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Med Surg 32-35 guide
| Question | Answer |
|---|---|
| Billroth ll surgery | Is a partial Gastrectomy where the remaining stomach is connected to the jejunum, bypassing the duodenum typically used in treatment of PUD and Gastric cancer |
| Causes of peptic ulcer disease | Eroding of stomach lining usually from H. Pylori or use of NSAIDS |
| Client instructions for upper GI series involving a barium swallow | NPO 8hrs before procedure. Discourage smoking prior to procedure, During procedure client drinks thick chalky barium. Client is asked to increase fluid intake to expel barium. Stomach checked for distention |
| S/S of gallbladder disease | Asymptomatic. Elevated temp, RR, pulse and vomiting. Inability to take a deep breath when examiner's fingers are pressed below liver margin (positive Murphy sign) |
| S/S of cholelithiasis | Asymptomatic. Elevated temp, RR, pulse and vomiting. Positive Murphy sign |
| Preop teaching of laparoscopic cholecystectomy | Careful attention to hygiene, avoiding exposure to blood/bodily fluids from high-risk group and activities, getting available vaccinations using immunoglobin or vaccine after exposure |
| Manifestations of liver transplant rejection | Depends on transplanted tissue and degree of failure |
| Type of hepatitis | Hepatitis A, B, C, D, E |
| Hepatitis prevention | Careful attention to hygiene, avoiding exposure from blood/body fluids and from high-risk groups and activities, vaccinations and IG vaccine after exposure |
| Discharge teaching of cholecystectomy | High protein, low fat diet. Obese clients are encouraged to lose weight. Fat slowly reintroduced into diet. |
| Triggers associated w/ exacerbation of ulcerative colitis | Environmental agents such as pesticides, tobacco, radiation, and food additives |
| Inflammatory bowel disease diet modifications | Limit dairy products, fatty food, fresh fruits and vegetables. Multivitamin and mineral supplements may be used. |
| Gastroduodenostomy complications | Surgical site leak, gastric distention, dumping syndrome (rapid entry food high in salt or sugar into jejunum), nutritional problems, excessive fat in stools (steatorrhea) and pyloric obstruction |
| Age related GI changes | -Decreased taste; increased use of salt leading to fluid excess; inability to taste harmful substances; decreased appetite -Decreased saliva; increased periodontal disease -Tooth loss and gingival retraction (poor denture fit) leads to malnutrition |
| Abdominal assessment techniques | Abdominal examination starts with inspection, then auscultation, percussion, and palpation. This prevents palpation from altering other assessment findings. |
| Barium enema nursing education to client | Report any rectal bleeding, abdominal pain, bloating or absence of any stool (all these can indicate constipation or bowel obstruction) |
| Normal vs abnormal stoma characteristics | Normal stoma has moist pink-red appearance, inadequate blood supply will cause the stoma to become blueish, necrosis will turn the stoma black |
| Risk factors for constipation | Fecal impaction, ulcers may develop from pressure on colon mucosa from mass of stool, straining can cause cardiac, neurologic and respiratory complications, megacolon |
| Lifelong concern of a client who had large portion of stomach surgically removed* | Nutritional problems especially w/ vitamin B12 and folic acid deficiency |
| GERD | sx: regurgitation, heartburn 2-3x weekly, hoarseness, sore throat. Test: endoscopy Therapeutic: avoid smoking, raise head 4-6 blocks |
| Medications used to relieve symptoms of GERD | Mild symptoms- antacids, H2 receptor agonists. PPIs for moderate to severe symptoms |
| What are the normal and abnormal colors of an ostomy and what do they indicate? | Normal colors are pink-red and moist. Blueish indicates lack of blood supply. Black indicates necrosis |
| Manifestations of liver transplant rejection | Dependent on involved transplant tissue or organ and degree of failure |
| Nursing consideration for a client who is comatose and tube fed* | Position head of bed 30-45 degrees, monitor for feeding intolerance |
| Pre and postop teaching of a client undergoing a barium swallow | Discoraged from smoking morning of procedure. NPO 8hrs prior to procedure. Pt should increase fluid intake to expel barium |
| Manifestations of cholelithiasis | Asymptomatic. Elevated temp, RR, pulse and vomiting. Positive Murphy sign |
| Assessment data of a client w bowel obstruction | -Abdominal pain & distention -Nausea and vomiting -Blood & mucus per rectum - Fecal vomiting may occur - Electrolyte imbalance |
| How to perform an abdominal assessment involving the assessment techniques and the rationale for the order in which to perform it | |
| Complications of GERD | Asthma, aspiration pneumonia, bronchospasm, laryngospasm, chronic bronchitis, esophagitis's that can progress to Barretts esophagus |
| Risk factors for gastric cancer | H pylori, pernicious anemia, obesity, smoking, increased salt intake, occupational exposure to mining, metal processing, or rubber manufacturing, and alcohol |
| Manifestations of hypovolemic shock of a client who is having a gastric bleeding | hypotension, weak thready pulse, chills, palpitations, dizziness, confusion, and cold/ clammy extremities |
| Manifestations of appendicitis | Anorexia, McBurney's point, fever |
| Complications of gastroduodenostomy procedure | Surgical site leak, gastric distension, dumping syndrome, nutritional problems, Steatorrhea, and pyloric obstruction |
| Causes of peptic ulcer disease (PUD) | stomach or duodenum is eroded, usually from H. pylori infection or use of NSAIDS |
| Diet modifications to prevent exacerbations of inflammatory bowel disease | Limit dairy, fatty foods, fresh fruits and vegetables |
| Age related changes to GI tract | -Oral cancer risk increased -Slower gastric motility; constipation -Gastric mucosa atrophy; decreased absorption of drugs -Relaxed lower esop. sphincter; epigastric distress -Decreased gag reflex and dysphagia; aspiration risk |
| Age related changes to liver | -Increased secretion of cholesterol; gallstones increased -Decrease in volume & blood flow in liver; decreased metabolism of drugs; risk for injury due to drug toxicity |
| Age related changes to pancreas | Increased pancreatic cancer, increased acute pancreatis |
| Ileostomy | liquid to mushy stool |
| Ascending colostomy | Liquid to mushy, foul odor |
| Right transverse colostomy | Mushy to semi formed |
| Left transverse colostomy | Semi formed, soft |
| Descending or sigmoid colostomy | Soft to hard formed |
| Amino acid metabolism | protein -> amino acids -> ammonia -> urea -> into urine excretion |
Created by:
SamarhaP