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If your not sure what answer should be entered, press the space bar and the next missing letter will be displayed. When you are all done, you should look back over all your answers and review the ones in red. These ones in red are the ones which you needed help on. Question: Nursing Assessment for Answer: Heartburn after eating that radiates to shoulders/arms, feeling of fullness/discomfort after eating, positive diagnosis (several episodes) by fluroscopy or barium swallow, gastroscopy Question: interventions for GERD/HerniasAnswer: small, frequent meals; eliminate irritating foods; sit up while eating & 1 hr after; stop eating 3 hrs before bed; elevate HOB on blocks; meds Question: What position patient be in?Answer: Fowlers/Semi fowlers reduces amt of regurgitation and stomach tissue upward thru diaphragm opening Question: Teaching for Answer: difference btw hernia & MI Symptoms, be for aspiration possibility; teach meds Question: UlcerAnswer: ulceration that pentetrates wall of GI tract Question: Causes of Answer: H pylori, stress, drugs (NSAIDS, ), alcohol, smoking Question: Symptoms of Answer: Belching, bloating, epigastric pain to back & relieved by antacids, melena Question: Potential Complications of Answer: Hemorrhage, , perforation Question: Interventions for Answer: symptom onset/relief; monitor COCA of stools, test for occult blood;small freq , no bedtime snacks, no caffeine, Question: When do you give , a mucosal healing agent?Answer: 1-2 hrs after and one hour before bedtime Question: Dumping postop of stomach surgeryAnswer: secondary to rapid entry of food into jejunum pulls water out of bloodstream, occurs 5-30 mins post eating; symptom: vertigo, syncope, swewating, pallor, tachycardia; Question: interventions for syndromeAnswer: minimized by freq meals high protein/low fat/low carb diet; do not consume liquids with meals, do not lie down after eating Question: what medicines to prevent PUD?Answer: salicylates, NSAIDS, in high doses, reserpine, anticoags Question: symptoms of GI Bleed such as?Answer: dark tarry stools, coffee ground emesis, bright red rectal bleeding, fatigue, pallor, severe abd pain (indicates perforation), Decreased BP, pulse, cool extremities, abd mass/bruit, Question: & PUDAnswer: Stress can cause or exacerbate ulcers. teach stress reduction & those with family hx must medical follow up Question: of Crohns diseaseAnswer: chronic inflammation thru entire intestinal mucosa w/periods of remission & exacerbation. occurs teenage/childhood. no cure just tx. with Question: of Crohns DiseaseAnswer: abdominal pain unrelieved by defecation, diarrhea, , weight loss, constant fluid loss, low grade fever, perforation of intestine d/t inflammation Question: for CrohnsAnswer: bowel elimination pattern, control diarrhea. low residue/low fat /high protein/high calorie diet. vitamin . provide bowel rests, I/O, serum electrolytes, weight 2x week, Question: Teaching for w/crohnsAnswer: avoid diarrhea causing foods ie dairy & spicy , avoid smoking, caffeine, pepper, alcohol, Question: patho Ulcerative Answer: superficial mucosa of colon causing bowel to narrow, shorten, and thicken. /colonoscopy tests, Question: loss in GI tractAnswer: 100-200ml/day but 8L Question: Assessment for Answer: diarrhea, abd pain, intermittent /rectal bleeding, liquid stools w/blood, mucus & pus, anemia Question: NI for Answer: bowel pattern/Control diarrhea, low residue/low fat/high protein/high cal diet, no dairy, avoid spicy or diarrhea causing foods, I&O, electrolytes, emotional Question: Opiate drugs and GI Answer: so must be given with care & monitored Question: DiverticulitisAnswer: pouches in intestinal wall. can lead to bowel perforation Question: Assessment for Answer: left lower quadrant pain, increased , rectal bleeding, signs of intestinal obstruction, Question: of intestinal obstructionAnswer: constipation altering with diarrhea, abd , anorexia, low grade fever Question: NI for Answer: well balanced high fiber diet unless inflammation is present, include bulk forming laxatives, increase fluid to 3L, monitor I/O, , bowel elimination, avoid constipation, observe for complications -obstruction, peritonitis, hemorrhage, infection Question: Intestinal -causesAnswer: adhesions (most common), hernia, intusseception
Neurogenic - paralytic ileus, spinal cord ; vascular causes Question: Nutritional of client w/Diverticulitis (hesi hint)Answer: Acute phase-NPO graduating to liquids; recovery phase- no fiber or bowel irritating foods; maintenance-high fiber w/bulk to prevent pooling of foods & avoid small poorly digested foods such as popcorn, nuts, seeds Question: Bowel Obstruction vs non mechanical (hesi Hint)Answer: mech- due to outside bowel caused by disorder inside bowel or blockage; non mech- d/t paralytic ileus which isnt an actual physical blockage Question: NA for ObstructionAnswer: sudden onset of ab pain, tenderness or guarding, hx of abd surgeries, hx of , distention, increased peristalsis then becoming absent when paralytic ileus occurs, high pitched sounds diminishing to absent with late mech obstruction Question: Blood gas analysis with obstruction (hesi hint)Answer: alkalotic state if obstruction is high gastric acid secretion; acidotic state if obstruction is low blocking base secretion Question: NI for obstructionAnswer: NPO w/iV fluids & electrolytes; monitor I/O, catheter, NG intubation, food./fluids restricted 8-10hrs if surgery, prophylactic antibiotics, NG intub done before surgery unless complete obstruction Question: for CirrhosisAnswer: degeneration of liver tissue causing enlargement d/t alcoholism, viral , hepatoxins, infections, congenital abnormalities. Initially hepatomegaly then liver hardens and becomes nodular Question: NA for Answer: hx alcohol or drug use, work hx of to chemicals medication hx of hepatoxic drugs, family hx. Question: NA for - physicalAnswer: weakness, malaise, anorexia, weight loss, palpable liver. abd girth increases, jaundice, fetor hepaticus, asterixis, mental changes, spider , ascites, neuropathy, hematemesis, Question: Clinical manifestations of (hesi hint)Answer: yellow skin, sclera or mucous membranes; dark color urine (bilirubin in urine); clay or colored stools (absence of bilirubin) Question: Fetor Answer: distinctive breath odor of chronic liver disease with a or musty odor Question: of ascites (hesi hint)Answer: paracentesis or peritoneovenous Question: Tx of varices caused by portal hypertension in liver (hesi hint)Answer: may rupture and cause hemorrhage. insertion of balloon tamponade, vasopressors, vitamin K, coagulation and blood transfusions Question: Lab in CirrhosisAnswer: elevated , AST, ALT, alkaline phosphate; decreased Hct, Hgb, albumin Question: (hesi hint)Answer: ammonia is not broken down so serum level rises causing confusion/mental changes; also metabolism of drugs is slowed so they remain in system Question: Complications of Answer: ascites, portal hypertension, esophageal varices, , resp distress, coag defects Question: NI for Answer: adm vit supplements (ABCK) mental status, avoid initiating bleeding (no uncessary sticks, electric razor, soft tooth brush, maintain venipressure 5 mins, check stools for blood, prevent straining w/defecation. restrict protein, skin care Question: NI for (continued)Answer: low sodium/low fat/high carb diet. restrict/monitor Question: What drug is used for Answer: Question: pathoAnswer: of liver cells Question: NA for Answer: exp (sex, blood, parenteral, oral-fecal) recent transfusions, Question: Individuals at risk for Answer: homosexual males, iv drug users, piercings/tattoos, living in crowded conditions, health care Question: assessment for hepatitisAnswer: fatigue, malaise, weakness, anorexia, n/v, jaundice, myalgia, dull headaches, irritability, abd tenderness RUQ, elevation of enzymes Question: NI for Hep A (hesi hint)Answer: provide environment conducive to eating d/t n/v- odors, encourage pt to sit up while eating, small frequent meals, antiemetic b4 eating Question: NI (hesi hint)Answer: rest & adequate nutrition, monitor drug therapy d/t drugs being in liver, do not resume drugs or use OTC during tx for hepatitis w/out dr approval Question: for pancreatitisAnswer: non bacterial inflammation of pancreas. acute- digestions of the pancreas by its own enzymes d/t alcohol ingestion & biliary tract disease. -progressive destructive w/permanent dysfunction Question: NA pancreatitisAnswer: severe mid epigastric pain radiating to back w/alcohol consumption or fatty meal; abd guarding, rigid boardlike abd, n/v, temp, tachycardia, dcreased bp, bluish flank discoloration or periumbilical area, elevated , lipase or glucose levels Question: NA pancreatitisAnswer: continuous burning or gnawing abd pain, ascites, steatorrhea, , weight loss, jaundice, dark urine, s/s of DM Question: NI acute Answer: NPO, NG suction, TPN, pain med, antacids PPI, H2; side laying w/knees to chest, avoid alcohol, fatty & spicy foods, blood sugar (insulin if needed),monitor for hypocalcemia Question: NI Chronic Answer: administer analgesics, pancreatic enzymes (mix w/fruit juice or applesauce, monitor coca of stool to enzyme tx effectiveness, low fat bland diet, monitor for s/s of DM Question: pancreatic pain (hesi hint)Answer: acute pain located retroperitoneally. any enlargement of pancreas causes the to stretch tightly. sitting up or leaning forward reduces pain Question: (graves disease)Answer: excessive thyroid Question: Common tx for Answer: thyroid ablation by medication, radiation, thyoidectomy, adenectomy (removing anterior portion of (tsh) Question: NA for Answer: enlarged thyroid (goiter), weight loss, diarrhea, heat intolerance, tachycardia, Inc BP, , exopthalmos Question: Labs for Answer: T3 >220, T4 >12, low TSH indicates primary disease, high level =pituitary prob, thyroid scan Question: NI for Answer: calm restful atmosphere, for s/s thyroid storm, Question: Thyroid (hesi hint)Answer: life threatening uncontrolled d/t graves. s/s fever, tachycardia, agitation, anxiety, htn. maintain adequate airway. PTU/tapazole antithyroid drugs to tx thyroid storm with propanolol Question: for hyperthyroidismAnswer: daily HRT, medic alert bracelet, s/s of hormone replacement overdose or ; diet- high cal high protein low caffeine low fiber (if diarrhea), eye care. Question: tx for Answer: medications-take as prescribed; radiation -GI irritant, is radioactive; thyroidectomy Question: Post op (hesi hint)Answer: be prepared for laryngeal edema. trach kit with O2 and suction machine. calcium accessible; check for bleeding, support neck, Question: calcium implications w/thyroidectomy d/t removal of glands (hesi hint)Answer: normal serum calcium 9-10.5. best of prob is decrease in calcium level post op Question: If glands removed change of tetany increases so...(hesi hint)Answer: monitor calcium level, check for tingling of toes, and circumoral; check for chovsteks & trousseaus sign Question: Hypothyroid - coma (hesi hint)Answer: can be precipitated by acute illness, withdrawal of meds, anesthesia, or hypoventilation. airway must be kept patent and ventilator support if needed Question: NA hypothyroidismAnswer: weight gain, constipation, bradycardia, fatigue, cold intolerance, thin brittle hair, think brittle , goiter, periorbital edema. Question: Teachings for Answer: medication , effects, s/s of myxedema coma, 3L fluid intake, increase activity, high fiber diet. avoid sedation (leads to resp distress) Question: 's disease - andrenocortical deficiencyAnswer: autoimmune disorder - lack of cortisol, & androgens. diagnosis made by ACTH stimulation test. Question: in Addisons' disease (hesi hint)Answer: that pts must follow prescribed regimen precisely. no suddenly and must taper off dosage. Question: NA for Answer: fatigue, weakness, weight loss, anorexia, postural hypotension, hypOglycemia, hypOnatremia, , hyperpigmentation, alopecia (loss of body hair), hypovolemia Question: NI for Addisons Answer: VS q15 mins if crisis, monitor I/O & weight, rise slowly d/t hypotn, monitor electrolytes Question: Crisis (Hesi hint)Answer: sudden withdrawal of steroids or stress. vascular - fast IV of fluids; IV glucose for hypOglycemia, essential to administer Hydrocortisone and aldosterone replacement Question: syndromeAnswer: excess adrenocorticoid caused by chronic corticosteroid administration, adrenal, pituitary or hypothalamus Question: Physical assessment of 'sAnswer: moon face, hump, truncal obesity, abd stiae, muscle atrophy, hirsuitism, hyperpigmentation, amenorrhea, thinning of skin Question: Lab findings in Answer: HypErglycemia, , HypOkalemia, increased cortisol, Question: NI for 'sAnswer: protect from infection, monitor for s/s of infection, teach safety measures, low sodium diet, encourage vit D & , wean from steroids. Question: Admininstration (hesi hint)Answer: teach clients to take steroids with meals to prevent gastric . dont skip doses, Question: ketoacidosisAnswer: glucose >350, ketonuria, PH 6.8-7.2 Question: TX of Answer: isotonic IV fluids, slow of regular insulin, potassium replacement, Question: non hyperosmolar hyperglycemiaAnswer: no ketones hyperglycemia, dehydration, plasma hyperosmolity, changed mental Question: tx non hyperosmolar hyperglycemiaAnswer: isotonic IV , IV insulin (if needed) Question: Why do diabetics have trouble with wound ? (hesi hint)Answer: high blood glucose adds to damage of capillaries causing permanent scarring. causes disruption of capillary elasticity, promoting probs such as diabetic retinopathy, poor , cardiovascular issues Question: What is glycosylated hgb (A1C)? Hesi Answer: indicates glucose control over 120 days (life of red blood cells). valuable measure of diabetic Question: Insulin Answer: lift skin/90degree ; refrig or room temp (28 days); rotate injection sites, clear(reg) before cloudy) Question: DM Answer: carb counting/exchange lists; time meals to med peak times; 55-60% carbs/12-15% protein/ 30% or less fat. complex carbs, fiber low fat. Bedtime snack prevent insulin reaction to long acting insulin peaks. Question: Sick day for insulinAnswer: keep taking ; monitor glucose more frequently, watch for hypEr glycemia Question: Body to illness & stress regarding Blood sugar (hesi hint)Answer: bodies response is to glucose therefore any illness results in hypErglycemia Question: Exercise regimen r/t Answer: regular non strenuous exercise; after mealtime & with ; snack might be needed before or during exercise; Question: what to do if unable to if client is hypO or hypEr glycemic (hesi hint)Answer: for hypOglycemia Question: acting insulin (humalog/novolog)Answer: 5-15min onset, 2-3hr peak or less; give 15 mins of a meal Question: Acting (regular)Answer: 30-60min onset, 2-3hr peak, can be IV Question: Intermediate (NPH)Answer: 1-2hr onset, 6-12 hr peak; mix with acting Question: Long (ultralente/lantus)Answer: 4-8hr , 14-20 hr peak, once daily @bedtime, do not mix Question: S/S of Answer: 3 P's, blurred vision (type2), , weight loss, syncope Question: Tx of Answer: , check BG, assess for ketoacidosis Question: S/S of Answer: HA, nausea, sweating, tremors, lethargy, hunger, confusion, slurred speech, tingling around mouth, anxiety, Question: tx of of Answer: occurs rapidly and can be life threatening. give complex carbs such as cracker & peanut butter and seek medical attention, check BG Question: SMBG (hesi hint)Answer: provides tight glucose control to prevent long term complications; monitor before meals, bedtime and when symptoms occur; results and report to provider Question: Foot care for Answer: checked daily, washed with mild soap & warm water dried well esp between toes; moisturize but not toes; clean socks, nails filed straight across. Question: tract obstruction-BPHAnswer: enlargement or hypertrophy of the prostate in men over old. Question: Tx of Answer: TURP Question: NA of Answer: increaed freq of voiding; nocturia, dribbling, hesitancy, decrease size/force of , acute urinary retention, bladder distention Question: Bladder with Turp (hesi hint)Answer: ballon causes continuous feeling of needing to void, do not try and void catheter or it will cause bladder spasms. medications to prevent spasms given. Question: irrigation with TURP (hesi hint)Answer: use only sterile saline to prevent cellular shifts Question: Drainage after Answer: reddish pink clearing to pink. some small clots. monitor for bright red bleeding w/large viscous clots. normal for some bleeding & small clots to be passed. If amts sh/be reported Question: Prostate Answer: before age 40, 2nd leading cause of male death; high risk-multiple sex partners, STD's and some viral infections Question: NA for cancerAnswer: PSA Question: interventions related to Orchitis? Answer: rest with scrotal elevation, application of ice, admin of analgesics and antibiotics. partner if bacterial, mumps vaccine, nsaids or antiinflammatories Question: nursing education related to orchiectomy? Answer: decreased levels after the removal. Avoid sexual activity for 2-4 weeks after surgery, avoid lifting heavy weights or strenuous activity, s/s of infection. Increase fluids & high fiber diet to avoid constipation. Will also need follow up appt Question: Identify nursing assessments related to toxic shock (TSS)?Answer: Sudden onset, high temp (>102), HA, sore throat, vomiting, diarrhea, generalized rash, hypotension, Rash on palms and soles of hands/feet, confusion, muscle aches, redness of eyes/mouth/throat and Question: ProlapseAnswer: downward displacement of uterus. Can on other structures. bladder, rectum, small intestine can protrude thru vaginal wall Question: CystoceleAnswer: of anterior vaginal wall with prolapse of bladder Question: Answer: relaxation of posterior wall with prolapse of rectume Question: Tumors - uterineAnswer: more in black women, non parity women. most common symptom is abnormal uterine bleeding. TX D&C, ablation Question: cancerAnswer: 95% squamous cell cancer; HPV ; Question: Hesi for Cervical cancerAnswer: pap smear annually to age 39, then 2-3 years; laswer/crysurgery for small lesions; invasive cancer / hysterectomy/conization. chemo not effective Question: Care of pt with radiation Answer: transmission precautions; isolation (provide support); leadlined container; client must remain in bed; time with client Question: cancerAnswer: germ |
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