U world GI- DONE
aparoscopic cholecystectomy -decreased postoperative pain, better cosmetic results, shorter hospital stays, and fewer days for recovery versus the open technique. -Postoperative teaching includes: Diet - a low-fat diet is recommended postoperatively as it is well tolerated. A regular diet can be resumed after a few weeks although weight loss may be recommended (Option 1). Activity and work - resume normal activity slowly, as tolerated. Most individuals can return to work within a week (Option 2). Incision care and hygiene - dressings can be removed the day after surgery, and showering is permitted at this time. Signs and symptoms of infection (redness, edema, pus, severe pain, nausea, fever, chills) should be reported immediately (Option 3). -BATHS NOT permitted until incisions are healed
*Hypokalemia, high protein intake, gastrointestinal bleeding, constipation, hypovolemia, and infection can precipitate hepatic encephalopathy* IMPORTANT TO KNOW!!!!
peritonitis pts lie STILL and take SHALLOW breaths also the pain progresses to other areas of the abd diverticulitis: acute pain (usually in the left lower quadrant) and systemic signs of infection (eg, fever, tachycardia, nausea, leukocytosis). Complications: abscess formation (continuous fever despite antibiotics and palpable mass) and intestinal perforation resulting in diffuse peritonitis (progressive pain in other quadrants of the abdomen, rigidity, guarding, rebound tenderness).
*Nasogastric tubes are contraindicated after gastric surgery* due to potential disruption of the surgical site, which can cause hemorrhage and anastomotic leak (Option 2). Postoperative nausea would be controlled using IV antiemetics. bariatric surgery: Clients are placed on a clear liquid diet for the first 48-72 hours after bariatric surgery to promote healing. The diet is restricted to low-carbohydrate (eg, sugar-free) liquids to decrease the risk of dumping syndrome, low Fowler position is preferred during mealtimes as it slows gastric emptying, reducing the risk of dumping syndrome.
*An SBFT* the nitty gritty -NPO at midnight -barium swallow -a bunch of xrays -inc fluids -If brown stools do not return after 72 hours or abdominal pain or fullness is present, contact the HCP. -endoscope is NOT used to complete an SBFT. -NO bowel prep needed examines the anatomy and function of the small intestine using x-ray images taken in succession. Barium is ingested, and x-ray images are taken every 15-60 minutes to visualize the barium as it passes through the small intestine Clients should be instructed as follows: Fast 8 hours prior to the examination. The test usually takes 60-120 minutes, but if obstruction or decreased motility is present, it can take longer. Drink plenty of fluids after the examination to facilitate barium removal. Chalky stools may be present 24-72 hours after the examination. (Option 1) Black, tarry stools (melena) are not an expected symptom of an SBFT; melena is indicative of gastrointestinal bleeding and should be reported immediately to an HCP. Educational objective: An SBFT uses sequential x-ray images to visualize the structure and function of the small intestine. The client should fast for 8 hours prior to the examination. Stools may be chalky for up to 72 hours. Black, tarry stools indicate a potential gastrointestinal bleed and should be reported immediately.
*small bowel obstruction* - fluid and gas collect proximal to the obstruction, producing rapid onset of nausea and *vomiting* -colicky intermittent abdominal pain and abdominal distension -delay could lead to vascular compromise, bowel ischemia, or perforation. -Nursing management of an obstruction includes placing the client on NPO status, inserting a nasogastric tube, administering prescribed IV fluids, and instituting pain control measures. *large-bowel obstruction* -gradual onset of symptoms, cramping abdominal pain, abdominal distension, *absolute constipation*, and lack of flatus. *Constipation and decreased flatus* resulting from small-bowel obstruction would occur later, as the stool and gas in the large colon would be expelled for a few days.
The guaiac fecal occult blood test is used to assess for microscopic blood in the stool as a screening tool for colorectal cancer. The steps for collecting a sample include: 1. Assess for recent ingestion (within last 3 days) of red meat or medications (eg, vitamin C, aspirin, anticoagulants, iron, ibuprofen, corticosteroids) that may interfere and produce false test results. 2. Obtain supplies (Hemoccult test paper, wooden applicator, Hemoccult developer), wash hands, and apply nonsterile gloves 3. Open the slide's flap and use the wooden applicator to apply 2 separate stool samples to the boxes on the slide. Collect from 2 different areas of the specimen as some portions of the stool may not contain microscopic blood 4. Close the slide cover and allow the stool specimen to dry for 3-5 minutes. 5. Open the back of the slide and apply 2 drops of developing solution to the boxes on the slide 6. Assess the color of the Hemoccult slide paper within 30-60 seconds. A positive guaiac result will turn the test paper blue, indicating presence of microscopic blood in the stool 7. Dispose of used gloves and the wooden applicator and perform hand hygiene. 8. Document the results
A client with cirrhosis may experience pruritus (itching) -cut nails short -wear long-sleeved cotton shirts and cotton gloves. -Baking soda baths, calamine lotion, and cool, wet cloths also help. -Cholestyramine increases the excretion of bile salts through feces, thereby decreasing itching. -no hot baths makes it worse -no harsh soaps Cholestyramine (Questran) may be prescribed to increase the excretion of bile salts in feces, thereby decreasing pruritus. It is packaged in powdered form, must be mixed with food (applesauce) or juice (apple juice), and should be given 1 hour after all other medications.
IBS - chronic bowel condition -diarrhea, constipation, or a combination of both. -reducing diarrhea or constipation, abdominal pain, and stress. -Clients can manage symptoms with diet, medications, exercise, and stress management. To manage IBS, clients should restrict gas-producing foods (eg, bananas, cabbage, onions); caffeine; alcohol; fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) (eg, honey, high-fructose corn syrup, wheat); and other gastrointestinal (GI) irritants (eg, spices, hot/cold food or drink, dairy products, fatty foods). Clients should gradually increase fiber intake (eg, whole grains, legumes, nuts, fruits, vegetables) as tolerated. Foods that are generally well tolerated include proteins, breads, and bland foods (Option 4).
Acute care for diverticulitis focuses on allowing the colon to rest and the inflammation to resolve. This includes: NPO status - more acute cases require complete rest of the bowel. Less severe cases may be handled at home, and clients may tolerate a low-fiber or clear liquid diet (Option 3). IV fluids to prevent dehydration when NPO (Option 4) Pain relief via IV medications to maintain NPO status (Option 1) Preventing increased intraabdominal pressure to avoid perforation and rupture (Option 2) Preventing increased intestinal motility - avoid laxatives and enemas
Measures to prevent constipation -diet high in fiber (whole grains, fruits, vegetables), daily intake of at least 8 glasses of water or other fluids, and exercise. A fiber supplement such as psyllium or bran may be advised. -no red meats I think clear liquids for 24 hrs is for colonoscopy and barium enema isn't necessary for the clear liquid however both will include glycolutyle enemas bowel empty and npc at midnight
Barium enema -contraindicated for clients with acute diverticulitis as it may rupture inflamed diverticula and cause subsequent peritonitis. -Preprocedure instructions include: Take a cathartic (eg, magnesium citrate, polyethylene glycol) to empty stool from the colon. Follow a clear liquid diet the day before the procedure to aid in bowel preparation and to prevent dehydration; avoid red and purple liquids. Do not eat or drink anything 8 hours before the test (Option 2). Expect to be placed in various positions during the procedure. You may experience abdominal cramping and an urge to defecate (Option 3). -Postprocedure instructions include: Expect the passage of chalky, white stool until all barium contrast has been expelled (Option 1). Take a laxative (eg, magnesium hydroxide [Milk of Magnesia]) to assist in expelling the barium. Retained barium can lead to fecal impaction (Option 4). Drink plenty of fluids to promote hydration and eat a high-fiber diet to prevent constipation.
colorectal symptoms -Blood in the stool (eg, positive occult blood, melena) from fragile, bleeding polyps or tumors (Option 2) Abdominal discomfort and/or mass (not common) (Option 1) Anemia due to intestinal bleeding, which may result in fatigue and dyspnea with exertion (Option 4) Change in bowel habits (eg, diarrhea, constipation) due to obstruction by polyps or tumors (Option 3) Unexplained weight loss due to impaired nutrition from altered intestinal absorption (Option 5)
Clients over age 50 should receive routine colorectal cancer screening...occult blood test every year, colonoscopy every 10 years). Nausea and vomiting are expected side effects when opioid pain medications are initiated. However, tolerance develops quickly and persistent nausea is rare.
dumping syndrome -This results in hypotension, abdominal pain, nausea/vomiting, dizziness, generalized sweating, and tachycardia. -Consume meals high in fat, protein, and fiber, which take more time to digest and remain in the stomach longer than carbohydrates (Option 1). These foods also help meet the body's energy needs. Avoid consuming fluids with meals because this causes stomach contents to pass faster into the jejunum, which worsens symptoms. Fluid intake should occur up to 30 minutes before or after meals. Slowly consume small, frequent meals to reduce the amount of food in the stomach (Option 3). Avoid meals high in simple carbohydrates (eg, sugar, syrup) because these may trigger symptoms when the carbohydrates break down into simple sugars. Avoid sitting up after a meal because gravity increases gastric emptying. Instead, lying down after meals is encouraged (Option 5).
Fasting can cause multiple health problems, including increased stress, slowing of the body's metabolism, muscle damage, fluid loss, increased hunger, depletion of nutrients, and physical symptoms such as headache, dizziness, fatigue, and muscle weakness.
fiber rich diet -prevents colorectal cancer -improves glycemic control -weight loss -reduces risk of vascular disease -regulates bowel movement -dec cholesterol -red stroke and CAD Foods that are protein and/or calorie dense include: -Whole milk and dairy products (eg, milkshakes), fruit smoothies Granola, muffins, biscuits Potatoes with sour cream and butter Meat, fish, eggs, dried beans, almond butter Pasta/rice dishes with cream sauce
Foods high in tyramine (eg, aged cheese, yogurt, cured meats, fermented foods, broad beans, beer, red wine, chocolate, avocados) Low intermittent suction to the gastric lumen of a balloon tamponade tube is used to drain stomach contents.
Complications/problems commonly associated with enteral feedings include aspiration, tube displacement, hyperglycemia, diarrhea, abdominal distension, enteral tube misconnections, and clogged tubes. hyperglycemia (gluconeogenesis) occurs in clients receiving both enteral feedings and TPN.
Foods rich in iron include: Meats (eg, beef, lamb, liver, chicken, pork) Shellfish (eg, oysters, clams, shrimp) Eggs, green leafy vegetables, broccoli, dried fruits, dried beans, brown rice, and oatmeal...Eating foods rich in vitamin C (eg, citrus fruits, potatoes, tomatoes, green vegetables) with iron-rich foods will enhance iron absorption but coffee and tea consumption interferes with this process.
Paraesophageal hernias are a medical emergency. Interventions to reduce herniation include the following: -Diet modification—avoid high-fat foods and those that decrease lower esophageal sphincter pressure (eg, chocolate, peppermint, tomatoes, caffeine). Eat small, frequent meals, and decrease fluid intake during meals to prevent gastric distension. -Avoid consumption of meals close to bedtime and nocturnal eating (Option 3). Lifestyle changes—smoking cessation, weight loss (Option 2). Avoid lifting or straining (Option 5). Elevate the head of the bed to approximately 30 degrees—this can be done at home using pillows or 4 - 6 inch blocks under the bed (Option 1).
Hepatic encephalopathy (HE) -is a frequent complication of liver cirrhosis. -Precipitating factors include hypokalemia, constipation, gastrointestinal hemorrhage, and infection. -sleep disturbances (early) to lethargy and coma. Mental status is altered, and clients are not oriented to time, place, or person -A characteristic clinical finding of HE is presence of asterixis (flapping tremors of the hands). It is assessed by having the client extend the arms and dorsiflex the wrists (Option 2). Another sign is fetor hepaticus (musty, sweet odor of the breath) from accumulated digestive byproducts. Spider angiomas (eg, small, dilated blood vessels with bright red centers), gynecomastia, testicular atrophy, and palmar erythema are *expected* findings in *cirrhosis* due to altered metabolism of hormone in the liver.
Borborygmi sounds are loud, gurgling sounds suggesting increased peristalsis. Potential disease processes resulting in borborygmi include gastroenteritis, diarrhea, and the early phases of mechanical obstruction. Clients with GERD generally do not need to minimize or eliminate dairy products from the diet; however, they should choose low-fat or nonfat products.
High-pitched, gurgling sounds signify normal bowel sound...Bowel sounds are normally intermittent (every 5-15 seconds), high-pitched, gurgling sounds that can be auscultated with the diaphragm of the stethoscope in all 4 quadrants. Bowel sounds following abdominal manipulation may be absent for 24-48 hours
Clients with lactase deficiency can prevent unpleasant gastrointestinal symptoms by avoiding lactose-containing dairy products (eg, milk, ice cream), eating cheese or yogurt in moderation, and supplementing with lactase enzymes. Vitamin D and calcium supplementation is also recommended.
Lactase deficiency is not an immune reaction (allergy) to milk products. Rather, the gastrointestinal symptoms are due to a deficiency of the enzyme lactase and the resultant inability to digest lactose.
priority post hemmoroidecctomy is pain management paralytic ileius -not take medications by mouth (due to NPO status), and opioid medications should be avoided as they prolong paralytic ileus. Instead, non-opioid IV analgesics (eg, ketorolac, ibuprofen, acetaminophen) should be administered as prescribed if the client is in pain.
Nursing management for the post-hemorrhoidectomy client includes the following: Pain relief: Initially, pain is managed with pain medications, including nonsteroidal anti-inflammatory drugs (eg, ibuprofen) and/or acetaminophen; opioids can be prescribed initially but may worsen constipation. Beginning 1-2 days postoperatively, warm sitz baths are used as a means to relieve pain. Clients often dread their first bowel movement due to severe pain with defecation. Therefore, pain must be appropriately controlled to prevent further constipation (Option 2). Preventing constipation: Encourage a high-fiber diet and adequate fluid intake (at least 1500 mL/day). Administer a stool softener such as docusate (Colace) as prescribed. An oil-retention enema may be used if constipation persists for 2-3 days (Option 1).
UC -Easily digested foods such as enriched breads, rice, pastas, cooked vegetables, canned fruits, and tender meats are included in the diet. Raw fruits and vegetables, whole grains, highly seasoned foods, fried foods, and alcohol are avoided. The well-balanced diet includes at least 2000-3000 mL/day of fluid to maintain fluid and electrolyte balance and hydration. -Multivitamins containing calcium are often prescribed to supplement nutrition and should be taken regardless of symptoms - Diet journaling is recommended to assist with identifying triggers (Option 5).
PEG TUBE becomes dislodged? get the surgeon that inserted it asap. do not put anything back in that hole. -A PEG tube's tract begins to mature in 1-2 weeks and is fully established in 4-6 weeks. Tube dislodgement <7 days from placement requires surgical or endoscopic replacement. Attempting to reinsert a tube through an immature tract can result in improper placement into the peritoneal cavity, leading to peritonitis and sepsis.
*Pain during defecation* usually indicates a rectal problem such as inflammation, anal fissure, or thrombosed hemorrhoids. Copious, bile-colored (greenish-brown) drainage is expected in a client with a *small bowel obstruction*. The nurse should watch for signs and symptoms of electrolyte imbalances (hypokalemia), dehydration, and metabolic alkalosis. Perforation or irritation of these areas during the procedure can cause acute pancreatitis, a potentially life-threatening complication after an ERCP. Signs and symptoms include acute epigastric or left upper quadrant pain, often radiating to the back, and a rapid rise in pancreatic enzymes (eg, amylase, lipase) (Option 3).
Refeeding syndrome is a potentially lethal complication of nutritional replenishment in significantly malnourished clients and can occur with oral, enteral, or parenteral feedings. After a period of starvation, carbohydrate-rich nutrition (glucose) stimulates insulin production along with a shift of electrolytes from the blood into tissue cells for anabolism. The key signs of refeeding syndrome are rapid declines in phosphorous, potassium, and/or magnesium (mnemonic PPM). Other findings may include fluid overload, sodium retention, hyperglycemia, and thiamine deficiency. Actions to prevent refeeding syndrome include the following: Obtaining baseline electrolytes Initiating nutrition support cautiously with hypocaloric feedings Closely monitoring electrolytes Increasing caloric intake gradually
ingual hernia -protrusion of abdominal contents through the inguinal canal, which appears as a bulge in the lateral groin. -occurs spontaneously or results from increased intraabdominal pressure (eg, heavy lifting). -commonly in male -intestinal strangulation develops, the client requires emergency treatment to prevent bowel ischemia or perforation. Strangulation symptoms include abdominal distension, severe pain, nausea, and vomiting. -prevent hernia reoccurrence after surgical repair, the client is taught to avoid activities that increase intraabdominal pressure (eg, coughing, heavy lifting) for 6-8 weeks -If sneezing or coughing are unavoidable, the client should splint incisions and keep the mouth open while sneezing. -Scrotal support garments and ice packs help decrease postoperative pain and scrotal swelling. The scrotum should be elevated with a pillow while the client is in bed. -The nurse monitors urine output to assess for difficulty voiding after inguinal hernia repair. Male clients are encouraged to stand when voiding to improve bladder emptying. -reposition frequently, ambulate as soon as possible, and practice deep breathing every 2 hours.
Strangulation symptoms include abdominal distension, severe pain, nausea, and vomiting. if a pt has a BLEED ie GI BLEED do not give them anything RED colored!!!! avoid straining c esophageal portal htn
A reduction or energy expenditure of 3,500 calories (kcal) will result in a weight loss of 1 lb (0.45 kg).
Sugary beverages, such as regular soft drinks, are key contributors to the excess consumption of calories and the obesity epidemic. Individuals who are attempting to lose weight should consume beverages with nutritional value and little-to-no caloric value, including: Water Club soda (flavored or unflavored) (Option 2) Unsweetened tea and/or coffee (Option 5) Fresh vegetable juice (Option 3) Nonfat or low-fat milk (in limited amounts)
Hepatic encephalopathy -key finding loc, asterexis, fretur ACUTE DIVERTICULITITS -IV antbx -NPO -NG -IV fluids -REST -NOTHING goes up the butt!!! that ish could pop those lil sacks
The best assessment finding for indicating improved nutritional status is a steady weight gain over a specified period. Serum prealbumin is a faster and more reliable indicator of current nutritional status than serum albumin.
Identify and eliminate foods that cause gas and odor (broccoli, cauliflower, dried beans, brussels sprouts) (Option 1). Empty the pouch when it becomes one-third full to prevent leaks due to increasing pouch weight (Option 2). (Option 3) Stool produced in the ascending and transverse colon is semiliquid, which eliminates the need for irrigation.
The nurse is admitting a client with cholelithiasis and acute cholecystitis. Suddenly, the client vomits 250 mL of greenish-yellow stomach contents and reports severe pain in the right upper quadrant with radiation to the right shoulder. Which intervention would have the highest priority? The highest priority intervention for an actively vomiting client with cholelithiasis is maintenance of strict NPO status to avoid additional gallbladder stimulation.
Clients aiming to achieve a healthy weight must take a multifaceted approach to eating and implement lifestyle changes. The nurse can assist clients with these changes by helping them form realistic and consistent modifications. Effective strategies include: Eliminating sugar-containing beverages (eg, soda, juice, alcohol) to decrease non-nutritive caloric intake Setting realistic goals to maintain motivation and prevent frustration and abandoned efforts; 1-2 lb (0.45-0.91 kg) per week is a healthy, realistic goal (Option 2). Planning healthy meals and keeping nutritious snacks readily available to decrease likelihood of poor dietary choices (eg, fast food, vending machines) (Option 3) Eating small, frequent meals to decrease hunger and tendency to overeat Exercising about 30-60 minutes daily to promote weight reduction. Even small changes (eg, parking further away, using stairs instead of the elevator) can have long-term benefits (Option 5). Getting adequate sleep (usually about 7-9 hours/night); sleep deprivation is associated with weight gain and obesity. no fruit juices bc they have a lot of sugar
The nurse is caring for a client in the postanesthesia care unit following a gastroduodenostomy. Which of the following nursing interventions are appropriate? Select all that apply. 1. Applying bilateral sequential compression devices 2. Encouraging splinting of the incision with a pillow when coughing 3. Keeping the client NPO until bowel sounds return 4. Maintaining supine positioning at all times 5. Repositioning and irrigating a clogged nasogastric tube PRN Correct 1 2 3 In the postoperative period, the nurse should elevate the head of the bed to improve ventilation and reduce the risk of aspiration. Only clients who experience dumping syndrome should lay supine for a short period after eating. (Option 5) Clients may have a nasogastric tube postoperatively for gastric decompression. Clogged nasogastric tubes should be reported to the surgeon. Attempting to manipulate or flush the device may disrupt the surgical site, causing hemorrhage or gastric perforation.
The dwell time of peritoneal dyalisis is based on the prescribed dialysis method and should not be extended without a prescription!!! HYPOnatremia and LOW albumin is seen c cirrhosis elevated is pt time, bilirubin , ALT AST ammonia
The nurse is caring for a client who has a postoperative paralytic ileus following a bowel resection for colon cancer. The client is receiving patient-controlled analgesia (PCA) with morphine. Which nursing diagnoses (NDs) are appropriate to include in the client's care plan? Select all that apply. Acute pain related to tissue damage as evidenced by the use of PCA with an opioid. Pain is usually most intense 12-36 hours after surgery (Option 1). Dysfunctional gastric motility related to bowel manipulation during surgery, anesthesia, and opioid analgesia as evidenced by absent or hypoactive bowel sounds 48-72 hours following surgery secondary to a paralytic ileus. It is a common complication following abdominal surgery (Option 2). Imbalanced nutrition, less than body requirements related to the increased metabolic demand needed for tissue and wound healing as evidenced by the inability to ingest adequate caloric intake secondary to a paralytic ileus and the lack of interest in eating secondary to the ileus, the adverse effects of anesthesia, and analgesic medications (Option 3). Risk for infection - The risk for being invaded by pathogenic organisms is increased in this client due to loss of primary defenses (ie, protective skin barrier), lack of adequate nutrition to meet the body demands, and altered immunity due to the presence of cancer cells (Option 5).
Hypomagnesemia: Ventricular arrhythmias (torsades de pointes): This is the most serious concern (priority). Neuromuscular excitability: Manifestations of low magnesium, similar to those found in hypocalcemia and demonstrated by neuromuscular excitability, include tremors, hyperactive reflexes, positive Trousseau and Chvostek signs, and seizures
The nurse is caring for a client with acute pancreatitis admitted 2 days ago. Which assessment finding is most concerning? 1. Blood glucose levels for the past 24 hours are ≥250 mg/dL (13.9 mmol/L) [14%] 2. Client is lying with knees drawn up to the abdomen to alleviate pain [9%] 3. Five large, liquid stools that are yellow and foul-smelling [13%] 4. Temperature of 102.2 F (39 C) with increasing abdominal pain [62%] 4 Clients with acute pancreatitis are at risk for pancreatic abscess development. This mainly results from secondary infection of pancreatic pseudocysts or pancreatic necrosis. *High fever, leukocytosis, and increasing abdominal pain may indicate abscess formation* (Option 4). The abscess must be treated promptly to prevent sepsis. The health care provider should be notified immediately as antibiotic therapy and immediate surgical management may be required. (Option 1) Elevated blood glucose is an expected finding in clients with pancreatitis. Elevated blood glucose is associated with pancreatic dysfunction and may necessitate insulin administration, but this is not the most concerning finding. (Option 2) Clients with acute pancreatitis often report severe, burning midepigastric abdominal pain that radiates to the back. Clients may seek relief from pain by positioning themselves in the knee-chest position, which decreases intra-abdominal pressure. Pain relief interventions should be attempted, but this is not the priority. (Option 3) The client with pancreatitis may develop steatorrhea (eg, fatty, yellow, foul-smelling stools) due to a decrease in lipase production. Although fluid and nutritional status are important, this does not take precedence over a possible surgical emergency. Educational objective: Acute pancreatitis may cause severe midepigastric abdominal pain, elevated blood glucose levels, and steatorrhea. The nurse should watch closely for high fever, increasing abdominal pain, and leukocytosis as these findings may indicate infection of the necrosed pancreas or pancreatic abscess formation.
The nurse is assessing 4 clients in the emergency department. Which client should the nurse prioritize for care? 1. Client with liver cirrhosis and ascites who has increasing abdominal distension and needs therapeutic paracentesis 2. Client with new-onset ascites from a suspected ovarian mass who needs paracentesis for diagnostic studies 3. Client with ulcerative colitis who has fever, bloody diarrhea, and abdominal distension and needs an abdominal x-ray 4. Nursing home client with dementia who has stool impaction and abdominal distension and needs stool disimpaction
Toxic megacolon -Clients present with abdominal pain/distension, bloody diarrhea, *fever*, and signs of shock (eg, hypotension, tachycardia). -This is a common, life-threatening complication of inflammatory bowel disease and is seen more frequently in ulcerative colitis than in Crohn disease. diverticulititis is perforation, uc is stoic megacolon
Cardinal symptoms of acute calculous cholecystitis include pain in the RUQ and referred pain to the right shoulder and scapula a few hours after eating fatty foods. Associated symptoms include fever, chills, nausea, vomiting, and anorexia.
Verify that the client received necessary information to give consent and witness informed consent.. DO NOT educate about the procedure or obtain the informed consent that is the jib of the doctor doing the procedure. you focus on verifying the consent was signed etc.
A 70-year-old client is admitted to the hospital with a lower gastrointestinal bleed. After assisting the client back to bed, the nurse finds approximately 600 mL of frank red blood in the commode. The client is now pale and diaphoretic and reports dizziness. Which action should the nurse perform first? the pt is in distress sooooo no assessment quickly put him supine to inc the blood flow to his vital organs and inc pressure
Wound evisceration is a medical emergency. The client should be placed in low Fowler's position with the knees bent to reduce tension on the open wound. The nurse should remain with the client while another staff member obtains sterile saline and gauze to cover the wound. A side-lying lateral position (recovery position) is often used following emergency situations such as cardiac arrest or seizure
A 78-year-old client recovering from a hip fracture tells the home health nurse, "I haven't had much of an appetite lately and have been really tired. I'm worried I'm not eating enough." Which question is the priority for the nurse to ask? 1. "Are you able to prepare your own meals?" [22%] 2. "Are you feeling lonely or depressed?" [23%] 3. "Have you lost any weight unintentionally?" [31%] 4. "How many meals do you eat each day?" [22%] Incorrect Correct answer 3 Malnutrition occurs when there is insufficient nutrient intake to meet body needs and relates to multiple factors (eg, poor diet, chronic illness, physical or cognitive impairments). Malnutrition may impair critical physiologic processes (eg, organ and immune system function, wound healing) and can have rapid and potentially lethal implications. Therefore, nurses should frequently assess clients for malnutrition, particularly those at increased risk (eg, advanced age, altered functional status). Assessing for malnutrition involves collecting dietary data (eg, 24-hour diet recall), laboratory values (eg, albumin or prealbumin), physical measurements (eg, BMI), and history of recent weight loss (Option 3). Reports of weight loss, especially unintentional, are critical findings often indicative of malnutrition. In addition, weight loss of ≥5% in 1 month or ≥10% in 6 months may indicate serious conditions (eg, cancer, tuberculosis, failure to thrive). (Option 1) Impaired functional status may contribute to a client's malnutrition. The nurse should prioritize assessing for the presence of malnutrition before assessment of contributing factors. (Option 2) Assessment of psychologic factors (eg, depression, loneliness) is important to determine possible reasons for malnutrition but should be performed only after determining the extent of malnutrition. (Option 4) Meal frequency, eating habits, and recent diet changes are possible contributing factors leading to malnutrition that should be assessed after determining malnutrition risk. Educational objective: Malnutrition occurs when nutrient intake is insufficient for body requirements. Nurses evaluating clients for malnutrition should first assess for unintentional weight loss, an important indicator of malnourishment. Afterwards, contributing factors of malnutrition (eg, functional status, mood alteration, diet) should be evaluated.
acute appendicitis pts Pain and nausea may be managed with prescribed IV analgesics (eg, morphine) and antiemetics stoma 1/8'' In the *immediate* postoperative period of an ileostomy-instructed to thoroughly chew food and monitor for changes in stool output. -Foods to be avoided include: High fiber: popcorn, coconut, brown rice, multigrain bread (Options 3 and 4) Stringy vegetables: celery, broccoli, asparagus (Option 2) Seeds or pits: strawberries, raspberries, olives Edible peels: apple slices, cucumber, dried fruit After an ileostomy, a client may consume fruits and vegetables that are pitted, peeled, and/or cooked (eg, peaches, bananas, potatoes). After the ileostomy heals, the client reintroduces fibrous foods one at a time.
The hospitalized client with anorexia nervosa is started on nutrition via enteral and parenteral routes. Which client assessment is the most important for the nurse to check during the first 24-48 hours of administration? *Refeeding syndrome* is a potentially fatal complication of nutritional rehabilitation in chronically malnourished clients. Electrolytes, especially *phosphorous, potassium, and magnesium, must be monitored frequently* during the first few days of nutritional replenishment. The client's lack of oral intake results in the pancreas making less insulin. *After the client receives food or IV fluids with glucose, insulin secretion is increased, leading to phosphorous, potassium, and magnesium* shifting intracellularly. Phosphorus is the primary deficient electrolyte as it is required for energy (adenosine triphosphate). *Hypophosphatemia causes muscle weakness and respiratory failure* Deficiencies in potassium and magnesium potentiate cardiac arrhythmias. Therefore, aggressive initiation of nutrition without adequate electrolyte repletion can quickly precipitate cardiopulmonary failure.
acute pancreatitis: Clients are at risk of developing hypovolemia (third spacing of fluids), acute respiratory distress syndrome (due to intense systemic inflammatory response), and hypocalcemia (necrosed fat binding calcium). appendicitis: The client will attempt to decrease pain by lying still with the right leg flexed and preventing increased intraabdominal pressure (eg, avoiding coughing, sneezing, deep inhalation).
The highest postoperative priority after a laparoscopic cholecystectomy is prevention of any respiratory complications potentiated by carbon dioxide administration during surgery hence The client is placed in the Sims' position to facilitate movement of carbon dioxide (CO2) utilized during surgery to fill the abdominal cavity.
bouts of diarrhea are self-limiting and last ≤48 hours. Clients experiencing diarrhea that lasts >48 hours or accompanied by fever or bloody stools should be evaluated by a health care provider (HCP). Instructions on rest, fluids, and acetaminophen are helpful and would be the primary choice if the diarrhea had been occurring ≤48 hours without other symptoms.
Jackson pratt -Perform hand hygiene as asepsis must be maintained to prevent the transmission of microorganisms even though there is less chance of bacteria entering the wound using a closed-wound drainage device (eg, JP, Hemovac) than an open-drain device (eg, Penrose) -Pull the plug on the bulb to open the device and pour the drainage into a small, calibrated container -Empty the device every 4-12 hours unless it is 1/2 to 2/3 full before then because as the small capacity bulb (100 mL) fills, the amount of negative pressure in the bulb decreases (Option 1) Compress the empty bulb by squeezing it from side-to-side with 1 or 2 hands until it is totally collapsed. Although the reservoir can be collapsed by pressing the bottom towards the top, compressing the sides of the reservoir (bulb) is recommended as it is more effective in establishing negative pressure (Option 3) Clean the spout on the bulb with alcohol and replace the plug when it is totally collapsed to restore negative pressure (Option 4)
celiac disease -NO BROW... Barley Rye Oats Wheat NO BREAD -Rice, corn, and potatoes are gluten free and are allowed on the diet (Option 3). -No processed foods dinner rolls, cookies, breads, baked goods, breaded stuff, pasta colonoscopy clear liquids 24 hrs before test NPO 8-12 hours before test glycol The enteral route is preferred for feeding. Enteral feedings maintain the integrity of the gut, prevent stress ulcers, and help prevent the translocation of bacteria into the bloodstream.
A cone-tip applicator is used to instill the irrigation solution into the stoma. An enema set should never be used to irrigate a colostomy. A cone-tip applicator is specifically made to avoid damage to the sensitive colostomy opening.
constipation: 30 g of fiber, exercise, bowel regimen avoid delaying defecation when the urge is felt, defecate at the same time each day, and track bowel movements to identify if there is a change in bowel patterns (Option 1)
The Valsalva maneuver is contraindicated in the client diagnosed with increased intracranial pressure, stroke, head injury, heart disease, glaucoma, eye surgery, abdominal surgery, and liver cirrhosis bc of the liver cirrhosis.
esophageal varies can rupture from sudden increase in portal venous pressure (eg, coughing, straining, vomiting) and from mechanical injury (eg, chest trauma, consuming sharp/hard foods). NASOGASTRIC INSERTION without visualization of the esophagus
vegans have Peripheral neuropathy (eg, tingling, numbness) (Option 4) Neuromuscular impairment (eg, gait problems, poor balance) Memory loss/dementia (in cases of severe/prolonged deficiencies) bc they dont eat animals so they have vit b12 def.
no sodium for cirrhosis pt
Nurses caring for clients with appendicitis should prioritize client care according to the ABCs (ie, airway, breathing, circulation). Initiating IV crystalloids (eg, normal saline) is a priority action that prevents circulatory collapse resulting from fluid losses (eg, vomiting, diarrhea) and NPO status. A histamine-related reaction (eg, pruritus) is an expected adverse effect associated with the administration of epidural morphine (Astramorph) give them Benadryl
peptic ulcers: -Meal timing: Eating multiple small meals throughout the day or eating shortly before sleeping may actually worsen PUD by increasing stomach acid secretion. -To reduce ulcer formation risk, clients with PUD should be instructed to stop smoking; avoid chronic NSAID use; *avoid meals or snacks before sleeping* and limit alcohol and caffeine consumption.
*viral hep NOT transmitted via URINE ......can be transmitted via saliva entering the bloodstream so using a toothbrush and receiving a bite can be bad bc there was a break in structure! seems, vaginal secretions, blood is also a big way to get the hep.* VERY IMPORTANT Although kissing, sneezing, sharing drinks/utensils, and breastfeeding are not known routes of transmission, hepatitis B could possibly be transmitted through saliva entering the bloodstream via sharing a toothbrush or receiving a bite.
rebound tenderness= peritonitis Abdominal cramping and flatus is expected after colonoscopy *Peritonitis is a common but serious complication of peritoneal dialysis Typically, the earliest indication of peritonitis is the presence of cloudy peritoneal effluent. Later manifestations include *low-grade fever*, chills, generalized abdominal pain, and rebound tenderness. The nurse should collect peritoneal effluent from the drainage bag for culture and sensitivity*
clients undergoing paracentesis must be monitored closely for hypotension...which is why we give our lil pts albumin to pull that water back in the vascular space thus inc their BP
with RouXX en Y bypass a stomach is indeed directed and made very small so expect intrinsic factor and dumping syndrome Fever spike after an esophagogastroduodenoscopy (EGD) or colonoscopy could be a sign of infection from perforation and should be reported!!!!