta adrenergic blocking agents they prevent the progression of ischemia to myocardium, give complete relief of anginal pain activity restrictions and O2 during pain

(3) how to treat raynauds disease

calcium channel blockers nitroglycerin ointment avoid cold surgical sympathectomy for severe symptoms

(1) Drug of choice for a person that cannot take Lithium

carbamazepine it is contraindicated if pt. is taking MAOIs (Isocarboxazid (Marplan) Phenelzine (Nardil) Selegiline (Emsam) Tranylcypromine (Parnate)

(1) What is the mood stabilizer used when lithium is not tolerant

carbamazepine (Tegretol)

(3) what are the ACE inhibitors

catopril enalapril lisinopril fosinopril ramipril blocks production of angiotensin II which causes vasolidation and excretes sodium and water

IBD - associated factors

cause: autoimmune genetic link + trigger diet, air pollution, stress, smoking: have effects on immune system and gut flora fats and meat: increased risk fruits, veg, and fiber: decreased risk OCPs and NSAIDs exacerbate Crohn's

(3) what is raynauds disease

caused by emotional stress or cold skin color changes with temp cover up when in cold temp

The nurse is preparing to administer famotidine to a postoperative patient with a colostomy. The patient states they do not have heartburn. What response by the nurse would be the most appropriate? "It will reduce the amount of acid in the stomach." "It will prevent air from accumulating in the stomach

causing gas pains." "It will prevent the heartburn that occurs as a side effect of general anesthesia." "The stress of surgery is likely to cause stomach bleeding if you do not receive it.","It will reduce the amount of acid in the stomach." Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.

(1) define labile

changing rapidly and often

symptoms of systemic​ peritonitis

characterized by​ fever, tachycardia,​ tachypnea, restlessness,​ confusion, disorientation, and oliguria

how to assess NGT

check the position of the tube every 2-4 hours or PRN withdraw aspirate and teest pH <5 check the tape or mark on NGT assess for respiratory distress during lung assesment position the pt. document I and Os the feeds should not hang longer than 4hrs weights as ordered blood tests dietitian

(1) Hypomania

cheerful and exalted self. increase in motor activity without functional impairment

What are the "other" therapies for stomach cancer

chemotherapy, and radiation (Provided before and after surgery reduces tumor recurrence and prolongs survival) Gastrostomy or jejunostomy feeding tube placement (Used for long-term enteral feedings after surgery or palliative for those with advanced disease)

(3) major signs and symptoms of a heart attack in women and men

chest pain or discomfort nausea , lightheaded, unusually tired pain or discomfort in the jaw, neck or back, arm or shoulders shortness of breath

(3) manifestations of CAD

chest pain that is more than angina diaphoresis SOB generalized weakness

(3) angina pectoris

chest pain that results when the heart does not get enough oxygen severe chest pain caused by myocardial ischemia sudden discomfort in chest, jaw, shoulders back and arms

(3) what is the essential HTN

chronic elevation in BP that occurs without disease

(1) In crisis the one yr anniversary is

critical

Can occur in any portion of GI tract Involves all layers of intestinal wall Usually affects the jejunum and ileum

crohns disease

(1) what are the levels neurotransmitters in bipolar disorder (depression and mania)

decrease in serotonin, acetylcholine and an increase in glutamate

(1) Lithium level after 3.5 mEq/L

delirium seizure coma cardiovascular collapse death possible

(1) Lithium toxicity at 3.5 mEq/L

delirium, seizures, coma, cardiovascular collapse, and death

(1) decanoate**

depot antipsychotic IM 1.5 20-21 gauge needle Z track method every 2 to 4 weeks

(1) Bipolar II Milder

depression & hypomania Hx occupational functioning still intact

what is the most common side effect of celiac disease

diarrhea is the most common although 38% of pts are asymptomatic

Which clinical manifestations of inflammatory bowel disease does the nurse determine are common to both patients with ulcerative colitis (UC) and Crohn's disease (select all that apply.)? Restricted to rectum Strictures are common Bloody

diarrhea stools Cramping abdominal pain Lesions penetrate intestine,Bloody, diarrhea stools Cramping abdominal pain Clinical manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.

(3) what are the calcium channel blockers that treat HTN

diltiazem verapamil nifedipine nicardipine amlodipine felodipine

a hard

distended abdomen (indicating possible intraabdominal bleeding)

In the presence of an obstruction, the appendix becomes

distended with fluid secreted by its mucosa. The pressure within the appendix increases, impairing blood supply and leading to inflammation, edema, ulceration, and infection.

Delaying defecation is a factor the contributes to the development of

diverticular disease

undigested food may collect inside the diverticula can cause .

diverticulitis

what are the complications of diverticulosis

diverticulitis hemorrhage

Diverticulosis is a term used when diverticula or diverticular disease is present. But if any of the pouches becomes inflamed, .

diverticulitis occurs

The nurse would educate the community group about blood in​ stools, abdominal​ cramps, stools that are narrow in​ diameter, and constipation alternating with diarrhea because these are manifestations of

diverticulosis

Which instruction should the nurse include when providing discharge instructions to a client diagnosed with peripheral arterial disease?

dont use a heating pad on the lower extremities. elastic support hose.reduce circulation so avoid 3. Instruct the client to walk daily for at least 30 minutes.to increase collatoral 4. Tell the client to check both feet for red areas weekly

(3) what are the diagnostic tests for DVT

duplex ultrasiund venography CT and MRI venous duplex imaging photoplethysmography ambulatory venous pressure

Nursing process for PUD (assessment and physical examination)

during the health history obtain Complaints of epigastric or left upper quadrant pain, heartburn, or discomfort Character, severity, timing, and relationship to eating Measures used to obtain relief Nausea or vomiting Presence of bright blood or "coffee-ground" material in vomitus Current medications, including the use of aspirin or other NSAIDs Cigarette smoking and use of alcohol or other drugs exam- General appearance, including height and weight Vital signs, including orthostatic changes Abdominal assessment, including shape, contour, bowel sounds, and tenderness to palpation Presence of obvious or occult blood in the vomitus and stool

what is the best damn way ever to prevent diverticular disease

eat yer vegetables and fruits not too much red meat or fat lots of water lose weight probably exercise wouldn't hurt avoid increasing intraabd pressure (N/V, constipation, bending, lifting, tight clothing) they used to teach that you should avoid nuts and seeds bc they can get stuck in the diverticula but apparently not anymore. so eat that granola.

Related to PUD, chronic infection of H. pylori bacteria results on

educed protection of gastric mucous by the gastric mucus. Repeated episodes of the inflammatory response in the chronic infection causes gastric cell damage without providing immunity to the repeated infection

What nutritional practice is recommended for a client managing pud in the evening

eliminate bedtime snacks to promote sleep

(3) management of PAD

endovascular repair angioplasty stenting radiation therapy percutaneous transluminal angioplasty PTA

lots of things can cause abd pain. what is found in each area?

epigastric pain can be r/t: PUD, MI, chole, pancreatitis *RLQ*: appendix, bowel, ureter, bladder, genital *RUQ*: liver, gallbladder, kidney, ureter *LUQ*: stomach, kidney, ureter *LLQ*: bowel, ureter, bladder, genital periumbilical pain can be r/t: small/large bowel obstruction, early appendicitis, AAA

complications of diverticulitis

erosion of bowel wall -> perf if body able to wall off perf -> abscess if not -> peritonitis

if chronic heartburn is not properly treated it can increase the risk of __________

esophageal cancer

What are some complications of GERD if left untreated?

esophageal strictures dysphagia barrett esophagus

(1) acute mania

euphoria, elation- continuous high, fragmented though, psychomotor activity , with impaired functioning

(1) Common side effect of lithium carbonate (Lithboid) that affects adherence

excessive weight gain. The nurse should explain to the client that weight gain is a common side effect of lithium carbonate. The nurse should educate the client on the importance of medication adherence and discuss concerns with the prescribing physician if the client does not wish to continue taking the medication.

what is strangulated intestinal obstruction

extremely serious and requires immediate medical attention

(1) Assessment for Bipolar depression

fam history substance abuser? domestic violence? mood and affect? suicide , plan? energy/ability sleep- perform ADLS and socializing

what are the risk factors of crohns disease

familial tendency 15-40 yrs autoimmune nausea and vomitting

Symptoms of a person experiencing dumping syndrome

flushing is an early sign that occurs within 5-30 mins of eating. orthostatic hypotension tachycardia

soft diet

foods must require little chewing and be easy to digest

A patient with diverticulitis should avoid which foods

foods with seeds such as popcorn, caraway seeds, figs and berries

(3) atherogenesis

formation of fatty plaque on the wall of an artery Stage 1- fatty streak stage 2- plaque progression stage 3- plaque disruption

Bulky

foul smelling Yellow, grey, and greasy,Characteristics of steatorrhea

Most colorectal cancers develop

from adenomatous polyps that develop into adenocarcinomas.

(3) what are the loop diuretics to treat HTN

furosemide bumetanide torsemide ethacrynic acid

Accumulation of fluid

gas, and GI contents → abdomen distention → low fluid, abscess and third spacing → hypotension and hypovolemic shock → bowel ischemia, necrosis, perforation,Pathophysiology for intestinal obstruction

Diagnosing IBD

goal: R/O other diseases, then differentiate between UC and Crohn's *labs* CBC: anemia? WBC: infection? lytes: vomiting or diarrhea? albumin: nutrition? ESR, CRP: inflammation? *imaging* contrast barium enema U/S, CT, MRI colonoscopy to visualize tissue, ulcerations, pseudopolyps, strictures, obtain Bx

(1) Grapefruit r/t the treatment of bipolar depression

grapefruit juice causes many interactions and should be avoided while treating bipolar depression

Cimetidine (Tagamet) Famotidine (Pepcid0 Ranitidine (Zantac) Nizatidine (Axid)

h2 receptor blockers that treat GERD

Where is McBurney's point?

halfway between navel and R iliac crest ("halfway" according to the book, 2/3 to, like, everyone else.)

(1) Suicide assessments / lethality scales

hamilton depression rating scale ASW national institute of mental health columbia- suicide severity rating scale (C-SSRS)

What is a GI Hernia

herniation into the thorax, through esophageal hiatus

(3)Why is HTN the silent killer

high BP is asymptomatic , can cause damages in the blood vessels in heart, kidneys and brain, eyes

When bacteria enter the peritoneal space, mast cells release

histamine and other vasoactive substances. This leads to local vasodilation and increased capillary permeability. With continued contamination, the peritoneal cavity will be inflamed. This inflammation causes fluid to shift into the peritoneal space, or third spacing. Circulating blood volume is depleted causing hypovolemia, and systemic infection or septicemia will develop.

(1) bipolar II milder

history of depression and hypomania, not full blown mania and does not affect social and occupational function

What is a polyp

hypergrowth of tissue from the bowel wall that protrudes into the bowel. The most common location for the development of these growths is the sigmoid colon and rectum.

What is the purpose of a CBC in the diagnosis of stomach cancer

identification of anemia.

What is the pathophysiology and risk involved in Barrett's esophagitis?

if GERD is left untreated the client may develop the complication. Pathophysiology: In Barrett's esophagus, normal tissue lining the esophagus -- the tube that carries food from the mouth to the stomach -- changes to tissue that resembles the lining of the intestine. it increases risk for esophageal adenocarcinoma

(3) what are things to monitor for in potassium sparing diuretics

if given with ACE inhibitors , monitor for hyperkalemia avoid salt substitutes containing potassium blue urine from triamterene monitor for impotence (weakness)

(3) high risk predictors for angina pectoris

if the angina is increased in duration, frequency, or at rest the associated ST segment or the T wave changes on the ECG

In the assessment of a client with diverticular disease it is important to ask

if the client has experienced nausea and vomiting because these are symptoms of diverticular disease. Blood may be visible in stool because of the irritation of the intestinal mucosal lining. The abdomen will most likely be​ tender, especially on the left side. Bowel sounds will be present but may be hyperactive or hypoactive.

Which client problem would be priority in a client diagnosed with arterial occlusive disease who is admitted to the hospital with a foot ulcer?

impaired skin integrity The client has a foot ulcer; therefore, the protective lining of the body—the skin—has been impaired

what is a intestinal obstruction

impairment of the forward movement of intestinal contents

(1)Severe bipolar disorder

impairs occupational functioning, relationships and requires hospitalization

(3) where does DVT usually form

in the lower extremeties or pelvic deepvevin

where does diverticula most often form

in the sigmoid colon

When treating GERD which nutrition interventions are implemented

in treating GERD the patient should be advised to eliminate acidic foods (tomato products, citrus, spicy, chocolate fatty foods, peppermint, alcohol) They should try to maintain an ideal body weight, eat smaller meals, refrain from eating meals 3h before bedtime. After eating, stay upright for 2 hours and the head of their bed should be elevated with 6-8 inch blocks

s/s appendix has perfed

inc pain high fever (remember old ppl may not have fever)

MI and is hypotensive which assessment would you find

increased HR and RR The client may not be able to compensate for long, and decreased oxygenation and cool, clammy skin will occur later.

what is peritonitis

inflammation of the peritoneum, is a serious complication of abdominal disorders. It is usually caused by bacteria entering the peritoneal cavity from a perforated ulcer, ruptured appendix, perforated diverticulum, necrotic bowel, or during abdominal surgery. Other causes of peritonitis include pelvic inflammatory disease (PID), gallbladder rupture, abdominal trauma, and peritoneal dialysis.

what is appendicitis

inflammation of the vermiform appendix, is a common cause of abdominal pain. It is the most common reason for emergency abdominal surgery. It can occur at any age but is more common in adolescents and young adults. It is slightly more common in men than women. results from contamination of the tissue by the client's own resident bacteria.

A colostomy may be indicated if there is an (colorectal cancer)

inoperable tumor obstructing the bowel; the bowel was resected and needs to heal; or the sigmoid colon, rectum, and anus are permanently removed.

(3) what are the manifestations of PAD

intermittent claudification pain caused by reduced blood flow cramping aching fatigue cold, numbness, pallor, cyanosis weakness diminished or absent pulses shiny dry skin sparse hair ulcers poor healing the pain increases with ambulation , elevation of extremity rest the limb erectile dysfunction

complications of crohns disease

intra abdominal abscessess intestinal fistulas peritonitis development of fistulas

(1) Dystonia (EPS)

involuntary muscle spasms/ movements int he face arms legs

What are the surgeries used to treat GERD

involves increasing LES pressure -laparoscopic fundoplication (Gastric fundus wrapped around the distal esophagus Treatment of choice for GERD) -nissen fundoplication (the most common procedure for GERD. Fundus of the stomach wrapped around the lower esophagus, and the edges are sutured together)

Cause not known Prevalence is 10% to 20% Abdominal pain and discomfort Changes in stool patterns Diagnosis based on 6 months of symptoms

irritable bowel syndrome IBS

laparotomy surgery

is done if peritonitis caused by a perforation, gangrenous bowel, or inflamed appendix and is used to close the perforation or remove the damaged and inflamed tissue Peritoneal lavage, or washing of the peritoneal cavity with warm isotonic fluid, may be done during surgery. Will have a Penrose or Jackson-Pratt closed drainage system placed during surgery

The nurse is discussing the importance of exercise with the client diagnosed with coronary artery disease. Which intervention should the nurse implement?

isotonic excercise that increase muscle tone walk 30 mins a day the client should not exercise in the cold wear closed toed shoe

(2) How does smoking cigarettes increase the risk for peptic ulcers

it inhibits the secretion of bicarbonate by the pancreas

(2) How does Famotidine (Pepcid) treat acid in the gastric mucosa

it is a h2 receptor blocker that reduces the amount and effects of hydrochloric acid on the gastric mucosa

(2) How does Omeprazole (Prilosec) treat acid in the gastric mucosa

it is a proton pump inhibitor that reduces the amount and effects of hydrochloric acid on the gastric mucosa

(3) what is beta blocker 1

it is cardioselective MAE metoprolol atenolol esolol

What is the incidence of GI hernias

it is more prevalent on western countries the chance is more prevalent in western countries, it is more common in women, obesity, pregnancy, and intra-abdominal pressure

(2) How does Sucralfate (Carafate) treat acid in the gastric mucosa

it prevents the damaging effects of acid and pepsin on the gastric tissues

How does the risk factor of cigarette smoking cause gastric ulcers

it prevents the pancreas from secreting bicarbonate it also allows the GI juice to flow more rapidly into the duodenum

linx system

jewelry around esophagus

Buttocks

knees, and elbows,Dermatitis herpetiformis is a rash on these locations

(1) delirous mania

labile, clouded thinking agitation with purposeless movement

(1) anger manifestation

lack of control

(3) what are the complications of HTN

large and small vessel damage organ damage retinopathy nephrosclerosis CKD renal failure ischemic heart disease angina left ventricular hypertrophy heart failure peripheral arterial disease

An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client?

long-term use is associated with osteoporosis and osteoporosis-related fractures. This client is already at higher risk for this problem and should be instructed to increase calcium and vitamin D intake.

(3) what are the ARBS drugs used to treat HTN

losartan valsartan irbesartan candesartan olmesartan

tx for stage 2 CRC

lower-risk: wide resection & anastomosis higher-risk: wide resection & anastomosis plus chemo

Education regarding prevention of diverticular disease

maintain a high fiber diet Ensure an adequate oral intake of fluids Ensure adequate daily exercise Encourage a low sugar diet

treatment for HTN

maintain body weight DASH diet limit alcohol Participate in aerobic exercise for 30 minutes 5 or 6 days of the week. stop smoking manage stress

Tubular and tubulovillous polyps can develop into

malignant tumors but not as frequently as adenomatous polyps.

(1) Signs of bipolar disorder

manic-depression hallucination/delusion may be present affects ADL's to the point of hospitalization

manifestations that include a sore throat caused by the reflux of gastric​ contents, which is acidic in nature and irritates the mucous lining. Over​ time, the lower esophageal sphincter may become damaged because of repeated exposures to acidic gastric contents and permit the movement of stomach contents into the esophagus. This esophageal irritation may result in difficult or painful swallowing. Heartburn is likely to occur but would occur after meals and when​ intra-abdominal pressure increases or body position enhances gravitational backflow of stomach contents

manifestations of GERD

Manifestations of epigastric pain that is described as burning or aching in nature because acidic gastric contents bathe the​ open, ulcerated area of the stomach or duodenum. The pain is noted when the stomach is empty when gastric secretions are present without food to digest.

manifestations of PUD

Therapeutic interventions that address reduced fluid volume related to peritonitis include

measuring all​ output, including urine every 1 to 2​ hours, and measuring gastrointestinal drainage every 4 hours. Cardiac output can also give information about fluid balance.

People with GERD experience

mild to severe heartburn sour taste in mouth/morning, regurgitation, coughing, belching and chest pain. They may have atypical symptoms like asthma or a cough. Obesity, pregnancy, hiatal hernias increase the chances and onset is 50 y/o

(3) what would you monitor for in thiazide diuretics

monitor for dehydration hypokalemia hyperglycemia risk for digoxin toxicity if hypokalemia is present

(3) what would you monitor for in loop diuretics when treating HTN

monitor for dehydration hyponatremua hypochloremia hypokalemia hypocalcemia hypomagnesemia there is an increased risk for digoxin toxicity in hypokalemia risk for postural hypotension and ototoxicity avoid late time admin monitor for hyperglycemia

(3) monitor while taking HTN

monitor for orthostatic hypotenstion results in dry cough monitor for hyperkalemia and avoid potassium salt may cause angioedema which is life threatening so give epinephrine

Sucralfate is a

mucosal barrier fortifier (protector)

(1) akinesia (EPS)

muscular weakness (pseudoparkisonism)

how do antacids work

neutralize gastric acid and relieve pain at the site of esophageal and gastric mucosa.

(1) The do not list for taking meds for bipolar disorder

never discontinue abruptly even when pt. is feeling better drive while taking a new drug ETOH and OTC that interacts Pregnancy Sun/Heat exposure Smoking Antidepressants are not FDA approved to treat bipolar disorder, or mania to avoid serotonin syndrome

what is the surgery for incarcerated hernia

nissen fundoplication

(3) A highly stressed client is newly diagnosed with hypertension. What nonpharmacologic treatment option would best help the client maintain normal blood​ pressure?

non competetive sports aerobic exercise 5-6 days meditation

(3) what is coronary artery disease

nonmodifiable risk factors are age heredity male modifiable risk factors hyperlipidemia HTN smoking diabetes inactivitu obesity

(3) what is beta blocker 2

nonselective beta blockers LPN labetalol propranolol nadolo contraindicated in patient with asthma because it can cause bronchoconstriction may cause hypoglycemia in diabetics and erectile dysfuntion

(1) cyclothymia

not hypomanic yet, elevated and depressed mood disturbance for atleast 2 years functioning

The nurse would anticipate that a client with an acute bout of diverticulitis will initially be given

nothing by mouth with intravenous fluids.

Risk factors for the development of hernias include

obesity, pregnancy, weightlifting, and abdominal tumors.

Common cause of appendicitis?

obstruction caused by a fecalith (poop stone) also: inflammation tumor parasitic invasion edema of lymphoid tissue

The most common cause of appendicitis is an

obstruction caused by a fecalith, a hard mass of feces, a calculus, a foreign body, inflammation, tumor, parasites, or edema of lymphoid tissue

(2) Describe the characteristics of pain with Peptic Ulcer disease (PUD)

occurs 2-3 hours after meals,it is relieved by eating not avoiding food, patient will describe the pain in the epigastric region and radiates to the back, that transpired during the middle of the night

intestinal obstruction

occurs when intestinal contents cannot move through the lumen of the bowel. When there is an obstruction in the intestines, gas and fluid accumulate around the obstruction. This causes bowel distention, which interferes with peristalsis. The result is bowel atony and further distention. Blood flow to the distended area is compromised, which leads to necrosis. The bowel can become gangrenous and perforate into the abdominal, cavity causing peritonitis and sepsis. Intestinal obstructions are categorized as being either functional or mechanical

The nurse is teaching the client diagnosed with arterial occlusive disease. Which interventions should the nurse include in the teaching? Select all that apply. 1. Wash legs and feet daily in warm water. 2. Apply moisturizing cream to feet. 3. Buy shoes in the morning hours only. 4. Do not wear any type of knee stocking. 5. Wear clean white cotton socks

old water causes vasoconstriction and hot water may burn the client's feet; therefore, warm (tepid) water should be recommended. 2. Moisturizing prevents drying of the feet. 3. Shoes should be purchased in the afternoon when the feet are the largest. 4. This will further decrease circulation to the legs. 5. Colored socks have dye, and dirty socks may cause foot irritation that may lead to breaks in the skin.

(3) risk factors for PAD

older African americans smoking diabetes hyperlipidemia HTN

the sphincter in GERD is ____ allowing reflux

open

what if pt gets diverticulitis a lot

or gets complications?,oh man :( they probably need a colon resection maybe a temporary colostomy while stuff heals

A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The client's blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate

orthostatic changes to the blood pressure, indicating fluid volume loss. The nurse should start a large-bore IV with isotonic solution

The wound

ostomy, and continence nurse (WOCN) selects the site where the ostomy will be placed. What should be included in site consideration? The patient must be able to see the site. The site should be outside the rectus muscle area. It is easier to seal the drainage bag to a protruding area. A waistline site will allow using a belt to hold the appliance in place.,The patient must be able to see the site. In selection of the ostomy site, the WOC nurse will want a site visible to the patient so the patient can take care of it, within the rectus muscle to avoid hernias, and on a flat surface to more easily create a good seal with the drainage bag. Care should be taken to avoid skin creases, scars, and belt lines, which can interfere with the adherence of the appliance.

(3) hypertensive emergency

over 180/120 can cause potential organ damage may lead to stroke, angina, MI, damage to the eyes, kidneys and pulmonary edema it is caused by sudden withdrawal of meds, acute and chronic renal failure, chronic hypertension, and vasculitis

(1) aggression manifestations

pacing restless threatening, even with body language loud, argumentative saying obscene things suspicious threats!! panic destruction of property harmful defensive posture could cause physical harm to others

Manifestations of appendicitis include

pain aggravated by movement or​ coughing, a​ low-grade fever, and increased pain upon internal rotation of the right hip. Rebound tenderness is to McBurney point in the lower​ right,

Your client with colorectal cancer will have problems with

pain, nutrition, and grieving.

interventions for pt. w/ PUD

pain- SOCRATES, Meds, relaxation insomnia- meds, limit evening meal/snack, relaxation reduced intake- diet, schedule, dietician, monitor anemia other deficits active gi bleed- Monitor stools and gastric drainage for overt and occult blood. Provide intravenous fluid replacement therapy as prescribed. Provide blood replacement infusions as prescribed. Insert nasogastric tube and maintain position and patency. Measure and record gastric output every hour and then every 4 to 8 hours as condition warrants. Monitor hemoglobin, hematocrit, and serum electrolyte values. Assess bowel sounds, abdominal distention, girth, and tenderness every 4 hours. Maintain bed rest with head of bed elevated.

(3) management of pt with DVT

patient may ambulate as tolerated elevation 10-20 degrees above level of the heart local application of most heat dont massage area as clots can break loose wear GCS graduated compression stockings

A polypectomy is used to remove

pedunculated and small villous masses. Masses are removed with an electrocautery snare or hot biopsy forceps passed through the scope.

Avoid late night snacks and meals Avoid milk products at night Take fluids between meals and not with meals No high-fat foods Avoid chocolate

peppermint, caffeine, and acidic foods,Nutritional therapy for the treatment of GERD

What is the worst complication of diverticulitis

perforation of the bowel with resulting peritonitis. This occurs because of ischemia at occluded diverticula. The lack of blood supply weakens the intestinal mucosa and the intestinal muscular layer.

rigid board like abdomen absence of bowel sounds severe upper abdominal pain

perforation of the stomach

A hard mass fills the diverticula, reducing the blood supply to the area. This leads to ischemia and possible

perforation. If perforation occurs, abscesses can form along the bowel wall, leading to peritonitis.

(3) what to monitor while taking CCB

peripheral edema avoid grapefruit can lead to toxicity

what are the complications of diverticulitis

peritonitis abscesses bowel obstruction fistula formation hemorrhage

The nurse is educating a student nurse about risk factors associated with stomach cancer. What factor places a client at risk for developing this​ cancer?

pernicious anemia chronic gastritis achlorhydia

what happens in mechanical bowel obstruction

physical blockage in the lumen

The client previously had a diagnostic colonoscopy that showed a small pedunculated villous polyp. What is the treatment of choice for polyp removal in this​ client?

polypectomy

Your care of the client with stomach cancer will focus on interventions to address______

postoperative care nutritional needs feeding tuber care needs and ongoing care

(1) Assessment: risk factors of crisis

potential for violence or history of it their diagnosis, their current behavior. If they are angry, have aggression, and show signs of psychosis (delusions and hallucinations)

what is diverticula

pouches that develop along the inner lining of the large intestine, occurs anywhere in the colon except for the rectum

(1) decreased serotonin in depression and mania

predisposing factor-biogenic amine

Your client with colorectal cancer may be scheduled for abdominal surgery to remove the cancer and create a colostomy. Your client's needs at this time will include

preoperative preparation, postoperative care, and ostomy care.

what class is esomeprazole (nexium)

proton pump inhibitor

What is the drug of choice for GERD

proton pump inhibitors like Esomeprazole (nexium) Iansoprazole (Prevacid) Omeprazole (Prilosec) Pantoprazole (Protonix) rabeprazole (AcipHex)

what is herniation

protrusion of an anatomical structure from its normal location

(1) Antipsychotics in Bipolar depression treats

psychosis R/T hallucinations, delusions

(3) what are the complications of DVT

pulmonary embolism postphlebitic (post thrombotic) syndrome venous ulcers

The treatment of colorectal cancer includes surgery and the adjunctive use of

radiation and chemotherapy

labs to diagnose hernias

rbc , hgb, and hct levels serum albumin Aspartate aminotransferase (AST) Alanine aminotransferase (ALT) Alkaline phosphatase (ALP)

appendicitis diagnostic signs

rebound pain @ McBurney's point Psoas sign: hyperextension of leg Rovsing's sign: palpation of LLQ increases pain in RLQ

what is a nonmechanical bowel obstruction

reduced or absent peristalsis can be neuromuscular or vascular most common type is *paralytic ileus*

How do proton pump inhibitors work

reduces gastric acid secretion by inhibiting the action of the​ hydrogen-potassium-ATP pump.

what are the symptoms of GI hernias

reflux heartburn feeling full belching indigestion substernal chest pain

what is the medical focus of PUD

relief of the symptoms, eradicate the infection and prevent the complications

how to treat intestinal obstructions

relieving the obstruction and pressure to avoid perforation a NGT tube was used to decompress the bowel a surgery used is mechanical obstruction or strangulation

After eating a​ meal, a client with GERD should

remain in an upright position so the gastric contents will remain in the stomach and not be refluxed into the esophagus

Partial Gastrectomy surgery to treat stomach cancer

removal of a portion of the stomach (Gastroduodenostomy (Billroth I) and gastrojejunostomy (Billroth II) commonly used)

tx for stage 1 CRC

remove tumor and >=5cm of bowel on either side remove nearby lymph nodes

Changes in bowel habits Unexplained weight loss Vague abdominal pain Rectal bleeding Narrow

ribbon-like stool Weakness/fatigue,Signs and symptoms of colorectal cancer

what are diverticula? diverticulosis? diverticulitis?

saccular dilations/outpouchings of the colon mucosa diverticulosis: having diverticula they're common, esp in older adults, but most people don't get diverticulitis, wherein they become inflamed/bleed

Related to PUD cigarette smoking inhibits

secretion of bicarbonate by the​ pancreas, which is intended to buffer the acidity of the gastric secretions. Cigarette smoking also enhances rapid gastric transit into the​ duodenum, which is a common site of ulceration.

General NO foods on low residue diet

seeds, skins, nuts, whole grains, most raw veggies legumes, gassy vegetables, corn (inc popcorn) tough gristly meat pickles, olives MORE LIKE POPCORN, AMIRITE

postop CRC drainage is usually

serosanguineous

how can polyps adhere to the bowel wall

sessile (raised nodule) pedunculated (attached by a stalk

Sudden dramatic signs and symptoms Sudden

severe abdomen pain that radiates to the back Rigid, board-like abdomen Rapid and shallow breathing Tachycardia Absent bowel sounds,Signs and symptoms of perforation with PUD

nursing care of peritonitis

similar to appy management - NPO, pain, N/V, fluids

3 types of appendicitis

simple gangrenous perfed

(1) Bipolar 1 (Severe)

single manic episode, depression. hypomania occupational. occupational functioning impaired

where are mechanical bowel obstructions usually found

small bowel

(3) management of PAD ongoing interventions

smoking cessation control glucose (diabetics) avoid trauma, heat, sunburn to legs and feet

causes of nonmechanical bowel obstruction

some degree of paralytic ileus happens p any *abd sx. * other causes: - *peritonitis* - acute *inflammation* (eg pancreatitis, appendicitis) - hypokalemia or other lytes off - T- or L-*spine fracture*

(3) what are the potassium sparing diuretics to treat HTN

spironolactone triamterene amiloride it blocks the action of aldosterone resulting in retention of potassium

appendicitis s/s?

starts c *dull persistent* periumbilical pain that shifts to RLQ low-grade fever abdominal rigidity, tenderness, guarding rebound tenderness pt may prefer to lie still c RLE flexed.

(1) list de-esculation techniques

stay with client calm voice helpful attitude

how does a promotility agent work

stimulates gastric emptying

(3) in treatment of HTN what would you teach

stop smoking no alcohol ( 3 or more per day causes HTN) maintain weight

(1) Hamilton, ASQ, Columbia

suicide assessments

common causes of small bowel obstruction

surgical *adhesions* also *hernia, strictures, intussusception*

The nurse is caring for a client with inflammatory bowel disease who is being treated with corticosteroids. Which information would the nurse provide for the client about the​ medications?

taken with food or at mealtimes to reduce the gastrointestinal side effects. they should be taken consistently and not be stopped abruptly to reduce the possibility of adrenal shutdown. tends to retain​ fluid, and sodium tends to exacerbate the retention.​ the client should reduce the intake of foods that are high in sodium. tends to​ gain. tends to have​ blood pressure

What are some factors that contributes to the development of diverticular disease

the aging process a diet low in fiber decreasing activity A diet high in sugar and delaying defecation

(2) What is GERD

the backward flowing of gastric contents into the esophagus

the more distal the ostomy

the bowel movements will appear,more distal = more normal BM most water resorbed in colon, so ileostomies tend to have *watery* loose effluent

treatment of bowel obstruction depends on...

the cause - find and alleviate

if bowel perforation occurs in diverticular disease what are the signs

the client would experience severe abdominal pain. There will be an increase in abdominal girth as bowel contents leave the bowel and fill the peritoneal cavity. Bowel sounds will change because the intestinal contents will not be contained in the intestinal tract. Burping and flatus will not occur because air or gas will have escaped the gastrointestinal tract.

(3) What is systolic pressure indicate

the max pressure in aorta and the major arteries, the contraction

(3) what is diastolic pressure indicate

the minimum pressure in the arteries, the relaxation

(1) What is the most challenging obstacle in the treatment of those diagnosed with BPD

the most critical challenge in the care of clients diagnosed with bipolar disorder is that treatment is often compromised when clients choose not to take their medications. Clients diagnosed with bipolar disorder feel most productive and creative during manic episodes. This may lead to purposeful medication nonadherence. Symptoms of bipolar disorder will reemerge if medication is stopped.

The colostomy in diverticular disease is intended to be temporary to allow

the remaining affected bowel to heal. By not allowing stool to pass through the affected​ colon, irritation and inflammation are reduced.

Patient teaching on how to avoid dumping syndrome

the size of the stomach is reduced because of partial removal of it. food should be eaten in small meals not big meals, so intake water between meals not during Clients should lie down to reduce the effect of gravity on gastric motility.

The male client is diagnosed with coronary artery disease (CAD) and is prescribed sublingual nitroglycerin. what are the teachings

the tabs should be kept in a dark bottle to maintain potency they should burn or sting when under the tongue they should be kept close in case of pain one tab every 5 mins , after 3 doses call 911

(3) varicose veins

the veins are dilated, tortuous in the LE incompetent valves lead to valve reflux Jobs that require standing, History of phlebitis or clotsOther potential risk factors: low-fiber diet, smoking, hypertension, pregnancy, injury risk in older age, family history, female and obesity

how are polyps categorized

there are three types, tubular villous and tubulovillous they are also categorized by how polyps adhere to the bowel wall-sessile (raised nodule) pedunculated (attached by a stalk

(1) neuroanatomical factors of bipolar disease

there is a positive emission tomography (PET) depression is shown on the anterior left side of the brain and the mania shows a reduction of activity on the right side of the brain

(1) What is psychosis

they are not in tune with reality

(3) thiazide diuretics r/t potassium

they are potassium wasting

What is the onset for duodenal ulcers

they are the most common GI ulcer and develop between the ages of 30-55 yrs

Proton pump inhibitors treat GERD. How do they do so

they inhibit the hydrogen-potassium-ATP pump to reduce gastric acid secretion Theyre usually prescribed for 8 weeks, after treatment relaspe is possible they may interfere with the absorption of calcium and b12

(1) Describe anticonvulsants for Bipolar depression

they may increase or decrease the effects of many meds like birth control People with hypersensitivity to the drug, the elderly, those who have liver, renal, cardiac disease, are pregnant and lactating should avoid this drug

Prior endoscopy with dilation of the nares

they should be NPO there will be a sedative no gag reflex high fowlers position base lines inflate stomach to get a better picture passing flatus, and cramping (methicone anti-gas) after procedure check vitals and gag reflex

What happens when the ulcerated area perforates in peptic ulcer disease

they will experience severe pain in the upper abdomen. the bowel sounds will be absent because the GI System is not intact, the gastric contents wont be moving which is what causes bowel sounds. the rigid board like abdomen will be from gastric contents that have leaked out of the GI system and blood will begin to fill the abdomen. tachycardia from the pain and blood loss

How does the risk factor of Aspirin and NSAIDs cause gastric ulcers

those drugs interrupt prostaglandins (Class of local hormones that promote local inflammation and pain when released by cells in the body.) by disrupting COX which is the hormone that allows the release of prostaglandins The drug also crosses the lipid membrane of the GI cells, and damages them

(1) What is the intervention for crisis

try to solve the problem, the resolution of immediate crisis. help them FOCUS to restore a better level of functioning. Restore the person back to pre-crisis functioning or better.

surgeries used to treat colorectal cancer

tumor resection (choice) laser photocoagulation-Used for clients unable to tolerate major surgery Used for palliative surgery to remove obstructions Used to destroy small tumors Performed during endoscopic procedures local excision Performed during endoscopy Eliminates the need for abdominal surgery Used for small localized tumors fulguration Use of electrocoagulation to shrink tumors for clients who are poor surgical risks May need to be repeated if mass growth increases

(1) Fast acting antipsychotics

typical 1st generation

what is a duodenal ulcer and where can it be found

ulcer located in the duodenum, it usually develops in the proximal portion of the duodenum close to the pylorus they are usually less than 1 cm in diameter and sharply demarcated

gastric ulcer

ulcer located in the stomach, it is usually found on the lesser curvature and the area immediately proximal to the pylorus

Long-lasting inflammation and ulcers Affects the innermost lining of large intestine and rectum Symptoms usually develop over time (rather than suddenly)

ulcerative colitis

2 types of inflammatory bowel disease

ulcerative colitis Crohn's

What is the drug rifaximin (xifaxan) treat

uncomplicated diverticular disease

(1) Oculgyric crisis (EPS)

uncontrolled rolling to the back of the eyes, **if combined with Dystonia it can lead to laryngospasm which is dangerous and can lead to death

(1) crisis

unexpected situation that may require assistance with recovery

(3) A nurse in the outpatient clinic is admitting a client. The client was recently diagnosed with hypertension. The nurse would anticipate orders for what diagnostic tests for this​ client?

urinalysis electrocardiogram serum creatinine An electrocardiogram helps identify cardiac complications of hypertension. Hypertension causes enlarged left​ ventricle, dysrhythmias, and heart failure. Serum creatinine helps diagnose kidney damage from hypertension. The health care provider would order other diagnostic tests based on the results of a serum creatinine. Hypertension can cause kidney damage. A urinalysis will help identify signs of this damage such as proteinuria​ (protein in the​ urine) and microscopic hematuria

Can cause yellow/orange discoloration of the skin

urine, and tears,Education for Sulfasalazine

(3) ankle brachial index ABI used for and limits

used for PAD normal 0.9-1.3 0.41 to 0.9 mild to moderate PAD 0.4 and lower is severe PAD

diverticulitis

usually affects one of the diverticula. It most commonly occurs in the sigmoid colon and is caused by undigested food or bacteria that collect inside of the diverticula.

surgical Tx of Crohn's

usually done to address complications: - strictures - obstructions - bleeds - fistulas remove segment and anastomose ends of remaining bowel. (problem: recurrence often occurs at anastomosis)

diagnosing diverticulosis

usually found during routine sigmoid/colonoscopy

tx for stage 4 CRC

usually palliative - chemo, XRT to control spread and alleviate pain. some stage IV c limited lung/liver mets may be able to be cured

perioperative CRC care

varies! - some may bowel prep, some may not - may be able to maintain bowel function - or may have an ostomy - may have drains - may have open, packed wounds

(3) what contributes to DVT

venous stasis hypercoagubility immobility presence may not be known until pt. develops pulmonary embolism they usually begin in the deep veins of the calf some have no discomfort, others complain of unilateral pain, edema, warmth and tenderness

(3) the incidence of HTN

very prevalent, 1 out of 3, equal in men and women major risk factor stroke, heart disease, heart failure

Diarrhea and mucous discharge can occur as manifestations of which polyp in colorectal cancer

villous polyp

(1) What are the early signs of lithium toxicity at 1.5 mEq/L

vomiting, diarrhea

(3) teaching for pt with DVT

walk regularly do foot and ankle exercises and elevate the feet understand med regimen avoid sitting for a long time, standing, or crossing legs

(2) Common side effect of Valproic acid (Depakote)

weight loss

late symptoms of stomach cancer include

weight loss that is often severe, occult blood in the stool and a palpable mass as the tumor grows.

Fruits & veg that are OK on low-residue?

well-cooked potatoes without skin tomato sauce (no skin/seeds) bananas soft melon avocado canned/cooked fruit without skin/seeds God, this is a depressing diet

How do polyps occur

when epithelial cells in the bowels become tightly packed, overproduction occurds, excess cells group together and become an adenoma (Benign tumor of glandular tissue.)

When teaching the patient about the diet for diverticular disease

which foods should the nurse recommend? White bread, cheese, and green beans Fresh tomatoes, pears, and corn flakes Oranges, baked potatoes, and raw carrots Dried beans, All Bran (100%) cereal, and raspberries,Dried beans, All Bran (100%) cereal, and raspberries A high-fiber diet is recommended for diverticular disease. Dried beans, All Bran (100%) cereal, and raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots.

When evaluating the patient's understanding about the care of the ileostomy

which statement by the patient indicates the patient needs more teaching? "I will be able to regulate when I have stools." "I will be able to wear the pouch until it leaks." "The drainage from my stoma can damage my skin." "Dried fruit and popcorn must be chewed very well.","I will be able to regulate when I have stools." An ileostomy is in the ileum and drains liquid stool frequently, unlike a colostomy, which has more formed stool the farther distal the ostomy is in the colon. The ileostomy pouch is usually worn for 4 to 7 days or until it leaks. It must be changed immediately if it leaks because the drainage is very irritating to the skin. To avoid obstruction, popcorn, dried fruit, coconut, mushrooms, olives, stringy vegetables, food with skin, and meats with casings must be chewed extremely well before swallowing because of the narrow diameter of the ileostomy lumen.

(1) Anger manifestations

yelling/shouting intense eye contact easily offended and sensitive defensive to criticism passive-aggrassive lack of control flushed face anxious tense facial

A nurse in the outpatient clinic is gathering health information from a​ 24-year-old female client. The client tells the nurse that she used to take oral contraceptives but had to stop because of high blood pressure. The​ client's blood pressure is currently normal without medication. What is the best response by the​ nurse?

​"Oral contraceptives can cause the body to retain​ fluid, which contributes to​ hypertension." Oral contraceptives can affect the​ renin-angiotensin-aldosterone system. This causes the body to retain sodium and​ fluid, leading to hypertension. This is a known cause of secondary hypertension.

The nurse is reviewing the admission orders for a client admitted with peritonitis. The nurse recognizes that which orders will address the pathophysiology behind the​ diagnosis?

​0.9% NSS at 125​ mL/hr (Intravenous fluids are important to reverse the hypovolemia caused by the effects of histamine and third spacing) Imipenem​ (Primaxin) 250 mg IV every 6 hr. (Imipenem is a​ broad-spectrum antibiotic that will address infection until the specific infecting organism can be identified.) Parenteral nutrition is used as a supportive measure in peritonitis to provide nutrients while the bowel is not functioning.

Asymptomatic

Hiatal hernias are usually this in terms of signs and symptoms

Low fiber

High intraluminal pressure is from this

Glaucoma Bladder obstruction BPH Biliary obstruction

These are contraindications to using anticholinergics

Cultures Diet Alcohol intake Coffee Psychological stress Smoking

These are lifestyle factors that can cause PUD

Autoimmune problems H. pylori Smoking Exposure to irritants GAstritis PUD INjury

These are other causes of stomach cancer

Perforation Rupture

These are secondary causes of peritonitis

Maalox Mylanta

These are types of antacids

Toxic megacolon

This is a life-threatening enlargement of the colon

Avoid triggers

This is a lifestyle modification for the treatment of GERD

Duodenal

This is a more common type of PUD

Diverticulosis

This is a non-inflamed diverticula

More pillows

This is a non-medical treatment of GERD

Reduces inflammation in the GI

This is how Sulfasalazine relieves symptoms in irritable bowel disease

Reduces the amount of acidity and motility in the stomach

This is how a vagotomy treated PUD

Stimulates gastric acid secretion

This is how alcohol can cause PUD

Creates a stress response

This is how burns causes gastritis

Stimulates gastric acid secretion

This is how coffee can cause PUD

Does not allow the mucosal barrier to renew itself

This is how corticosteroids can cause PUD

The body is trying to bypass the obstruction

This is how fistulas form in colorectal cancer

Months Intermittently in a lifetime

This is how long chronic PUD lasts for

Increases acid

This is how psychological stress can cause PUD

Causes metabolic acidosis

This is how renal failure causes gastritis

Causes metabolic acidosis

This is how sepsis causes gastritis

Delays healing of the gastric mucosa

This is how smoking can cause PUD

A client with stomach cancer will manifest which symptoms (early signs)

-early satiety -anorexia -indigestion -vomiting -ulcer like pain relieved by antacids after meals

A complication of PUD is obstruction, how is it managed

-gastric decompression with NG suction -IV fluids with electrolytes to restore imbalances Treatment: balloon dilation of the gastric outlet via upper endoscopy

Chronic PUD

This is the most common type of PUD

Lactose intolerance

This is the most common type of malabsorption syndrome

Hemoglobin

This is the most important lab for an upper GI bleed

McBurney's point

This is the most tender point in the *early* stage of appendicitis

Intestinal biopsy

This is the number one diagnostic rest for celiac disease

Prozac

This is the number one drug that can cause PUD (Hint: it is an SSRI)

Steatorrhea

This is the number one sign of malabsorption syndrome

Endoscopy

This is the number one test for chronic abdominal pain

Surgery

This is the number one treatment for stomach cancer

30 minutes

This is the onset for antacids

1 hours

This is the onset of H2 blockers

5-6

This is the optimal pH for digestion

IV fluids NG tube Clear liquid diet Soft foods

This is the order of progression of nutritional therapy for nausea and vomiting

CTZ

This is the part of the brain where antiemetics work

Vomiting

This is the partial ejection of foods from the stomach

HOB 30 degrees Should not lay down 2-3 hours after eating

This is the positioning for GERD

Organisms causing swelling

This is the primary cause of peritonitis

Treat the underlying cause

This is the primary treatment for nausea and vomiting

Can go through the wall of the digestive organ

This is the problem with chronic PUD

Protein that is OK on low-residue

Milk/dairy OK unless you're lactose intolerant Tender, lean meat OK Eggs OK None of the above are high fiber foods, so generally OK if soft

For which client would the nurse suggest the provider not prescribe misoprostol (Cytotec)?

Misoprostol can cause abortion, so pregnant women should not take this drug

Vagotomy

This is the the removal of part of the vagus nerve

Colorectal cancer

This is the third most common form of cacer

HALO

This is the treatment of Barrett's esophagus

Strictures

This is the twisting of the bowel

Hematemesis

This is the vomiting of blood

Angiogenesis inhibitors

This is used for targeted therapy in colorectal cancer

EGD

This is used for the diagnosis of Barrett's esophagus

H&P Signs and symptoms Barium swallow Upper GI endoscopy Biopsy

This is used for the diagnosis of GERD

EGD Endoscopy with biopsy Endoscopic U/S (EUS) Barium swallow CT/MRI

This is used for the diagnosis of esophageal cancer

Use a wire or mesh that is placed to strengthen the abdominal wall

This is what is done for a herniorrhaphy

If conservative treatment does not work Ulcer is going to perforate

This is when surgery is done for the treatment of PUD

Acute pain in the LLQ Palpable abdomen mass Systemic signs and symptoms of an infection Abscess (localized pus) Peritonitis (if it bursts)

Signs and symptoms of diverticulitis

Asymptomatic Abdomen pain Bloating Flatulence

Signs and symptoms of diverticulosis

Severe heartburn Difficulty swallowing Food impaction in the esophagus N/V Weight loss

Signs and symptoms of eosinophilic esophagitis

Progressive dysphagia Sub-sternal Pain (late) Weight loss Regurge Location → sore throat Choking → hoarseness

Signs and symptoms of esophageal cancer

Bleeding in the vomit

Signs and symptoms of hemorrhage in PUD

Rectal bleeding on one side of stool Pruritus Prolase Pain (increased with pressure)

Signs and symptoms of hemorrhoids

Soft and reducible Severe burning pain relieved by sitting or standing Heartburn Dysphagia

Signs and symptoms of hiatal hernias

Feel like something is stuck in the throat

This is why a person will have a chronic cough with esophageal diverticula

Colon helps absorbs the water

This is why diarrhea occurs with irritable bowel disease

May trigger a spasm and may induce vomiting

This is why extremely hot and cold liquids are avoided for a clear liquid diet

Food is foul tasting

This is why regurgitation occurs with esophageal diverticula

1 in 15

This many people will have appendicitis

Cauterize the bleed

This may be done during an endoscopy for an upper GI bleed

Numbing medication

This may be given when going a rubber band ligation for hemorrhoids

Ileostomy

This may be needed after a total proctocolectomy

Ostomy

This may be needed after surgical removal of colorectal cancer

Wincing Guarding

This may occur with gentle palpation in acute abdominal pain

Abdomen discomfort and pain Indigestion Signs and symptoms of anemia Ascites Unexplained weight loss Early satiety

Signs and symptoms of stomach cancer

After cancer metastasized

Signs and symptoms of stomach cancer usually occur when this occurs

Hematemesis Melena Occult bleeding

Signs and symptoms of upper GI bleeding

GERD

Sleeping with the HOB elevated for achalasia helps with this

Folic acid

Sulfasalazine is given with this

Iron supplement Blood product

This should be done for anemia precipitated by irritable bowel disease

Drink during meals

This should be done for meals to help with symptoms of achalasia

Colonoscopy at 50 years old and every 10 years after

This should be done for the screening of colorectal cancer

Splint

This should be done if a person post-op of a herniorrhaphy needs to cough

Potassium supplement

This should be given if a person has irritable bowel disease and is on steroids

Use nasal spray in mouth

This should be known about PO cobalamin

How long they have been having the symptoms

This should be known about this history in colorectal cancer

Must call pharmacy 30 minutes before so they can bring it up

This should be known when preparing IV iron

family (first-degree relative) or personal history of colorectal cancer

adenomatous polyposis, or hereditary nonpolyposis colorectal cancer syndrome

(3) what kind of exercise HTN pt

aerobic, 30 mins 3-5 times a week with light weight training

Related to PUD NSAIDS

cross the protective lipid membrane of the gastric​ cells, which results in damage to the gastric epithelial cells.

(3) the benefit of ARBS

does not cause cough or hyperkalemia

Gastric ulcers are associated with an increased incidence of ______

gastric cancer

tx for bowel obstruction

gastric decompression but may need surgery

(3) what are venous disorders

affects lower extremities swelling, tightness, discomfort in LE DVT (unilateral extremity swelling) the venous system of LE is superficial and deep

If the diuretic has been tolerated but not effective to reduce the blood pressure, the diuretic will be

continued in addition to a medication from another drug class.

if blood is frank after surgery

give them cold water

There are four types of hernias:

inguinal, umbilical, incisional (ventral), and hiatal

what is a simple intestinal obsruction

no impairment of blood or nerves on intestinal wall

Total Gastrectomy surgery to treat stomach cancer

removal of the entire stomach (Anastomosis from the esophagus to the duodenum or jejunum performed)

(1) Akatasia (EPS)

restlessness/fidgeting

interventions to treat hiatal hernias

restricting certain foods small frequent meals not lying down after eating no alcohol, smoking, caffiene

(3) what is secondary HTN

results from some disorder like diabetes, or kidney disease

Grains that are OK on low-residue?

rice cream of wheat or grits rice krispies or corn flakes white bread, saltines

Lavage to clean Cold water

room temperature, or saline to stop the bleed,This may be done before an endoscopy for an upper GI bleed

a happy stoma looks?

rose to brick red

(1) Who does bipolar disorder affect the most

affects men and women equally, the age onset is 25 y/o, with an affluent (rich) economic stability it is not curable and reoccurs often

what is an intestinal infarct

aka intestinal strangulation severe bowel ischemia leads to edema, cyanosis, gangrene, possible perf of a segment

intestinal feeding tube placement is confirmed by securing a

alkaline pH reading, which is greater than a pH of 7

(1) mania

an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking.

Sessile is,

an appearance of a polyp​ (raised nodules) not a polyp type

what is celiac disease

an autoimmune disorder in the mucosal lining of the small intestine -gluten sensitive enteropathy

(2) H. Pylori

an infection caused by peptic ulcers, that includes bacteria that produces enzymes that reduce the efficiency of the mucous gel that protects the gastric mucosa

hospital care of diverticulitis

- NPO - IV fluids, abx - keep an eye out for abscess, peritonitis, bleed - watch those WBCs - give pain meds - when getting better, start PO fluids then progress to semisolid food

surgical treatment of UC

- UC only affects colon, so total colectomy is curative - can do ileal pouch - allows continence - if that doesn't/won't work: ileostomy When surgery is indicated: - more conservative Tx not working - complications like fistulas, obstructions, bleeds, perfs - suspected CA

goals of nutrition with IBD

- adequate nutrition - don't exacerbate s/s - maintain F&E - prevent wt loss no universal trigger foods - keep food diary

septicemia s/s

- fever - malaise - inc HR, RR - restless, disoriented - oliguria, dehydration - shock

Appendicitis is usually caused by an

an obstruction caused by a hard mass of​ feces, calculus, foreign​ body, inflammation,​ parasites, tumor, or edema

empty an ostomy bag when it is how full?

1/3

A patient is given a bisacodyl suppository and asks the nurse how long it will take to work. What is the best response by the nurse? 2 to 5 minutes 15 to 60 minutes 2 to 4 hours 6 to 8 hours

15 to 60 minutes Bisacodyl *suppositories* usually are effective within 15 to 60 minutes of administration, so the nurse should plan accordingly to assist the patient to use the bedpan or commode.

(3) hypertensive urgency sudden onset of

180/110 complaining of severe headache, SOB, nose bleed and anxiety

Emergency meds used for Psychosis

1st Gen Typical Antipsychotics Benzodiazepine Anticholinergics Antihistamines

40. A client newly diagnosed in a manic episode of bipolar disorder tells the nurse, "Now that I'm only sleeping 4 hours a night, I can get so much more work accomplished." Which ego defense mechanism is this client using? 1) Denial 2) Intellectualization 3) Rationalization 4) Suppression

2) Intellectualization Intellectualization occurs when an individual attempts to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis. The individual in the question is using reasoning to avoid dealing with feelings about the new diagnosis of bipolar disorder.

1. The 66-year-old male client has his blood pressure (BP) checked at a health fair. The BP is 168/98. Which action should the nurse implement first?

2. Instruct the client to see his health-care provider as soon as possible.

The client diagnosed with essential hypertension is taking a loop diuretic daily. Which assessment data would require immediate intervention by the nurse?

2. The client has a weight gain of 2 kg within 1 to 2 days. loop diuretic not working effectively

(1) may cause blood dyscrasia

valproic acid

(1) mood stabilizer used in conjunction with antimanic meds

valproic acid (depakote)

What percentage of clients older than the age of 50 have​ polyps, and are they mostly benign or​ malignant?

30% of clients older than the age of 50 years have polyps. The vast majority of polyps are considered to be​ benign although they can become malignant The incidence is equal in both men and women

Along with persistent, crushing chest pain, which signs/symptoms would make the nurse suspect that the client is experiencing a myocardial infarction?

Diaphoresis and cool clammy skin.

The male client diagnosed with essential hypertension has been prescribed an alphaadrenergic blocker. Which intervention should the nurse discuss with the client?

4. Change position slowly when going from lying to sitting position.

Age onset for diverticular disease and its incidence

85 and up it affects both men and women equally

1

500mL,This amount of blood lost is considered to be severe

Treatment length for GERD using proton pump inhibitors

8 weeks

The nurse identifies that which patient is at highest risk for developing colon cancer? A 28-yr-old man who has a body mass index of 27 kg/m2 A 32-yr-old woman with a 12-year history of ulcerative colitis A 52-yr-old man who has followed a vegetarian diet for 24 years A 58-yr-old woman taking prescribed estrogen replacement therapy

A 32-yr-old woman with a 12-year history of ulcerative colitis Risk for colon cancer includes personal history of inflammatory bowel disease (especially ulcerative colitis for longer than 10 years)

Increased WBC

A CBC shows this with peritonitis

High WBCs Low Hgb

A CBC will show this for an intestinal obstruction

Anemia

A CBC will show this in gastritis

Identify to prevent rupture

A CT is used for this in appendicitis

Look at tumor

A CT scan is used to do this for stomach cancer

Looks for a large tumor and metastasis

A CT/MRI looks for this in colorectal cancer

Ablation treatment that is mounted on an endoscope to burn the tissue

A HALO treatment is this

Ascities Abcess

A U/S or CT will show this for peritonitis

what is the definitive diagnosis of stomach cancer

A biopsy

Acute aortic aneurisms

AAA

The health-care provider prescribes an ACE inhibitor for the client diagnosed with essential hypertension. Which statement is the most appropriate rationale for administering this medication?

ACE inhibitors prevent vasoconstriction and sodium and water retention.

(3) meds used to treat HTN

ACEIs ARBS calcium channel blockers beta blockers diuretics

(1) What are the side effects of calcium channel blockers

ALL Mood stabilizers present side effects of: DWD Avoid in: pregnancy, elderly, liver kidney fail Risk for Suicide -------- Monitor I&Os, increase fluid, fiber, percaution in pt. with increase in intracranial pressure

(1) What are the side effects clonazepam

ALL Mood stabilizers present side effects of: DWD Avoid in: pregnancy, elderly, liver kidney fail Risk for Suicide -------- avoid in patients with glaucoma

Acute respiratory distress syndrome

ARDS

TEE

An EUS is similar to this

Your care of the client with stomach cancer will focus on interventions to address feeding tube care needs what are the interventions

Assess tube placement by aspirating stomach contents and checking the pH of aspirate to determine gastric or intestinal placement (pH ≤5, gastric placement; pH ≥7, intestinal placement). Abdominal x-ray also used to confirm tube placement. Inspect the skin around the insertion site for healing, redness, swelling, or drainage. Assess abdomen for distention, bowel sounds, and tenderness. Use sterile technique for dressing changes and site care. Provide mouth care to maintain integrity of oral mucosa. Teach the client and family tube care and provision of enteral feedings.

postoperative prep colorectal cancer

Assess vital signs as required after the procedure. Assess placement of nasogastric tube and connection to low suction if prescribed. Monitor amount, color, and odor of drainage from nasogastric tube and colostomy site. Communicate "no rectal temperatures, medications, or procedures" for the client recovering from an abdominoperineal resection. Monitor intravenous fluids as prescribed. Administer postoperative antibiotics as prescribed. Provide pain medication as prescribed and according to pain assessment findings.

Pain when standing Lying supine or with stretched pain Sitting and restless Pelvis assessment Rectal exams

Assessment for acute abdominal pain

A nurse admits a client who is experiencing an exacerbation of heart failure. Which action should the nurse take first?

Assessment of respiratory and oxygenation status is the priority nursing intervention for the prevention of complications. Monitoring electrolytes, administering diuretics, and asking about current medications are important but do not take priority over assessing respiratory status.

How would you conduct an assessment and health history for a pt. with colorectal cancer

Assessment: -general appearance -weight -abdominal shape -bowel sounds -abdominal tenderness -stool hemoccult test Health history: -usual bowel pattern, if theres recent changes -weight loss -fatigue -decreased activity tolerance -blood in stool -pain with defacation -abdominal/perianal pain -usual diet -history of bowel disorders

Clinical Manifestations Cholelithiasis

Asymptomatic Epigastric and/or RUQ pain Nausea; fatty food intolerance Flatulence, bloating, abdominal distention, diarrhea, light-colored stool Jaundice Fever and chills Palpable gallbladder

What is pernicious anemia and what is it a risk factor for related to the GI tract

Autoimmune disease that results in vitamin B12 deficiency because of lack of intrinsic factor production by the body. it is a risk factor for stomach cancer

5. The client diagnosed with rule-out myocardial infarction is experiencing chest pain while walking to the bathroom. Which action should the nurse implement first?

Have the client sit down immediately

. Which meal would indicate the client understands the discharge teaching concerning the recommended diet for coronary artery disease? 1. Baked fish, steamed broccoli, and garden salad. 2. Enchilada dinner with fried rice and refried beans. 3. Tuna salad sandwich on white bread and whole milk. 4. Fried chicken, mashed potatoes, and gravy.

Baked fish, steamed broccoli, and garden salad

Glowing pouch in esophagus

Barium studies for esophageal diverticula will show this

Esophageal metaplasia

Barrett's esophagus is also called this

Recurrent exacerbation and remissions

Because irritable bowel disease is chronic, this can occur

Removed with colonoscopy

Because polyps are pre-cancerous, this must occur

A nurse assesses a client who is scheduled for a cardiac catheterization. Which assessment should the nurse complete prior to this procedure?

Before the procedure, the nurse should ascertain whether the client has an allergy to iodine-containing preparations, such as seafood or local anesthetics. The contrast medium used during the procedure is iodine based. This allergy can cause a life-threatening reaction, so it is a high priority

symptoms of hiatal hernia

Belching Feeling of stomach fullness Dysphagia Gastric reflux Substernal chest pain Gastric bleeding

A nurse cares for a client recovering from prosthetic valve replacement surgery. The client asks, "Why will I need to take anticoagulants for the rest of my life?" How should the nurse respond?

Blood clots form more easily in artificial replacement valves.

signs and symptoms of peritonitis

Board-like abdominal rigidity Decreased or absent bowel sounds tachypnea caused by the systemic infection and the pain response.

Tubulovillous Polyp

Both globelike and broad-based mass that is pedunculated with sections that appear as raised nodules or sessile Contains both tubular epithelium and villi

Older patients

Botulinum toxin injection is usually done for this demographic with achalasia

Endoscopy

Botulinum toxin injection is usually done under this

Short-term (1-2 years)

Botulinum toxin injection provides this type of relief

LES

Botulinum toxin is injected into this location with achalasia

IM SQ PO

Cobalamin is given through this route

(1) A nursing instructor is teaching about the Roberts' Seven-stage Crisis Intervention Model. Which nursing action should be identified with Stage IV?

Help the client deal with feelings and emotions. Stage IV: Deal with Feelings and Emotions

Liquid

Corticosteroids are given through this route for eosinophilic esophagitis

Antacids are not working (last resort) and avoided all foods and are still showing symptoms

Corticosteroids are used for eosinophilic esophagitis if this occurs

Asthma

Corticosteroids are usually given for this lung disease

30 minutes before an antacid

Cytoprotective drugs should be given at this time

(3) management of HTN

DASH diet reduce sodium low fat fruits and vegetables aerobic exercise, 3-5 times and light weight training

Iron deficiency anemia

Iron is give for irritable bowel disease because of this complication

Hemorrhage Strictures Perforation Fistulas Colonic dilations

Local problems of irritable bowel disease

Peritoneal edema Ascities Possible adhesions

Massive fluid shifts may cause this

Teduglutide (Gattex) Cholestyramine (Questran)

Medications for the treatment of short bowel syndrome

Peptic ulcer disease

PUD

midepigastric pain indicated

PUD

what are the symptoms of appendicitis

RLQ Pain N & V Rebound tenderness Guarding

Stress-related mucosal disease

SRMD

Prevent constipation

The diet for hemorrhoids is to do this

fulguration surgery (colorectal)

Use of electrocoagulation to shrink tumors for clients who are poor surgical risks May need to be repeated if mass growth increases

how to diagnose celiac disease

a biopsy and serologic test

contusions

abrasions, or bruising over the abdomen

Clear liquid diet

broth, coffee, tea, clear fruit juices, jello, popsicles.

tx for stage 3 CRC

maybe: XRT/chemo a surgery surgery chemo

Septic shock Hypovolemic shock

Complications of inflammation in acute abdominal pain

Regurgitation

This is hot/bitter/sour liquid going up through the stomach

Increases gastric acid secretion

This is how NSAIDs can cause PUD

Hypovolemic shock

This is low-volume shock

Marinol

This is medical marijuana

Radiologic studies

This is not useful in the diagnosis of gastritis

Rebound tenderness

This is pain with the release of pressure

Surgical adhesions

This is scar tissue build and sticking to another

Peritoneum

This is the *sterile* lining of the abdominal cavity

Neutralizes the acid that the stomach builds up

This is the MOA of antacids

Anal fistula

This is the abnormal tunnel from the anus/recum to the buttock or vaginal area

Lactase deficiency

This is the absence or deficiency of the lactase enzyme

5-15mL every 15-20 minutes

This is the amount and frequency of liquids for a clear liquid diet

7-10 days

This is the amount of time it takes for iron to take effect IV

2-3 week

This is the amount of time it takes for iron to take effect PO

Celiac disease

This is the autoimmune induced damage to the small intestines due to intestine wheat, barley, and rye

Unknown

This is the cause of esophageal cancer

Irritable bowel disease

This is the chronic autoimmune disease that leads to the widespread inflammation and tissue destruction

Achalasia

This is the chronic esophageal motility disorder that causes an impaired relaxation of the LES

Hiatal hernia

This is the condition in which part of the stomach pushes up through the diaphragm muscle.

Reflux more than 2 times in a week

This is the criteria for GERD

Risk for complications

This is the criteria for esophageal diverticula surgery

Endoscopy with biopsy

This is the definitive diagnosis of esophageal cancer

Achalasia

This is the delayed emptying of the lower esophagus

Billroth II does not have a bile duct and removes the antrum and duodenum

This is the difference from Billroth I and Billroth II

Main complication of anal fissures

development of fecal incontinence

Eosinophilic esophagitis

This is the esophageal edema due to an infiltration of eosinophils

Crohn's disease

This is the inflammation of * any segment of the GI tract* (mouth to the anus)

Appendicitis

This is the inflammation of the appendix

H. pylori

This is the most common microorganism for gastritis

HA

This is the most common side effect of proton pump inhibitors

Makes the GI more narrow

This is the problem with esophagitis in GERD

(1) what is delirious mania

the consciousness is clouded severely, the acute mania is intensified. functioning impaired

(3) What is pulse pressure

the difference between systolic and diastolic BP

(1) Lithium toxicity at 2 mEq/L

tremors, sedation, confusion

Places a balloon that dilates the esophagus (has to be done multiple times

This is the procedure for a pneumatic dilation

Hernia

This is the protrusion of an internal organ through the abdominal opening through a weak area in the wall

a murphys sign is positive with

gallbladder inflammation

med treatment for stress ulcers

h2 receptor blockers PPI sucralfate for prophylaxis

Which cardiac enzyme would the nurse expect to elevate first in a client diagnosed with a myocardial infarction?

troponin

NG tube Accurate I&O

Treatment of an obstruction from PUD

Prognosis

Treatment of colorectal cancer depends on this

Combo therapy (Radiation and chemotherapy) Surgery Nutritional therapy Palliative care

Treatment of esophageal cancer

Supportive care Preventative

Treatment of gastroenteritis

how to treat hypertensive crisis

Treatment within 1 hour is needed to: Prevent cardiac, renal, and vascular damage Reduce morbidity and mortality, continuos IV

If a diuretic is not effective in controlling the blood pressure,

a medication from another drug classification will be prescribed in place of the diuretic.

complication of surgery for Crohn's

*short bowel syndrome* from repeatedly resecting lengths of bowel can't maintain hydration/nutrition

large bowel obstruction s/s

- gradual onset *pain* - persistent pain *vomiting* - *none* until late *distention* - *present* *constipation* - *total,* no BM at all. bowel sounds present then become hypoactive.

UC: complications

- inc risk for and severity of C. diff - toxic megacolon - bowel perf r/t toxic megacolon - inc risk of colorectal CA

Which statement by the client diagnosed with coronary artery disease indicates that the client understands the discharge teaching concerning diet?

"I should bake or grill any meats I eat."

Nursing care for appendicitis

- maintain NPO - VS and assess for CIC - IV fluids, pain meds, antiemetics - NGT prn pre and postop postop care - usually lap so they go home within 24h - early amb within a few hours - advancing diet as tolerated - back to normal activity 2-3 weeks postop.

UC: characteristics

- onset young adult or older adult - constant abd pain - diarrhea - rectal bleeds - tenesmus (feeling like you need to poop even when you just did) - fever during exacerbations

Crohn's characteristics

- onset young adult or older adult - cramping abd pain - diarrhea - fever - weight loss - nutrition problems, malabsorption (fat and B12 absorbed in ileum only) - RLQ pain alleviated c BM

Crohn's: complications

- perianal abscesses and fistulas - strictures (scar tissue forms and is not stretchy, creates narrow areas in bowel) - inc risk for and severity of C. diff - bowel perf r/t full thickness inflammation - inc risk of small bowel CA (also of colorectal CA but not as much as with UC)

ostomy care: an appropriate pouching system is important to:

- protect the periostomy skin - dependable stool collection

small bowel obstruction s/s

- rapid onset *pain* - *colicky* pain *vomiting* - *present,* may be copious *distention* - may or may not be present *constipation* - *BMs gradually decreasing* to constipation boborygmi, visible peristaltic waves

The nurse is preparing to administer a dose of bisacodyl to a patient with constipation and the patient asks how it will work. What is the best response by the nurse? "It will increase bulk in the stool." "It will lubricate the intestinal tract to soften feces." "It will increase fluid retention in the intestinal tract." "It will increase peristalsis by stimulating nerves in the colon wall."

"It will increase peristalsis by stimulating nerves in the colon wall." Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. Fiber and bulk- forming drugs increase bulk in the stool. Water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.

surgical management of bowel obstruction

- resect affected segment - partial/total colectomy - colostomy or ileostomy - polyp rem, stricture dilation, tumor rem can often be done c colonoscopy

(1) Which of the following nursing statements or questions represent appropriate communication to assess an individual in crisis?

"Tell me what happened." "What coping methods have you used, and did they work?" "Describe to me what your life was like before this happened."

(1) A despondent client who has recently lost her husband of 30 years tearfully states, "I'll feel a lot better if I sell my house and move away." Which nursing response is most appropriate?

"This may not be the best time for you to make such an important decision." During crisis intervention, the nurse should guide the client through a problem-solving process. The nurse should help the individual confront the source of the problem, encourage the individual to discuss changes he or she would like to make, and encourage exploration of feelings about aspects of the crisis that cannot be changed.

A nurse cares for a client who is recovering from a myocardial infarction. The client states, "I will need to stop eating so much chili to keep that indigestion pain from returning." How should the nurse respond?

"What do you understand about what happened to you?" Clients who experience myocardial infarction often respond with denial, which is a defense mechanism. The nurse should ask the client what he or she thinks happened, or what the illness means to him or her

23. The client diagnosed with a myocardial infarction asks the nurse, "Why do I have to rest and take it easy? My chest doesn't hurt anymore." Which statement would be the nurse's best response?

"Your heart is damaged and needs about four (4) to six (6) weeks to heal." the heart tissue is dead, stress or activity may cause heart failure

what is the reason pt.s are advised to lye down after eating if they have had a partial gastrectomy

"Your stomach is a smaller size because part of it has been​ removed, and the food that you ate moves through it more quickly. When you lie​ down, gravity slows down the rate at which food leaves the stomach and is digested and​ absorbed."

(1) A client comes to a psychiatric clinic experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What long-term outcome is realistic in addressing this client's crisis?

"the client will return to previous adaptive levels of functioning by week 6" The nurse should identify that a realistic long-term outcome for this client is to return to previous adaptive levels of functioning. The nurse should work with the client to develop attainable outcomes that reflect immediacy of the situation.

most common causes of large bowel blockage

#1 colorectal *CA* then *diverticular* disease and sigmoid *volvulus*

Which tests are used to diagnose GERD

**Barium - (to evaluate the esophagus, stomach and upper small intestine) **Upper endoscopy- (visualize the esophagus to biopsy tissue for analysis) bernstein test- (diagnose GERD by creating a response in the esophagus with the use of acid solution or normal saline) **24-hr ambulatory ph monitoring -(diagnose GERD with the use of an electrode inserted through the nose into the esophagus to record data about the acid content) esophageal manometry- (measures pressure of the esophageal sphincters and esophageal peristalsis)

peritonitis s/s

*abd:* pain, tenderness (esp rebound) rigidity spasm distension bowel activity alteration stillness tachypneic, shallow breathing tachycardia fever N/V

causes of peritonitis - secondary:

*appendicitis* - ruptured *bowel* perf *diverticulitis* - ruptured *ischemia* *pancreatitis* *peptic* ulcer perf *peritoneal* dialysis *postop* (anastomosis tear) *trauma* - blunt or penetrating

44. Sophie is admitted to an inpatient psychiatric unit in an acute manic episode. She is morbidly obese and believes she is a famous ballerina. She repeatedly runs from one end of the unit to the other and attempts to twirl around while standing on chairs in the patient lounge. She is prescribed temazepam (Restoril) for sleep, and since her admission she has generally slept for five to six hours each night. What should the nurse consider to be the priority nursing diagnosis? 1) Risk for Injury related to excessive hyperactivity. 2) Disturbed Sleep Pattern related to manic hyperactivity. 3) Imbalanced Nutrition, Less than Body Requirements, related to inadequate intake. 4) Situational Low Self-esteem related to embarrassment secondary to high-risk behaviors.

1) Risk for Injury related to excessive hyperactivity. According to Maslow's hierarchy of needs and this client's presentation, safety is a priority. The impulsiveness and hyperactivity seen in clients diagnosed with acute mania puts them at risk for injury.

(2) In what order does GERD occur

1- reflex of gastic juices 2-gastric juice enter lower esophageal sphincter 3-the esophageal mucosa is exposed in the lower esophagus 4- pepsin, acid, bile are exposed to the esophageal mucosa 5- inflammation of the esophageal mucosa occurs 6-ulceration of the esophagus eventually occurs

. The nurse is teaching the Dietary Approaches to Stop Hypertension (DASH) diet to a client diagnosed with essential hypertension. Which statement indicates that the client understands teaching concerning the DASH diet?

1. "I should eat at least four (4) to five (5) servings of vegetables a day." 2 or fewer servings of meat, very little white streaks low fat milk 7-8 serv of grain

When treating GERD which lifestyle interventions are implemented

When treating GERD one should stop smoking, avoid wearing tight clothes and avoid bending over educate causative factors, encourage lifestyle changes

(3) what is peripheral arterial disease PAD

a blockage of the artery does not let o2 and nutrients to the LE

what is crohns disease (inflammatory bowel disease)

inflammation may develop anywhere in the GI tract appears as patches commonly at the end of the small intestine it may extend through the entire thickness of the bowel wall

What is peptic ulcer disease (PUD)

a break in the mucous lining of the GI tract leading to its contact with GI juice , it can occur anywhere in the tract as long as it is exposed to acid-pepsin secretions the onset is usually per older clients between the ages of 55-70

(1) What is a crisis situation

a disequillibrium from which an individual or group may require assistance with recovery, going through a stressful situation a difficult or dangerous situation

Drug therapy for primary and secondary hypertension usually begins with

a diuretic as the drug of choice. The dose is slowly increased until the blood pressure is controlled.

The peritoneum is

a double-layered serous membrane lining the walls and organs of the abdominal cavity. The space between the two layers contains serous fluid and is normally sterile.

When the appendix has​ burst,

a laparotomy is the surgery of choice (Surgical removal: laparoscopy or open laparotomy)

Not for diagnosis Rule out other causes of pain

A UA is used for this in appendicitis

Perforation Peritonitis

A rigid abdomen indicates this

(1) What is bipolar disorder/manic depression?

a mood disorder in which episodes of both depression and mania (excessive euphoria) occur. It is characterized by "mood swings." One moment the patient is in a profound depression, then manic episode and then normal.

(3) diagnostic test for PAD

ankle brachial index contrast angiography

Hemorrhoids Fissures Abscesses and fistulas

anorectal disorders

meds used for GI hernias

antacids histamine h2 receptor blockers PPI proton pump inhibitors

Maalox Mylanta Gaviscon Aludrox Gelusil Riopan Tums Amphojel

antacids that treat GERD

Lack of proteins

Abdomen distention from celiac disease is due to this

Dilated loops in intestines Paralytic ileus

Abdominal X-rays will show this in peritonitis

Complications of peritonitis may be life threatening and include the following:

Abscess formation Fibrous adhesions in the abdominal cavity, which can cause obstruction Septic shock

Tight squeeze that has dilation due to food

Achalasia causes this in the body

Esophageal peristalsis

Achalasia has the absence of this

The student nurse learns about risk factors for gastric cancer. Which factors does this include

Achlorhydria Chronic atrophic gastritis Helicobacter pylori infection Pernicious anemia

30 minutes before meals and multiple times in a day

Acid protective drugs should be taken at this time

Intervention for the patient with GERD regarding Acute pain

Acute Pain: -provide frequent small meals -restrict fatty, acidic, foods, coffee and alcohol -stop smoking -meds as prescribed even after symptoms are relieved -teach long term management of GERD

Bleeding Peritonitis Pressure on other organs

Acute abdomen pain may be due to these complications

hours to days

Acute gastritis has this type of onset and lasts for this long

Gastroesophageal reflux disease

GERD

Squamous cell cancer

Adenocarcinoma is this type of cancer

The nurse is caring for a client diagnosed with a myocardial infarction who is experiencing chest pain. Which interventions should the nurse implement? Select all that apply.

Administer an aspirin orally BC antiplatelette Apply oxygen via a nasal cannula.

step down therapy

After 1 year of blood pressure control medication, the client will begin step-down therapy or efforts to reduce the dosage and number of drugs being used. This therapy is most effective in clients who have incorporated lifestyle changes to control hypertension.

A client who had a partial gastrectomy has several expected nutritional problems. What actions by the nurse are best to promote better nutrition?

After gastrectomy, clients are at high risk for anemia due to vitamin B12 deficiency, folic acid deficiency, or iron deficiency. The nurse should provide supplements for all these nutrients.

(1) EPS

Akinesia, Akathisia, Dystonia, Oculogyric Crisis use AIMS scale

The incidence of coronary artery disease and hypertension is higher in

American Indians than in whites or Asian Americans

High fatality

Gastric PUD has this prognosis

Older women

Gastric PUD usually occurs with this demographic

(1) A client diagnosed with bipolar disorder has been taking lithium carbonate (Lithobid) for one year. The client presents in an emergency department with a temperature of 101F (38C), severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms?

Lithium carbonate toxicity

Your client with appendicitis will be treated with intravenous fluids, medications, and surgery. What are they

IV fluids to restore or maintan vascular volume and prevent electrolyte imbalances antibiotics to reduce inflammation and infection is given before surgery and continued for 48 hrs postoperatively Appendectomy surgery is the treatment of choice laparotomy surgery when the appendix has ruptured

(1) what are the bipolar mood stabilizers

anti-manic anticonvulsants antipsychotics calcium channel blockers anticholinergics

post-myocardial infarction. The nurse assesses an S3 heart sound. Which intervention should the nurse implement?

Notify the health-care provider immediately.it indicates left ventricular failure, it is potentially life threatening of MI

Massive fluid shifts

Peritonitis causes this in the body

6-12 hours

Peritonitis from perforation of PUD occurs around this time

(1) the combination of oculgyric crisis and dystonia can cause

laryngospasm ( a spasm of the vocal cords that temporarily makes it difficult to speak or breathe) which is dangerous and can lead to death

where are diverticula most common

left (descending, sigmoid) colon

Postpolypectomy care (colorectal)

Assess for rectal bleeding. Monitor blood pressure and heart rate. Assess for pain. Provide pain medication as prescribed. Teach on expectations after the procedure.

Manifestation that will assist in confirmation of diverticular disease

left-sided abdominal pain

streak in sputum after surgery

let physician know

Short-acting

Antacids are this, which provides quick relief

3-4 hours

Antacids last for this long

Take 1-3 hours after meals and hour of sleep

Antacids should be taken at this time

(2) Treatment for pt. admitted with gastritis and + H. pylori

Antibiotics like - Amoxicillin (Amoxil) are used to treat the infection

Multiple rounds

Antibiotics need this to be effective for the treatment of PUD

Your client with colorectal cancer will have problems with nutrition, what are the interventions

Assess nutritional status. Consult a dietician for meal planning, caloric intake, and nutritional requirements. Assess client's ability to resume oral intake after bowel surgery. Monitor food and fluid intake each meal. Monitor daily weight. Administer parenteral nutrition if prescribed.

goal of care for acute diverticulitis?

let the colon rest let inflammation subside maybe can do @ home c PO abx and clear liquids maybe going to have to go to the hospital if it's bad.

Sucralfate (Carafate)

Antiulcer agent that treats GERD.

(1) Anticholinergics , Antipasmodics, Antihistamines used to treat EPS

Antocholinergics** benztropine (cogentin) antipasmodic** trihexyphenidyl (artane) antihistame** dephylhedrine (benadryl) --elderly, young

Fecal obstruction

Appendicitis is due to this

10-30 years old

Appendicitis occurs to this age group

simple appendicitis

Appendix is inflamed and intact

The elderly client has coronary artery disease. Which question should the nurse ask the client during the client teaching?

Are you sexually active?" it is a risk factor for angina

Gangrenous appendicitis

Areas of tissue necrosis and microscopic perforations present

What is the most serious complication that results from reflux of gastric contents into the pharynx

Aspiration occurs when gastric contents reflux into the tracheobronchial tree, it could result in bronchitis or pneumonia

(3) post op for PAD

Assess circulation of extremities distal to bypass graft: color, temperature, capillary refill, sensory & motor functions, doppler, ABI, doppler, pulses Notify surgeon if pulse disappears: thrombotic occlusion of graft Monitor urine output to decrease edema, LOC Avoid crossing legs Monitor for compartment syndrome (edema, pain, loss of sensation): elevate legs and perform exercises to decrease edema

An older client has gastric cancer and is scheduled to have a partial gastrectomy. The family does not want the client told about her diagnosis

Assess family concerns and fears The nurse should use open-ended questions and statements to fully assess the family's concerns and fears. Asking "why" questions often puts people on the defensive and is considered a barrier to therapeutic communication. Refusing to follow the family's wishes or keep their confidence will not help move this family from their position and will set up an adversarial relationship.

The three major complications of colorectal cancer are:

Bowel obstruction Perforation of the bowel Direct extension of the tumor to neighboring organs

(3) treatment for PAD

life long aspirin pentoxifylline- reduces blood viscosity, to prevent platelet aggregation cilostazol- inhibit platelet aggegration, promotes vasolidation clopidogrel- prevents thromboemboli Lipid-lowering agents: statins

where does ulcerative colitis occur (inflammatory bowel disease)

limited to large intestine (colon and rectum) appearing as continuous pattern in pt or entire colon there is inflammation of innermost lining of the intestine

(1) What medication becomes toxic when electrolytes like Na and Mg are depleted

lithium

The nurse needs to monitor for metastatic lesions from stomach cancer in the​

liver, lungs, ovaries, and peritoneum

purpose of surgery c peritonitis?

locate cause of inflammation drain purulence repair damage e.g. perfs

Villous adenomas Polyp

Broad-based sessile mass shaped like cauliflower Usually found in the rectosigmoid area Size up to 5 cm Greater potential to be malignant

treatment meds for peritonitis before the causing bacteria is found

Broad-spectrum antibiotics such as imipenem (Primaxin) or meropenem (Merrem) are used until the offending bacterium is identified.

1-2 hours after a meal

Burning/gaseous pain occurs at this time for PUD

A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition

Canned apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, low- to moderate-carbohydrate diet. Coffee cake and other sweets must be avoided. Milk products and sweet drinks such as shakes must be avoided. Gas-forming foods such as broccoli must also be avoided.

Digoxin Coumadin Cimetidine Dilantin

Carafate binds to these drugs which can make them ineffective

The client who has had a myocardial infarction is admitted to the telemetry unit from intensive care. Which referral would be most appropriate for the client

Cardiac rehabilitation.

(1) A client has been diagnosed with major depressive episode. After treatment with fluoxetine (Prozac), the client exhibits pressured speech and flight of ideas. Based on this symptom change, which physician action would the nurse anticipate?

Discontinue the fluoxetine and rethink the client's diagnosis.

? _______ 12. The nurse is teaching a class on arterial essential hypertension. Which modifiable risk factors would the nurse include when preparing this presentation?

Discuss sedentary lifestyle and smoking cessation.

Obstruction Bleeding Perforation Peritonitis Fistula formation

Complications of colorectal cancer

Hemorrhage Perforation (fistula formation) Obstruction Metastasis

Complications of esophageal cancer

Blood loss High WBC

CBC for acute abdominal pain shows this

Look for blood loss

CBC for the treatment of a perforation of a PUD is done to do this

C. diff associated diarrhea

CDAD

Chemoreceptor trigger zone

CTZ

(1) A mood stabilizer that also treats arrhythmias/HBP but is contraindicated if there is increased intracranial pressure

Calcium channel blocker

Microorganism Medication Lifestyles

Causes of PUD

Inflammation Infection Obstruction

Causes of acute abdomen pain

Gallstones Biliary stasis Gallbladder inflammation Abnormal bile composition and reabsorption Cholesterol and pigmented gallstones

Cholelithiasis

Slowly and overtime

Chronic gastritis has this type of occurences

A nurse teaches a client with diabetes mellitus and a body mass index of 42 who is at high risk for coronary artery disease. Which statement related to nutrition should the nurse include in this client's teaching?

Clients at risk for cardiovascular diseases should follow the American Heart Association guidelines to combat obesity and improve cardiac health. The nurse should encourage the client to eat vegetables, fruits, unrefined whole-grain products, and fat-free dairy products while losing weight.You should balance weight loss with consuming necessary nutrients.

(1) Anticholinergic side effects

Confusion, dizziness, blurred vision, constipation, dry mouth, difficulty urination _

Drugs Rest Nutrition

Conservative treatment for PUD

Dehydration

Constipation due to and obstruction from PUD is caused by this

Your care of the client with stomach cancer will focus on interventions to address nutritional needs what are the interventions

Consult with dietician for a complete nutritional assessment and diet planning. Weigh daily. Monitor laboratory values. Provide preferred foods; have family prepare meals when possible. Provide nutritional supplements between meals as indicated and prescribed. Arrange for family or visitors to be present during meals to increase socialization and appetite. Administer pain and antiemetic medication as needed before meals

symptoms of appendicitis

Continuous mild generalized or upper abdominal pain Gradual intensification of pain over the next 4 hrs that localizes in the right lower abdominal quadrant Pain aggravated by moving, walking or coughing Localized and rebound tenderness at McBurney point Extension or internal rotation of the right hip increases the pain Low-grade fever Anorexia Nausea Vomiting

Complications (abscess or obstruction)

Criteria for surgery for the treatment of diverticulitis and diverticulosis

What are the most common symptoms of early gastric cancer?

Early satiety Anorexia Indigestion Vomiting Ulcer-like pain unrelieved by antacids after meals

(1) What are the anticonvulsants used to treat bipolar disorder

Tegretol (Carbamazepine) Depakote or Depakene (valproic acid) Klonopin (clonazepam) *benzo Lamotrigine (Lamictal)

Crohn's: pattern of inflammation

location,full thickness of bowel affected skip lesions cobblestoning occur anywhere in GI tract (from mouth to anus) most common site is distal ileum and proximal colon

UC: pattern of inflammation

location,mucosal layer affected continuous areas of inflammation pseudopolyps colitis = colon usually starts in rectum and progresses up colon

the extent of F&E problems in a bowel obstruction depends on

location: duodenum - metabolic alkalosis possible from N/V or NGT suction small bowel - rapid dehydration large bowel - F&E imbalances don't occur until late

The client diagnosed with essential hypertension asks the nurse, "I don't know why the doctor is worried about my blood pressure. I feel just great." Which statement by the nurse would be the most appropriate response?

Damage can be occurring to your heart and kidneys even if you feel great."

(1) A full manic episode emerging during antidepressant treatment (medication, electroconvulsive therapy, etc.), but persisting beyond the physiological effect of that treatment is sufficient evidence for a

manic episode and, therefore, a Bipolar I diagnosis.

The nurse requests a patient scheduled for colectomy to sign the operative permit as directed in the physician's preoperative orders. The patient states that the physician has not really explained very well what is involved in the surgical procedure. What is the most appropriate action by the nurse? Ask family members whether they have discussed the surgical procedure with the physician. Have the patient sign the form and state the physician will visit to explain the procedure before surgery. Explain the planned surgical procedure as well as possible and have the patient sign the consent form. Delay the patient's signature on the consent and notify the physician about the conversation with the patient.

Delay the patient's signature on the consent and notify the physician about the conversation with the patient. The patient should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the patient. The nurse should notify the physician, who has the responsibility for obtaining consent.

Chronic

Dermatitis herpetiformis is this in terms of duration

Esophageal duodenoscopy

EGD

Family history Allergic reaction to triggers

Eosinophilic esophagitis is caused by this

A patient is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? Nausea and vomiting Hyperactive bowel sounds Firmly distended abdomen Abrasions on all extremities

Firmly distended abdomen Clinical manifestations of abdominal trauma are guarding and splinting of the abdominal wall

Crohn's disease

Fistulas more commonly occur with this type of irritable bowel disease

Clear

Fluid is normally this in the peritoneal cavity

High sodium

Gatorade and broth can be used for a clear diet but should be used carefully because of this

Desserts and miscellany OK on low-residue

Great news! All that stuff you normally wouldn't eat because it has no redeeming nutritional value is acceptable: cake! cookies! pudding! ice cream! popsicles! candy! Nilla wafers! You can also have juice and soda as long as it's no pulp, no caffeine

diagnosing diverticulitis

H&P CT c contrast abd/CXR to r/o other causes

diagnosing bowel obstruction

H&P imaging sigmoidoscopy or colonoscopy CBC (watch for bleeds, infection) metabolic panel (watch for alkalosis)

how is appendicitis Dx'ed?

H&P physical exam CBC c WBC differential UA to r/o a UTI or whatever that could mimic s/s imaging: *CT (preferred),* ultrasound, MRI

How does the risk factor of H.Pylori cause gastric ulcers

H. Pylori is a bacteria that produces enzymes. The enzymes produced reduce the efficacy of mucous gel. The mucous gel protects the gastric mucosa, therefor its altered state is dangerous to the health of the GI system. Since the mucous gel is weakened, the GI system is exposed to gastric juice Ontop of that the body has an added inflammatory response to the infection which contributes to the cell damage in the GI system The response does not aid in immunity to the infection, therefore its increasing the damage,

Food and poor sanitization

H. Pylori is transmitted through this

Years

H. pylori can last in the digestive tract for this long

Stomach cancer

H. pylori with gastritis can cause this

-tidine

H2 receptor blockers end in this

Family history Personal history of IBD

Health factors that have an increased risk for colorectal cancer

31. A patient arrives in the emergency department with impaired consciousness, nystagmus, and seizures. It is determined that he is suffering from lithium toxicity. With these symptoms, his lithium level would be expected to be above___________mEq/L.

These symptoms are manifestations of severe lithium toxicity and could include coma and cardiovascular collapse. They occur when the lithium level exceeds 3.5 mEq/L.

Bright red Coffee grounds

Hematemesis can be this color

Anemia

Hemorrhage can lead to this with irritable bowel disease

Ulcer

Hemorrhage from hiatal hernias are due to this

Aluminum

If an H2 receptor blocker has this, it may cause constipation

Magnesium

If an H2 receptor blocker has this, it may cause diarrhea

Gastric cancer

If gastric secretions are high, this should be ruled out with gastritis

exploratory laparotomy with bowel resection.

If multiple polyps or large villous masses are​ found, the client may need to undergo an

Investigate for non-compliancy and other complications

If not responding to iron with irritable bowel disease, this should be done

Failure to respond to conservative treatment Abscess Fistula Intestine obstruction

Indication for surgery

calcium channel blockers htn

Inhibit the flow of calcium ions into vascular tissue and cardiac cells Relax arterial smooth muscle and lower peripheral vascular resistance

A hospitalized patient has just been diagnosed with diarrhea due to Clostridium difficile. Which nursing interventions should be included in the patient's plan of care (select all that apply.)? Select all that apply. Initiate contact isolation precautions. Place the patient on a clear liquid diet. Disinfect the room with 10% bleach solution. Teach any visitors to wear gloves and gowns. Use hand sanitizer before and after patient or bodily fluid contact.

Initiate contact isolation precautions. Disinfect the room with 10% bleach solution. Teach any visitors to wear gloves and gowns. Initiation of contact isolation precautions must be done immediately with a patient with C. difficile, which includes washing hands with soap and water before and after patient or bodily fluid contact. Alcohol-based sanitizers are ineffective. Visitors need to be taught to wear gloves and gowns and wash hands. A clear liquid diet is not necessary. The room will be disinfected with 10% bleach solution when the patient is dismissed and may be done periodically during the patient's stay, depending on the agency policy.

A 58-year-old male who describes his pain as intense stabbing that spreads across his chest

Intense stabbing, vise-like substernal pain that spreads through the client's chest, arms, jaw, back, or neck is indicative of a myocardial infarction. The nurse should plan to see this client first to prevent cardiac cell death

Obstruction

Irreducible hernias can lead to this

Large intestine Colon

Irritable bowel syndrome affects these part of the intestine

CBC UA CT US Abdominal X-ray Hiba scan

Labs for acute abdominal pain

Low hemoglobin Low hematocrit High BUN

Labs for an upper GI bleed

Asians Africans

Lactase deficiency is more common in this demographic

30 minutes after ingesting any diary product

Lactase deficiency signs and symptoms occur at this time

Which nutrients does proton pump inhibitors, a treatment for GERD interfere with

It may interfere with absorption of calcium and b12

symptoms of hemorrhoids

Itching and burning Swelling around anus Pain or discomfort Painless bleeding with bowel movement

Lower esophageal sphincter

LES

s/s diverticulitis

LLQ *pain* palpable abd *mass* *N/V* *fever* (maybe no fever in old people)

Nursing Management of Anal abscess & Fistula:

Lie flat for 1 to 2 days after surgery Increase fluids and fiber in diet Use pain medication as prescribed Sitz baths at least 3 times daily

Avoid eating giant upsets the stomach Deal with the physical symptoms Avoid gassy foods

Lifestyle changes for the treatment of irritable bowel syndrome

Obesity Physical inactivity Alcohol use Long-term smoking

Lifestyle factors that have an increased risk for colorectal cancer

Do not lift or strain

Lifestyle modifications for the treatment of hiatal hernias

Care for pt after appendectomy

Lifting and driving may be restricted for several weeks The client should be instructed to call the health care provider for fever and increased pain or drainage from the incision. Clients should be instructed about the importance of good hand hygiene when handling a surgical incision. The client should be encouraged to keep all follow up appointments with the health care provider. The client who has had an appendectomy will not be able to return to work 2 days postoperatively. Following up with the health care​ provider, notifying the health care provider of any​ fever, and washing the hands before cleaning the incision are all important discharge instructions.

Steroids

This is a type of ulcergenic drug

Esophageal Stomach Duodenal

Locations for an upper GI bleed

Middle or lower end of the esophagus

Locations for esophageal cancer

Zenker's diverticulum (upper) Traction divertivulum (middle) Epiphrenic diverticulum (lower)

Locations for esophageal diverticula

CDAD

Long-term use of proton pump inhibitors can cause this

A nurse assesses a client 2 hours after a cardiac angiography via the left femoral artery. The nurse notes that the left pedal pulse is weak. Which action should the nurse take?

Loss of a pulse distal to an angiography entry site is serious, indicating a possible arterial obstruction. The pulse may be faint because of edema. The left pulse should be compared with the right, and pulses should be compared with previous assessments, especially before the procedure. Assessing color (pale, cyanosis) and temperature (cool, cold) will identify a decrease in circulation. Once all peripheral and vascular assessment data are acquired, the primary health care provider should be notifies

When planning care for a client with​ diverticulitis, the nurse addresses the potential problem of pain. Which nursing interventions will assist in meeting this potential​ problem?

Maintaining nonpharmacologic pain management​ strategies, such as relaxation and distraction​ techniques Assessing the pain level using a standard pain rating scale and administering prescribed pain medications Maintaining bed​ rest, not promoting​ activity, Providing a client with a soft​ low-fiber diet with​ bulk-forming agents, not a soft​ high-fiber diet

Iron

Melena is black due to this

Indigestion of blood in the GI tract

Melena is caused by this

Bicarbonate from the small intestines

Metabolic acidosis from nausea and vomiting is due to a loss of this

Hydrochloric acid from the stomach

Metabolic alkalosis from nausea and vomiting is due to a loss of this

Regional lymph nodes Liver Lungs Bones Brain

Metastasis can occur to these locations with colorectal cancer

most colorectal cancers reoccur in how many years after initial diagnosis and​ treatment?

Most colorectal cancers reoccur within the first 4​ years

Colon

Most of the fluid in the GI is absorbed before it reaches here

The nurse should administer an as-needed dose of magnesium hydroxide after noting what information when reviewing a patient's medical record? Abdominal pain and bloating No bowel movement for 3 days A decrease in appetite by 50% over 24 hours Muscle tremors and other signs of hypomagnesemia

No bowel movement for 3 days Magnesium hydroxide is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. It would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

Low-residue diet is characterized by?

No high-fiber foods Residue = stuff that doesn't get digested

cause of colorectal CA?

No single causative factor. High risk: FHx of CRC and IBD. Other risk factors: red meat, obesity, smoking, inactivity, ETOH, DM2, being AA.

Very little side effects (no drowsiness or CNS side effects)

Ondansetron is preferred for an antiemetic because of this

A nurse is performing an assessment on a new​ client, who asks about the most common type of cancer in the United States. What is one of the most common types of cancer in the United​ States?

One of the most common types of cancer in the United States is colorectal cancer. The incidence of this type of cancer has been declining over the past 15 years mainly because of early diagnosis of polyps

Late

Onset of signs and symptoms of esophageal cancer

Clinical Manifestations of Anal abscess & Fistula:

Patients usually complain of severe, constant pain in anal region May have fever and general malaise Purulent rectal drainage may be present

1940

People born before this year most likely have H. pylori

risk for peritonitis

Peptic ulcer disease Diverticulitis Peritoneal dialysis

complications of appendicitis include

Perforation Peritonitis Abscess

Pre-cancerous

Polyps are considered to be this

Obstruction

Polyps can lead to this

Mucosal surface of the colon

Polyps come from this part of the body

what is a hiatal hernia

Portion of the stomach protrudes through esophageal hiatus of the diaphragm into the thoracic cavity

NPO 12-24 hours Prophylactic antibiotics* A-fib Possible ileostomy

Post-op care for intestinal obstruction surgery

Void after Monitor for scrotal edema Deep breathing (no coughing) No heavy lifting for 6-8 weeks

Post-op treatment for a herniorrhaphy

NG tube Chest tube

Post-op, a patient who had a partial/total gastrectomy should have this equipment

NG tube

Post-op, a person who underwent a vagotomy will need this

diuretics action in HTN

Preferred treatment in older adults Promote sodium and water excretion Adverse effects are usually dose related

Upper esophageal diverticula

Pressure is used for this type of esophageal diverticula

(1) Mania

Profound depression to extreme euphoria

Malignancy

Progressive dysphagia is a sign of this

IV piggyback Deep muscle injection

Promethazine should be given through this route

IV push

Promethazine should never be given through this route

what is the purpose of including psyllium when solid foods are reintroduced for a client with diverticulitis

Psyllium softens and adds bulk to the​ stool, which improves the motility of stool passage through the colon

A hypertensive crisis is a medical emergency, necessitating the immediate use of medications to achieve the goals of

Reducing the blood pressure by no more than 25% within minutes to 1 hour Reducing the blood pressure to 160/100 mmHg within 2 to 6 hours. Click here to see the

Prevent stress

Rest is promoted for the treatment of gastritis to do this

Bowel obstruction Kidney stones Gallstones

Restlessness while sitting may be a sign of this

Female Over the age of 60 History of ulcer disease Concurrent use of anticoagulants Ulcergenic drugs Chronic debilitating disease

Risk factors for NSAID induced gastritis

Diet Lifestyles Health factors

Risk factors for colorectal cancer

Smoking Increased alcohol Barrett's esophagus Central obesity History of achalasia

Risk factors for esophageal cancer

(3) Sartans went to arbys

Sartan is the suffix arbs is the class (angiotensin II receptor blockers)

(1) AIMS SCALE

Scale to measure involuntary movement, higher the number the worse

Pyrosis

This is another word for heartburn

Coffee Extremely hot or cold liquid

This is avoided for a clear liquid diet

Which diagnostic test is used to detect obstruction in the bowel

Serum osmolality is performed for a client as it detects alterations in fluid balance because of vomiting and fluid buildup in the bowel lumen. Vomiting and fluid buildup in the bowel is consistent with a bowel obstruction. a serum amylase level is done to detect elevations that would indicate bowel strangulation. A WBC is done for a client with a bowel obstruction to detect elevations that would indicate inflammation in the bowel. A CT scan is done for a client with a bowel obstruction to confirm a mechanical obstruction.

A nurse assesses a client who is recovering after a coronary catheterization. Which assessment findings in the first few hours after the procedure require immediate action by the nurse

Serum potassium of 2.9 mEq/L Expanding groin hematoma Rhythm changes on the cardiac monitor

(1) Serotonin Syndrome

Shivering and diarrhea to severe muscle rigidity, fever and seizures

Iron Cobalamin Food diary

Should should be done for nutritional treatment of irritable bowel disease

A nurse on the​ medical-surgical unit is providing care for a client recently diagnosed with coronary artery disease. The health care provider has instructed the client to stop smoking. The client asks the nurse about the value of stopping smoking. What is the best response by the​ nurse?

Smoking is a primary independent risk factor for coronary artery disease. Smoking cessation decreases the mortality rate from coronary artery disease significantly. Smoking cessation rather than smoking reduction is necessary to reduce risk and mortality from coronary artery disease. Clients who stop smoking will see benefits even if they have smoked for a number of years. Smoking cessation is essential for successful management of coronary artery disease. All cigarettes cause cardiovascular damage. Carbon monoxide and nicotine cause significant damage to the arterial walls and contribute to coronary artery disease

(1) Stages in crisis intervention

Stage 1 -rapid biopsychosocial assessment, ask them what is gong on *assessment stage 2 crisis interventions-rapid establish rapport (who can help you with ...) stage 3 crisis- identify other precipitants stage 4- deal with feelings and emotions stage 5- generate explore alternatives stage 6-implement an action plan stage 7- follow up 1 month and on anniverssary ***goal is by end of year they are better and not reliving crisis, be independent

Fatty stools

Steatorrhea is this

Liver

Stomach cancer can infiltrate very fast into this organ

Symptomatic relief

Sulfasalazine is used to treat this for irritable bowel disease

NPO IV fluids Rest Antiemetics

Supportive care for gastritis

Treat dehydration

Supportive care for the treatment of gastroenteritis

Herneotomy

Surgery for hiatal hernias

What is the treatment of choice for stomach cancer

Surgery. After surgery, your client will need interventions to address complications and have an alternative method of nutritional intake created

hemorrhoids

Swollen, inflamed veins in anal canal Increased pressure on veins from exertion Inside anus or under skin around anus

Joints Skin Mouth Eye

Systemic problems affect these areas with irritable bowel disease

hemorrhoids

This is dilated rectal veins due to high pressure

ongoing care intervention pt. w/ PUD

Teach about prescribed medication regimen, including expected effects and side and adverse effects. Instruct on the importance of following prescribed medication regimen even when symptoms are relieved. Teach the relationship between NSAIDs and smoking on peptic ulcer formation. Instruct client to keep all scheduled follow-up appointments with the health care provider.

SQ

Teduglutide is given through this route

The charge nurse is making assignments for clients on a cardiac unit. Which client should the charge nurse assign to a new graduate nurse? . The 44-year-old client diagnosed with a myocardial infarction. 2. The 65-year-old client admitted with unstable angina. 3. The 75-year-old client scheduled for a cardiac catheterization. 4. The 50-year-old client complaining of chest pain

The 75-year-old client scheduled for a cardiac catheterization.

(1) Which of the following are behavior assessment categories in the Broset Violence Checklist?

The Broset Violence Checklist is a quick, simple, and reliable tool that can be used to assess the risk of potential violence. Confusion Boisterousness Irritability

24. The client has just returned from a cardiac catheterization. Which assessment data would warrant immediate intervention from the nurse?

The client refuses to keep the leg straight. it could cause the insertion site to bleed, its arterial blood so they could die quickly

Esophageal cancer

There is a high risk for this with Barrett's esophagus

Insidious

The onset for colorectal cancer is this

The client diagnosed with arterial occlusive disease is one (1) day postoperative right femoral-popliteal bypass. Which intervention should the nurse implement?

The right leg should be elevated to decrease edema, not flat or hanging off the side of the bed (dependent). 2. The left leg could have a sequential compression device to prevent deep vein thrombosis, but it should not be on the leg with an operative incision site. 3. The client is one (1) day postoperative, and the pedal pulses must be assessed more than once every eight (8) or 12 hours. 4. The leg dressing needs to be assessed for hemorrhaging or signs of infection

Bleeding origin

The severity of an upper GI bleed is dependent on this

(3) what are the type of diuretics to treat HTN

Thiazide Loop Potassium sparing

(3) first choice med for essen HTN

Thiazide Diuretics hydrochlorothiazide chlorothiazide methylothiazide indapamide, chlorthalidone metolazone

Immediate Delayed

Timing for Tysabri hypersensitivity reactions

A nurse reviews a client's laboratory results. Which findings should alert the nurse to the possibility of atherosclerosis

Total cholesterol: 280 mg/dL Triglycerides: 200 mg/dL Low-density lipoprotein cholesterol: 160 mg/dL A lipid panel is often used to screen for cardiovascular risk. Total cholesterol, triglycerides, and low-density lipoprotein cholesterol levels are all high, indicating higher risk for cardiovascular disease.

Perforation

Toxic megacolon can lead to this with irritable bowel disease

C. Diff

Toxic megacolon can occur from this

1-2 days

Toxic megacolon occurs within this timeframe

Lifestyle modifications Nutritional therapy Drug therapy Non-medicinal Surgery Education

Treatment for GERD

Conservative Surgery

Treatment for PUD

Herniorrhaphy

Treatment for a hernia

Pneumatic dilation Symptomatic relief

Treatment for achalasia

NG tube Lavage

Treatment for acute gastritis

Surgery

Treatment for an anal fistula

laser photocoagulation surgery (colorectal)

Used for clients unable to tolerate major surgery Used for palliative surgery to remove obstructions Used to destroy small tumors Performed during endoscopic procedures

ace inhibitors HTN

Used for clients with diabetes, heart failure, history of MI, or chronic kidney disease Block the formation of angiotensin II to prevent vasoconstriction and sodium and water retention

beta blockers in HTN

Used for clients with heart failure, coronary heart disease, or diabetes Reduce peripheral vascular resistance Reduce the risk of heart failure and stroke Contraindicated for those with asthma or COPD because of bronchial constriction

what is a laparoscopy

Used for simple mechanical obstructions Removes or lyses scar tissue

(1) AIMS scale

Used to check if someone has EPS (monitor movement): to see if they need benztropine/cogentin

a​ high-fiber, not a​ low-fiber, diet is recommended to enhance transit of digested food through the colon. Adequate fluid intake also enhances the passage of stool through the colon. An active lifestyle strengthens the abdominal muscles and promotes transit of stool through the colon

With diverticular​ disease,

(1) What was formerly called manic depression

bipolar disorder

deep vein thrombosis

calf tenderness, positive homans

-pain in upper abdomen -intermittent pain -gnawing burning aching -hunger like pain when stomach is empty -older adults have chest pain, anemia -relieved with foods or antacids -lose weight

clinical manifestations of ulcers PUD

(1) Which mood stabilizer will you avoid bc pt. has glaucoma

clonazepan (klonopin)

Your client with colorectal cancer may need a ___ an opening made into the colon.

colostomy

two common types of ostomies are

colostomy ileostomy

(3) what is VTE

consists of 2 conditions the DVT and pulmonary embolism causes many deaths and affects many

Peritonitis occurs after the peritoneal cavity is

contaminated by a chemical irritant or infectious process. Perforation from an abdominal organ releases gastric juices or bile into the peritoneal cavity, causing an acute inflammatory response.

Stomach cancer

most common cancer worldwide, even though it is less common in USA Older adults with an onset of 63 y.o

(1) What is the therapeutic level of lithium and at what level does it begin to be toxic

0.5-1.2 it is toxic when it exceeds 1.5

52. A client who is prescribed lithium carbonate is being discharged from inpatient care. Which medication information should the nurse teach this client? 1) "Do not alter your dietary sodium intake." 2) "Have serum lithium levels checked every 6 months." 3) "Limit fluid intake to 1,000 mL per day." 4) "Adjust the dose if you feel out of control."

1) "Do not alter your dietary sodium intake." Clients taking lithium should consume a diet adequate in sodium and drink 2,500 to 3,000 mL of fluid per day. Lithium is a salt and competes in the body with sodium. If sodium is lost, the body will retain lithium, resulting in toxicity. Conversely, if sodium levels are significantly increased, it will reduce the level of lithium, resulting in decreased efficacy. Maintaining normal sodium and fluid levels is critical to maintaining therapeutic levels of lithium.

46. The physician has ordered lithium carbonate (Eskalith) for a client diagnosed with bipolar disorder. What is the most likely rationale for prescribing this drug? 1) Decrease hyperactivity 2) Control anger 3) Elevate the mood 4) Diminish anxiety

1) Decrease hyperactivity Lithium carbonate's primary therapeutic effect is to prevent or decrease the incidence of acute manic episodes and associated hyperactivity.

8. A client diagnosed with bipolar II disorder has a nursing diagnosis of impaired social interactions R/T egocentrism. Which short-term outcome is an appropriate expectation for this client problem? 1. The client will have an appropriate one-on-one interaction with a peer by day 4. 2. The client will exchange personal information with peers at lunchtime. 3. The client will verbalize the desire to interact with peers by day 2. 4. The client will initiate an appropriate social relationship with a peer.

1. A client's having an appropriate one-on-one interaction with a peer is a successful outcome for the nursing diagnosis of impaired social interactions. The test taker should note that this outcome is specific, client centered, positive, realistic, and measurable and includes a time frame.

10. A client experiencing mania states, "Everything I do is great." Using a cognitive approach, which nursing response would be most appropriate? 1. "Is there a time in your life when things didn't go as planned?" 2. "Everything you do is great." 3. "What are some other things you do well?" 4."Let's talk about the feelings you have about your childhood."

1. By asking, "Is there a time in your life when things didn't go as planned?" the nurse is using a cognitive approach to challenge the thought processes of the client.

11. A newly admitted client is experiencing a manic episode. The client's nursing diagnosis is imbalanced nutrition, less than body requirements. Which meal is most appropriate for this client? 1. Chicken fingers and French fries. 2. Grilled chicken and a baked potato. 3. Spaghetti and meatballs. 4. Chili and crackers.

1. Chicken fingers and French fries are finger foods, which the client would be able to eat during increased psychomotor activity, such as pacing. Because these foods are high in caloric value, they also meet the client's increased nutritional needs.

23. A client prescribed lithium carbonate (Lithium) 300 mg qam and 600 mg qhs presents in the ED with impaired consciousness, nystagmus, arrhythmias, and a history of recent seizure. Which serum lithium level would the nurse expect to assess? 1. 3.7 mEq/L. 2. 3.0 mEq/L. 3. 2.5 mEq/L. 4. 1.9 mEq/L.

1. Clients with a serum lithium level greater than 3.5 mEq/L may show signs such as impaired consciousness, nystagmus, seizures, coma, oliguria/anuria, arrhythmias, myocardial infarction, or cardiovascular collapse.

15. A client diagnosed with bipolar I disorder, most recent episode manic, is now ready for discharge. Which of the following resource services should be included in discharge teaching? Select all that apply. 1. Financial and legal assistance. 2. Crisis hotline. 3. Individual psychotherapy. 4. Support groups. 5. Family education groups.

1. During a manic episode, clients are likely to experience impulse control problems, which may lead to excessive spending. 2. Clients diagnosed with bipolar disorder can experience hyperactivity or depression, which may lead to ambivalence regarding his or her desire to live. Having access to a crisis hotline may help the client to de-escalate and make the difference between life and death decisions. 3. During a manic episode, a client most likely would have had difficulties in various aspects of interpersonal relationships, such as with family, friends, and coworkers. Individuals experiencing mania may be difficult candidates for psychotherapy because of their inability to focus. When the acute phase of the illness has passed, the client may decide to access an available resource to deal with interpersonal problems. Psychotherapy, in conjunction with medication maintenance treatment, and counseling may be useful in helping these individuals. 4. During a manic episode, a client would not be a willing candidate for any type of group therapy. However, when the acute phase of the illness has passed, this individual may want to access support groups to benefit therapeutically from peer support. 5. During a manic episode, a client may have jeopardized marriage or family functioning. Having access to a resource that would help this client restore adaptive family functioning may improve not only relationships but also noncompliance issues and dysfunctional behavioral patterns, and ultimately may reduce relapse rates. Family therapy is most effective with the combination of psychotherapeutic and pharmacotherapeutic treatment.

18. A nurse working with a client diagnosed with bipolar I disorder attempts to recognize the motivation behind the client's use of grandiosity. Which is the rationale for this nurse's action? 1. Understanding the reason behind a behavior would assist the nurse in accepting and relating to the client, not the behavior. 2. Change in behavior cannot occur until the client can accept responsibility for his or her own actions. 3. As self-esteem is increased, the client will meet individual needs without the use of manipulation. 4. Positive reinforcement would enhance self-esteem and promote desirable behaviors.

1. Grandiosity, which is defined as an exaggerated sense of self-importance, power, or status, is used by clients diagnosed with bipolar affective disorder to help reduce feelings of insecurity by increasing feelings of power and control. When the nurse understands the origin of this behavior, the nurse can better work with, and relate to, the client.

24. A client is newly prescribed lithium carbonate (Lithium). Which teaching point by the nurse takes priority? 1."Make sure your salt intake is consistent." 2. "Limit your fluid intake to 2000 mL/day." 3. "Monitor your caloric intake because of potential weight gain." 4."Get yourself in a daily routine to assist in avoiding relapse."

1. Lithium is similar in chemical structure to sodium, behaving in the body in much the same manner and competing with sodium at various sites in the body. If sodium intake is reduced, or the body is depleted of its normal sodium, lithium is reabsorbed by the kidneys, and this increases the potential for toxicity.

28. A client diagnosed with bipolar affective disorder is prescribed divalproex sodium (Depakote). Which of the following lab tests would the nurse need to monitor throughout drug therapy? Select all that apply. 1. Platelet count. 2. Aspartate aminotransferase (AST). 3. Fasting blood sugar (FBS). 4. Alanine aminotransferase (ALT). 5. Serum depakote level.

1. Platelet counts need to be monitored before and during therapy with Depakote because of the potential side effect of blood dyscrasias. 2. Aspartate aminotransferase is a liver enzyme test that needs to be monitored before and during therapy with Depakote because of the potential side effect of liver toxicity. 4. Alanine aminotransferase is a liver enzyme test that needs to be monitored before and during therapy with Depakote because of the potential side effect of liver toxicity. 5. Depakote levels need to be monitored to determine therapeutic levels and assess potential toxicity.

5. A newly admitted client diagnosed with bipolar I disorder is experiencing a manic episode. Which nursing diagnosis is a priority at this time? 1. Risk for violence: other-directed R/T poor impulse control. 2. Altered thought process R/T hallucinations. 3. Social isolation R/T manic excitement. 4. Low self-esteem R/T guilt about promiscuity.

1. Risk for violence: other-directed is defined as behaviors in which an individual demonstrates that he or she can be physically, emotionally, or sexually harmful to others. Because of poor impulse control, irritability, and hyperactive psychomotor behaviors experienced during a manic episode, this client is at risk for violence directed toward others. Keeping everyone in the milieu safe is always a nursing priority.

13. A client diagnosed with bipolar I disorder in the manic phase is yelling at another peer in the milieu. Which nursing intervention takes priority? 1. Calmly redirect and remove the client from the milieu. 2. Administer prescribed prn intramuscular injection for agitation. 3. Ask the client to lower his or her voice while in the common area. 4. Obtain an order for seclusion to help decrease external stimuli.

1. When a client experiencing mania is yelling at other peers, it is the nurse's priority to address this situation immediately. Behaviors of this type can escalate into violence toward clients and staff members. By using a calm manner, the nurse avoids generating any further hostile behaviors, and by removing the client from the milieu, the nurse protects other clients on the unit.

27. A client on an in-patient psychiatric unit is prescribed lamotrigine (Lamictal) 50 mg qd. After client teaching, which client statement reflects understanding of important information related to lamotrigine? 1. "I will call the doctor if I miss more than 5 days before restarting the medication." 2. "I will schedule an appointment for my blood to be drawn at the lab next week." 3. "I will call the doctor immediately if my temperature rises above 100°F." 4."I will stop my medication if I start having muscle rigidity of my face or neck."

1. When the medication is titrated incorrectly, the risk for Stevens Johnson syndrome increases. Clients need to be taught the importance of taking the medication as prescribed and accurately reporting adherence.

41. A client diagnosed with bipolar disorder has been hospitalized for 2 weeks. The client asks the nurse, "Do you think that the doctor is ever going to discharge me?" Which is the appropriate nursing response? 1) "Ask your doctor when you can be discharged." 2) "Tell me more about your feelings about being hospitalized." 3) "You are not ready to go yet." 4) "Let the doctor know your feelings."

2) "Tell me more about your feelings about being hospitalized."

39. Tori has been diagnosed with bipolar I disorder and presents at her clinic appointment with complaints of feeling depressed and hopeless. What is the most important assessment for the nurse to make at this point? 1) If Tori has been taking her medication 2) If Tori is having thoughts of suicide 3) If Tori has had any new stressors in her life 4) If Tori is using alcohol

2) If Tori is having thoughts of suicide

55. The wife of a patient being treated with lithium for bipolar disorder states to the nurse, "My husband has been on lithium for 3 days and he's still as manic as ever." Which of the following is important for the nurse to include in patient/family education about lithium? 1) Lithium prevents relapse into depression but has no direct effects on manic episodes. 2) Lithium takes up to 3 weeks to reach peak effectiveness. 3) Lithium is a neurotransmitter that can trigger mania in some individuals. 4) Lithium can be rendered ineffective if the patient restricts sodium intake.

2) Lithium takes up to 3 weeks to reach peak effectiveness. This statement is true and is important for families and patients to understand so they don't prematurely interpret the medication to be ineffective.

33. A suicidal client with a history of manic behavior is admitted to the ED. The client's diagnosis is documented as "bipolar I disorder: depressed." What is the rationale for this diagnosis versus a diagnosis of major depressive disorder? 1) The physician does not believe the client is suffering from major depression. 2) The client has experienced a manic episode in the past. 3) The client does not exhibit psychotic symptoms. 4) There is no history of major depression in the client's family.

2) The client has experienced a manic episode in the past. According to the DSM-5 criteria, a manic episode rules out the diagnosis of major depressive disorder.

14. A client newly admitted with bipolar I disorder has a nursing diagnosis of risk for injury R/T extreme hyperactivity. Which nursing intervention is appropriate? 1. Place the client in a room with another client experiencing similar symptoms. 2. Use prn antipsychotic medications as ordered by the physician. 3. Discuss consequences of the client's behaviors with the client daily. 4. Reinforce previously learned coping skills to decrease agitation.

2. A newly admitted client experiencing an extremely hyperactive episode as the result of bipolar I disorder would benefit from an antipsychotic medication to sedate the client quickly. A mood stabilizer may be given concurrently for maintenance therapy and to prevent or diminish the intensity of subsequent manic episodes.

1. Which statement about the development of bipolar disorder is from a biochemical perspective? 1. Family studies have shown that if one parent is diagnosed with bipolar disorder, the risk that a child will have the disorder is about 28%. 2. In bipolar disorder, there may be possible alterations in normal electrolyte transfer across cell membranes, resulting in elevated levels of intracellular calcium and sodium. 3. Magnetic resonance imaging reveals enlarged third ventricles, subcortical white matter, and periventricular hyperintensity in those diagnosed with bipolar disorder. 4. Twin studies have indicated a concordance rate among monozygotic twins of 60% to 80%.

2. Alterations in normal electrolyte transfer across cell membranes, resulting in elevated levels of intracellular calcium and sodium, is an example of a biochemical perspective in the development of bipolar disorder.

53. Cameron, who has been treated with lithium for several months, was recently placed on sodium-depleting diuretics by his family physician. He now presents in the ER with tremors, psychomotor retardation, confusion, and giddiness. What is the most likely reason for his symptoms? 1) Cameron's lithium level has dropped R/T sodium depletion and he is experiencing a return of manic symptoms. 2) Cameron is experiencing extrapyramidal symptoms R/T a drug:drug interaction. 3) Cameron is experiencing lithium toxicity R/T sodium depletion. 4) Cameron is experiencing psychosis R/T lithium toxicity.

3) Cameron is experiencing lithium toxicity R/T sodium depletion. Sodium depletion increases the risk for lithium toxicity, and Cameron's symptoms are consistent with lithium toxicity.

36. A client is diagnosed with bipolar disorder. The family describes the client as being "on the move." The client sleeps 3 to 4 hours nightly, spends excessively, and has recently lost 10 pounds. During the initial client assessment, which client response would the nurse expect? 1) Short, polite responses to interview questions. 2) Introspection related to present situation. 3) Inability to remain seated and racing thoughts. 4) Feelings of helplessness and hopelessness.

3) Inability to remain seated and racing thoughts. In the manic phase of bipolar disorder the client experiences hyperactivity, restlessness, and flight of ideas. This would cause the client to have difficulty remaining seated and have problems organizing thoughts.

51. A client demonstrating manic behavior has become demanding and hyperactive. Which is the most appropriate nursing intervention to address these client behaviors? 1) Help lessen the client's feelings of guilt and rejection. 2) Warn the client that restraints may be necessary if behavior does not improve. 3) Maintain a supportive, structured environment, setting firm limits in a nonthreatening manner. 4) Introduce the client to peers in order to increase interpersonal contacts.

3) Maintain a supportive, structured environment, setting firm limits in a nonthreatening manner. The client is having difficulty controlling behavior and maintaining impulse control. The nurse must help the client to do so in an objective, nonjudgmental way, focusing on the behavior and not the client.

50. A client diagnosed with bipolar disorder is experiencing hyperactive behavior and weight loss. Which nutritional intervention would be most therapeutic for this client? 1) Allow the client full kitchen privileges to eat anything as needed (prn). 2) Initiate tube feedings with nutritional supplements. 3) Provide small, frequent feedings of finger foods. 4) Provide a quiet place where the client can sit down to eat meals.

3) Provide small, frequent feedings of finger foods. The client experiencing mania is unable to sit still long enough to eat an adequate nutritious meal. Small, frequent feedings with finger foods allow the client to eat during periods of hyperactivity.

12. A provocatively dressed client diagnosed with bipolar I disorder is observed laughing loudly with peers in the milieu. Which nursing action is a priority in this situation? 1. Join the milieu to assess the appropriateness of the laughter. 2. Redirect clients in the milieu to structured social activities, such as cards. 3. Privately discuss with the client the inappropriate provocative dress. 4. Administer prn antianxiety medication to calm the client.

3. Because dressing provocatively can precipitate sexual overtures that can be dangerous to the client, it is the priority of the nurse to discuss with the client the inappropriateness of this clothing choice.

4. A client diagnosed with cyclothymia is newly admitted to an in-patient psychiatric unit. The client has a history of irritability and grandiosity and is currently sleeping 2 hours a night. Which nursing diagnoses takes priority? 1. Altered thought processes R/T biochemical alterations. 2. Social isolation R/T grandiosity. 3. Disturbed sleep patterns R/T agitation. 4. Risk for violence: self-directed R/T depressive symptoms.

3. Disturbed sleep patterns is defined as a time-limited disruption of sleep amount and quality. Because the client is sleeping only 2 hours a night, the client is meeting the defining characteristics of the nursing diagnosis of disturbed sleep patterns. This sleep problem is usually due to excessive hyperactivity and agitation.

25. Which list contains medications that the nurse may see prescribed to treat clients diagnosed with bipolar affective disorder? 1. Lithium carbonate (Lithium), loxapine (Loxitane), and carbamazepine (Tegretol). 2. Gabapentin (Neurontin), thiothixene (Navane), and clonazepam (Klonopin). 3. Divalproex sodium (Depakote), verapamil (Calan), and olanzapine (Zyprexa). 4. Lamotrigine (Lamictal), risperidone (Risperdal), and benztropine (Cogentin).

3. Divalproex sodium (Depakote), an anticonvulsant, and verapamil (Calan), a calcium channel blocker, are used in the long-term treatment of BPAD. Olanzapine (Zyprexa), an antipsychotic, has been approved by the FDA for the treatment of acute manic episodes.

9. A client seen in the emergency department is experiencing irritability, pressured speech, and increased levels of anxiety. Which would be the nurse's priority intervention? 1. Place the client on a one-to-one observation to prevent injury. 2. Ask the physician for a psychiatric consultation. 3. Assess vital signs, and complete a physical assessment. 4. Reinforce relaxation techniques to decrease anxiety.

3. The nurse first should assess vital signs and complete a physical assessment to rule out a physical cause for the symptoms presented. Many physical problems manifest in symptoms that seem to be caused by psychological problems.

29. A client diagnosed with bipolar affective disorder is prescribed carbamazepine (Tegretol). The client exhibits nausea, vomiting, and anorexia. Which is an appropriate nursing intervention at this time? 1. Stop the medication, and notify the physician. 2. Hold the next dose until symptoms subside. 3. Administer the next dose with food. 4. Ask the physician for a stat carbamazepine (Tegretol) level.

3. When clients prescribed carbamazepine experience nausea, vomiting, and anorexia, it is important for the nurse to administer the medication with food to decrease these uncomfortable, but acceptable, side effects. If these side effects do not abate, other interventions may be necessary.

2. Which nursing charting entry is documentation of a behavioral symptom of mania? 1. "Thoughts fragmented, flight of ideas noted." 2. "Mood euphoric and expansive. Rates mood a 10/10." 3. "Pacing halls throughout the day. Exhibits poor impulse control." 4."Easily distracted, unable to focus on goals."

3. When the nurse documents, "Pacing halls throughout the day. Exhibits poor impulse control," the nurse is charting a behavioral symptom of mania. Psychomotor activities and uninhibited social and sexual behaviors are classified as behavioral symptoms.

16. A nursing instructor is teaching about the etiology of mood disorders. Which statement by a nursing student best indicates an understanding of the etiology of mood disorders? 1. "When clients experience loss, they learn that it is inevitable and become hopeless and helpless." 2. "There are alterations in the neurochemicals, such as serotonin, that cause the client's symptoms." 3. "Evidence continues to support multiple causations related to an individual's susceptibility to mood symptoms." 4. "Current research suggests that a genetic component affects the development of mood disorders."

3. When the student states that there is support for multiple causations related to an individual's susceptibility to mood symptoms, the student understands the content presented about the etiology of mood disorders.

54. A client is diagnosed with bipolar disorder. Which medication is the drug of choice for this diagnosis? 1) Risperidone (Risperdal) 2) Clozapine (Clozaril) 3) Lorazepam (Ativan) 4) Lithium carbonate (Eskalith)

4) Lithium carbonate (Eskalith) Lithium carbonate is the classic treatment and drug of choice for maintenance therapy for bipolar disorder. It stabilizes the mood lability that is characteristic of the disorder.

47. The activity therapist is planning an individualized program for a client diagnosed with bipolar I disorder: manic episode who is exhibiting hostility and excessive energy. Which activity would be most appropriate? 1) Writing memoirs 2) Team sports 3) Ping-pong 4) Walking

4) Walking Walking is the best activity choice because it is not considered competitive and provides an opportunity for the release of energy.

19. A nursing instructor is teaching about the criteria for the diagnosis of bipolar II disorder. Which student statement indicates that learning has occurred? 1. "Clients diagnosed with bipolar II disorder experience a full syndrome of mania and have a history of symptoms of depression." 2. "Clients diagnosed with bipolar II disorder experience numerous episodes of hypomania and dysthymia for at least 2 years." 3. "Clients diagnosed with bipolar II disorder have mood disturbances that are directly associated with the physiological effects of a substance." 4."Clients diagnosed with bipolar II disorder experience recurrent bouts of depression with episodic occurrences of hypomania."

4. Recurrent bouts of depression and episodic occurrences of hypomania are diagnostic criteria for bipolar II disorder. Experiencing a full manic episode would indicate a diagnosis of bipolar I disorder and rule out a diagnosis of bipolar II disorder.

17. A nursing instructor is teaching about the psychosocial theory related to the development of bipolar disorder. Which student statement indicates that learning has occurred? 1. "The credibility of psychosocial theories in the etiology of bipolar disorder has strengthened in recent years." 2. "Individuals are genetically predisposed to being diagnosed with bipolar disorder if a parent is mentally ill." 3. "Following steroid, antidepressant, or amphetamine use, individuals can experience manic episodes." 4."The etiology of bipolar disorder is unclear, but it is possible that biological and psychosocial factors are influential."

4. The etiology of bipolar disorder is unclear; however, research evidence shows that biological and psychosocial factors are influential in the development of the disorder.

26. The nurse is evaluating lab test results for a client prescribed lithium carbonate (Lithium). The client's lithium level is 1.9 mEq/L. Which nursing intervention takes priority? 1. Give next dose because the lithium level is normal for acute mania. 2. Hold the next dose, and continue the medication as prescribed the following day. 3. Give the next dose after assessing for signs and symptoms of lithium toxicity. 4. Immediately notify the physician, and hold the dose until instructed further.

4. The nurse needs to notify the physician immediately of the serum lithium level, which is outside the therapeutic range, to avoid any risk for further toxicity.

(1) Valproic acid (Depakene, depakote)

A classic BD med Therapeutic range is 50-150 mcg/mL Treats: Epilepsy, MANIC EPISODES, migraines, schizophrenia WEIGHTLOSS Contraindicated in blood dyscrasia and may cause a skin rash (Check CBC's, platelet count)

(1) What are the mood stabilizers overall side effects

ALL Mood stabilizers present side effects of: DWD Avoid in: pregnancy, elderly, liver kidney fail Monitor for depression and Risk for Suicide

(1) What is the side effect of Valproic acid

ALL Mood stabilizers present side effects of: DWD Avoid in: pregnancy, elderly, liver kidney fail Risk for Suicide -------- Blood dyscrasias (a prolong bleeding time, rashes requires blood draws

(1) What are the side effect of antipsychotics

ALL Mood stabilizers present side effects of: DWD Avoid in: pregnancy, elderly, liver kidney fail Risk for Suicide -------- EPS/Tardive Dyskensia

(1) What are the side effects of anticonvulsants

ALL Mood stabilizers present side effects of: DWD Avoid in: pregnancy, elderly, liver kidney fail Risk for Suicide -------- makes oral contraceptives ineffective

(1) What are the antipsychotic side effects (EXTRAPYRAMIDAL EFFECTS)

Akinesia- muscular weakness (pseudoparkisonism) Aktasia- restlessness/fidgeting Dystonia- involuntary muscle spasms/ movements int he face arms legs Oculgyric crisis- uncontrolled rolling to the back of the eyes, **if combined with Dystonia it can lead to laryngospasm which is dangerous and can lead to death tardive dyskinesia bizarre facial and tongue movement with a stiff neck. difficulty swallowing, potentially irreversible it is the most dangerous, use the AIMS scale

(1) Lithium Carbonate (Eskalith, Lithobid)

Anti-manic mood stabilizer Treats MANIA Must stay at a therapeutic level of 0.5-1.2 Avoid in liver dysfunction and interacts with MAOis, anticonvulsants, antihypertensives, avoid diuretics comply and take normal sodium intake to not throw of balance, can cause GI upset (take it with food)

(1) Clonazepam (klonopin)

Contraindicated if patient has glaucoma can treat: ACUTE manic episodes uncontrolled leg movements during sleep, neuralgias ------------- petit mal akinetic (rigid) mycoclonic seizres panic disorders

45. Harold is admitted to the psychiatric unit with bipolar I disorder: manic episode in a highly agitated state. His speech is rapid and incoherent, he is pacing and in constant motion, and he is loudly proclaiming that his "lawyers are on the way and every one of you is going to be sued for malpractice." Which of the following nursing interventions are appropriate in this situation? Select all that apply. 1) Provide an environment with low levels of stimulation. 2) Set limits on Harold's threats by instructing him that he is not permitted to sue the staff. 3) Convey a calm attitude and voice when communicating with Harold. 4) Put Harold in seclusion with restraints for the protection of himself and others. 5) Offer activities that will provide safe outlets for Harold's agitation and excessive energy.

Correct 1: Even little amounts of stimulation can increase symptoms and agitation in an acutely manic patient. Providing an environment with low levels of stimulation is a priority to reduce the risk of further escalation. Feedback 2: Although setting limits on unacceptable behavior may be necessary with this client, this example of communication is not limit setting but rather is a defensive response by the nurse and would likely promote increased, not decreased, agitation. Correct 3: Even little amounts of stimulation can increase symptoms and agitation in an acutely manic patient. Conveying a calm attitude and voice contributes to a lower level of stimulation when communicating with this patient. Feedback 4: Seclusion and restraint would not be appropriate at this point. These interventions are appropriate only when all other efforts to help the patient remain in control have failed and there is imminent risk of harm to self and/or others. However, it would be prudent to have plans in place to manage aggressive behavior if it continues to escalate. Correct 5: Offering activities that provide safe outlets for the excessive energy and hyperactivity that occur in manic episodes can be an effective distraction and a tool to reduce agitation.

35. Kelly has come to the mental health clinic for an assessment at the request of her husband. Kelly refuses to talk to the nurse until her personal assistant arrives. She states, "Apparently you don't know that I'm a famous person, and when my fans get here, you'll be glad my personal assistant is here to manage the crowd." The nurse meets with the husband to begin the assessment process. Which of the following observations by the husband are consistent with symptoms of a manic episode? Select all that apply. 1) "She has concocted this story about having a personal assistant and being a famous person; none of it is true." 2) "She has over-extended our credit cards, buying huge quantities of unnecessary items." 3) "Ever since we married, she has had periods where she makes superficial cuts on her wrists and becomes convinced I'm going to divorce her." 4) "I've noticed her behaving in a very provocative manner around other men." 5) "When we go to a party she drinks more alcohol than anyone there and inevitably becomes loud and obnoxious."

Correct 1: Kelly's false belief that she is a famous person is evidence of a delusion of grandeur, which is a symptom of a manic episode. Correct 2: Excessive spending is a common symptom in manic episodes. Feedback 3: Although borderline personality disorder is often comorbid with bipolar disorder, this behavior is more characteristic of the former. Correct 4: In acute manic episodes, one of the symptoms is increased sex drive, which could manifest in provocative and/or high-risk behavior. Feedback 5: Although there is a high incidence of substance use disorder in this population, this behavior is more symptomatic of the substance use than a manic episode.

43. The psychiatrist has asked the nurse to make an assessment of how well Aaron is responding to the lithium he is being prescribed. Which of the following observations by the nurse suggest that Aaron's manic episode is subsiding? Select all that apply. 1) Aaron is able to finish his meals seated at a table. 2) Aaron is sleeping an average of six hours per night. 3) Aaron demonstrates an ability to listen and respond appropriately to questions. 4) Aaron complains of feeling less energetic and creative. 5) Aaron states he doesn't want to keep taking lithium.

Correct 1: One of the symptoms of a manic episode is hyperactivity. Aaron's ability to sit still long enough to finish a meal suggests that he is not excessively hyperactive. Correct 2: A hallmark symptom of a manic episode is lack of sleep, sometimes for days at a time. Aaron's ability to sleep for 6 hours a night is evidence that the manic episode is subsiding. Correct 3: Distractibility is a symptom in manic episodes that interferes with a person's ability to listen and respond appropriately. Aaron's ability to do this suggests the manic episode is subsiding. Correct 4: Lithium's desired effect is to reduce the excessive energy and hyperactivity associated with manic episodes, so Aaron's report of less energy suggests that the medication is having a therapeutic effect. It is not uncommon, though, for patients to be less satisfied with this change because the high energy and creativity that occur in manic episodes is pleasurable. Feedback 5: Although adherence to medication is an issue that needs to be discussed, refusal or lack of desire to take medication is not necessarily symptomatic of illness.

38. Barbara asks to speak to the nurse about her husband, who has been diagnosed with bipolar I disorder. She tells the nurse she is thinking of divorcing her husband because his agitation "comes out of nowhere" and is "impossible to manage." She also admits to being "fed up with his extramarital affairs" and says "I just don't know what to say anymore." The nurse recognizes that family psychoeducational treatment is important in improving adjustment and preventing relapses. Which of the following are components of family psychoeducational treatment that will be beneficial to Barbara on the basis of her expressed concerns? Select all that apply. 1) Problem-solving skills training 2) Communication training 3) Education about the illness 4) Codependency education 5) Divorce training

Correct 1: Teaching Barbara some problem-solving skills addresses her concern that she is having difficulty managing her husband's outbursts. One option for Barbara might be to strategize with her husband how they can problem-solve about what to do when he has difficulty managing his agitation. Correct 2: Teaching Barbara communication skills responds to her concern that "I don't know what to say." One option might be assertive communication skills training so that Barbara develops confidence in her ability to communicate concerns directly to her husband. Correct 3: Teaching Barbara about symptoms of the illness may help her to better understand the dynamics of her husband's engaging in high-risk activities such as extramarital affairs. Feedback 4: Codependency education may be a component in family psychoeducational treatment, but there is no evidence that this is an issue for Barbara. Feedback 5: Divorce training is not typically a component of family psychoeducation and may imply that problem solving is a hopeless venture. There are many avenues that families can access for support and education to facilitate adjustment and reduce or prevent relapses.

49. Donald's wife asks the nurse why her husband has been ordered an anticonvulsant when he's never had a seizure and his real problem is bipolar disorder. Which of these teaching points by the nurse are accurate? Select all that apply. 1) The mechanism of action for anticonvulsants in bipolar disorder is unclear. 2) Anticonvulsants are used to prevent seizures that may be an undesired effect of other medications the patient is taking. 3) Anticonvulsants have demonstrated mood stabilizing effects in patients with bipolar disorder. 4) The FDA does require that antiepileptic medications carry a warning label indicating an increased risk for suicidal thoughts and behavior. 5) Anticonvulsants are prescribed to prevent alcohol withdrawal, which is common in patients with bipolar disorder.

Correct 1: This is a true statement. Although anticonvulsants have demonstrated benefits in mood stabilization, the mechanism of action is unclear. Feedback 2: Anticonvulsants are used in this population for their mood-stabilizing benefits, not to manage side effects of other medications. Correct 3: The mood-stabilizing effect of anticonvulsants is the primary reason for their use in patients with bipolar disorder. Correct 4: Although anticonvulsant medication has positive effects on the mood, it may increase the risk for suicide ideation and attempts, and the FDA does require a warning label to that effect, so this teaching point is accurate. Feedback 5: Although there is a high incidence of substance abuse, including alcohol abuse in this population, the primary use for anticonvulsants in patients with bipolar disorder is for its mood-stabilizing effects.

37. The parents of a teenage son who was recently diagnosed with bipolar disorder ask the nurse to provide them with information about this illness, since they had previously been told their son had ADHD. Which of the following is evidence-based information that can be shared with the family? Select all that apply. 1) ADHD is the most common comorbid condition in children and adolescents with bipolar disorder. 2) Bipolar disorder in children and adolescents is an acute condition that they usually outgrow. 3) There is evidence to support that psychosocial therapy enhances the effectiveness of pharmacological therapy in treatment of bipolar disorder in children and adolescents. 4) Stimulants used in the treatment of ADHD can exacerbate mania in children and adolescents with bipolar disorder. 5) Medication discontinuation can be considered after the patient has been in remission for two months.

Correct 1: This statement is an accurate, evidence-based piece of information. Feedback 2: Evidence supports that bipolar disorder in children and adolescents is a chronic illness with a high risk of relapse. Sensitivity and caution are warranted in deciding if and when this is appropriate information to share with the family, since it can be devastating news to the family that their child has a chronic illness with a high risk for relapse. Correct 3: This is an evidence-based statement and informs the parents of important information for considering treatment options. Correct 4: This is an evidence-based statement and informs the parents of important information for considering treatment options. Feedback 5: This is an inaccurate statement. Some evidence suggests that tapering or discontinuation of medication should be considered only after 12 to 24 consecutive months of remission, and some clients may require long-term or life-long pharmacotherapy.

34. To assist the psychiatrist in determining appropriate medication needs, the nurse has been asked to assess whether a patient is in a hypomanic or an acute manic state. Which of the following symptoms are consistent with hypomania? Select all that apply. 1) Cheerful mood, but underlying irritability surfaces rapidly when needs are not fulfilled 2) Fragmented cognition and perception; often psychotic 3) Delusions of grandeur 4) Easily distracted, which sometimes interferes with completing goal-directed activity 5) Extroverted and sociable

Correct 1: This symptom is consistent with hypomania. In contrast, the individual in an acute manic state presents as euphoric, as if on a continuous "high." Feedback 2: This symptom is more consistent with acute mania. The individual with hypomania more often presents with flighty and rapid flow of ideas but not overt fragmentation. Feedback 3: The individual with hypomania may present with an exalted sense of self, but delusions of grandeur are manifesting of an acute manic episode. Correct 4: This symptom is consistent with hypomania. In contrast, the person in an acute manic episode manifests with inexhaustible energy, poor impulse control, and marked interference with completing tasks. Correct 5: The person in a hypomanic episode typically presents as extroverted and sociable. In contrast, the individual in an acute manic episode typically presents as uninhibited and manipulative. Dress and behavior may appear disorganized and bizarre.

48. Haley is a 35-year-old woman being assessed for complaints of racing thoughts, impulsive agitation, and distractibility. She denies having ever been diagnosed with a mental disorder. Which of the following items are important for the nurse to include in Haley's initial assessment to assist in identifying the correct diagnosis? Select all that apply. 1) Family history of thyroid disorders 2) Family history of depression or bipolar disorders 3) Medications and other substances currently being taken 4) Birth order 5) Interest in attending group therapy

Correct 1: Thyroid disorders, particularly hyperthyroidism, could manifest as the symptoms Haley is describing, and since these disorders show a familial tendency it is beneficial to assess for family history of these disorders. Correct 2: The symptoms Haley is experiencing could be evidence of a bipolar disorder. Bipolar disorders and depression show familial tendencies, so it is beneficial to assess for history of these. Correct 3: Several medications and other substances can produce the symptoms Haley is describing, so a thorough history of substance and medication use is essential. Feedback 4: Haley's birth order in the family is irrelevant in identifying the correct diagnosis. Feedback 5: Identifying interest in treatment options should follow thorough assessment and diagnosis. Exploring Haley's interest in group therapy at the initial assessment will not contribute to identifying the correct diagnosis.

32. Elizabeth has been taking lithium for 4 weeks and complains that she thinks she might have lithium toxicity. Which of these findings by the nurse are consistent with lithium toxicity? Select all that apply. 1) Elizabeth has had very little urine output in the last 24 hours. 2) Elizabeth has had several bouts of diarrhea in the last 24 hours. 3) Elizabeth's lithium level is 1.2 mEq/L. 4) Elizabeth's temperature is 99.6°F. 5) Elizabeth complains of less energy since she started taking lithium.

Feedback 1: Excessive output of dilute urine, not inadequate output, is evidence of lithium toxicity. Correct 2: Severe diarrhea can be a symptom of lithium toxicity, but when assessed in combination with her temperature and the lithium level, it does not appear that lithium toxicity is the cause of the diarrhea. Feedback 3: This level is within the therapeutic range, and toxicity symptoms don't begin to appear until the lithium level exceeds 1.5 mEq/L. Feedback 4: The elevated temperature is not a symptom of lithium toxicity and suggests there may be an infection or other issue that is contributing to the patient's complaint of diarrhea. Feedback 5: People often report feeling less energy when they are on lithium because it is in contrast to the high energy associated with manic episodes. Symptoms of lithium toxicity include drowsiness, mental confusion, impaired consciousness, or coma. There is no evidence of those CNS symptoms in this scenario.

(1) What is hypomania

Mania that isn't as extreme or serious, it does not affect ADL's or impair functioning. They appear as outgoing, cheerful, easily distracted

(1) carbamezepine (tegretol)

Mono therapy (Taken by itself) should not be taken with Lithium. It is best for people who can not take Lithium. Do not take with MAOIs it may also treat epilepsy, trigeminal neuralgia, BIPOLAR DISORDER, resistant schizophrenia, management of alcohol withdrawal, restless leg syndrome, neuralgia

(1) Describe a person who is experiencing hypomania

Mood- cheerful an expansive, volatile and fluctuating Cognition- Exalted self, rapid ideas, flightily, none goal-directed & easily distractedActivity & Behavior -Increase motor activity, extroverted, sociable without close relationships they are doing okay, get easily distracted and are very outgoing

42. A patient being treated with lamotrigine (Lamictal) develops a purplish skin rash that is blistering. This is a rare but potentially life-threatening reaction to the medication known as___________ syndrome.

Stevens-Johnson Although Stevens-Johnson syndrome is rare, it is a life-threatening condition that has been associated with Lamictal (as well as some other medications). It is one reason that nurses should educate patients taking the drug to immediately report skin rash to their prescribing physician.

7. The nurse is reviewing expected outcomes for a client diagnosed with bipolar I disorder. Number the outcomes presented in the order in which the nurse would address them. 1. _____ The client exhibits no evidence of physical injury. 2. _____ The client eats 70% of all finger foods offered. 3. _____ The client is able to access available out-patient resources. 4. _____ The client accepts responsibility for own behaviors.

The outcomes should be numbered as follows: 1, 2, 4, 3.

(1) What are the pros and cons from 1st gen antipsychotics

They work fast, but have many adverse side effects if used for a long term. They are usually used for emergencies especially to treat combativeness. Causes extrapyramidal side effects (EPS)*

(1) What are the second generation antipsychotic drugs for bipolar disorder *ATYPICAL

Ziprasidone (Geodon) --------------------- *Slower acting, not first choice for someone combative Aripiprazole (Abilify) Olanzapine (Zyprexa) Quietiapine (Seroquel) Risperidone (Risperdal)

What are the classification of drugs that stabilize moods. (mood stabilizers)

anti-manic anti-convulsants antipsychotics calcium channel blockers anticholinergics (it is not a mood stabilizer it is adjunct therapy)

(1) tardive dyskinesia (EPS)

bizarre facial and tongue movement with a stiff neck. difficulty swallowing, could be reversible it is the most dangerous, use the AIMS scale AIMS used to measure involuntary movements, the higher the number the worse

(1) What are the first generation antipsychotic drugs for bipolar disorder *TYPICAL

chlorpromazine (thorazine) haloperidol (haldol) thioridazine (mellaril) fluphenazine (prolixin) perphenazine (trilafon)

(1) What are the pre-disposing factors of bipolar depression

drug/Substance abusers ( alcohol, cocaine, amphetamine, inhalers, anxiolytics) Medical condition affecting the right side of the brain biogenic amines - meaning low serotonin during both episodes of mania and depression. (Decrease in acteylcholine and an increase in glutamate) Genetics play a role as well

(1) During EPS side effects of the antipsychotics when would you use the AIMS scale

during tardive dyskinesia, it is a rating scale to measure involuntary movements, the higher the # the more dangerous

(1) define volatile

easily aroused or changeable; lively or explosive

(1) What is mania/euphoria

excessive excitement, enthusiasm, mental and physical hyperactivity. an elevated mood they can show signs of high self esteem, grandiosity, quick thoughts, excessive talkativeness, pressured speech "Nothing can stop me I'm all the way UPPP"

(1) What is acute mania

manic state that does impair functioning, psychosis may be present

(1) describe a person who is experiencing delirious mania

moOd- labile, despair to merriment to ecstasy to irritable to panic anxiety cognition- clouded thinking, confusion, disorientation to stupor. DELUSIONAL- grandiose, religion, persecutiom HALLUCINATIONS- auditory or visual Activity and behavior- frenzied, agitation, purposeless movement. potential exhaustion, injury to self or others. possible death if there are no interventions

(1) Describe a person who is experiencing acute mania

mood- euphoria, elation, continuous high subject to variations. irritable/anger to sadness and crying cognition- fragmented, racing thoughts, flight of idea, pressured speech, disorganized, incoherent, psychotic, hallucinations/delusions (paranoid and grandiose) activity and behavior- excessive psychomotor activity, hyper sexual, excessive behavior dt poor insight. deniable or unreliable of behavior SPIN. poor ADL's and flamboyant Overall, EXCESSIVE.