Hesi Final NR142
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| Nursing Assessment for GERD | show 🗑
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| show | small, frequent meals; eliminate irritating foods; sit up while eating & 1 hr after; stop eating 3 hrs before bed; elevate HOB on blocks; teach meds
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| What position should patient be in? | show 🗑
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| Teaching for GERD | show 🗑
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| Peptic Ulcer | show 🗑
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| Causes of PUD | show 🗑
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| Symptoms of PUD | show 🗑
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| Potential Complications of PUD | show 🗑
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| Interventions for PUD | show 🗑
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| show | 1-2 hrs after meals and one hour before bedtime
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| show | secondary to rapid entry of hypertonic food into jejunum pulls water out of bloodstream, occurs 5-30 mins post eating; symptom: vertigo, syncope, swewating, pallor, tachycardia;
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| show | minimized by small freq meals high protein/low fat/low carb diet; do not consume liquids with meals, do not lie down after eating
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| show | salicylates, NSAIDS, corticosteroids in high doses, reserpine, anticoags
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| show | dark tarry stools, coffee ground emesis, bright red rectal bleeding, fatigue, pallor, severe abd pain (indicates perforation), Decreased BP, rapid pulse, cool extremities, abd mass/bruit,
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| show | Stress can cause or exacerbate ulcers. teach stress reduction & those with family hx must obtain medical follow up
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| Patho of Crohns disease | show 🗑
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| Assessment of Crohns Disease | show 🗑
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| interventions for Crohns | show 🗑
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| Teaching for clients w/crohns | show 🗑
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| show | superficial mucosa of colon causing bowel to narrow, shorten, and thicken. sigmoidoscopy/colonoscopy tests,
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| show | 100-200ml/day but filters 8L
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| show | diarrhea, abd pain, intermittent tenesmus/rectal bleeding, liquid stools w/blood, mucus & pus, anemia
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| show | 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 support
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| show | depresses so must be given with care & monitored
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| show | Inflammed pouches in intestinal wall. can lead to bowel perforation
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| Assessment for Diverticulitis | show 🗑
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| show | constipation altering with diarrhea, abd distention, anorexia, low grade fever
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| NI for Diverticulitis | show 🗑
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| show | adhesions (most common), hernia, intusseception
Neurogenic - paralytic ileus, spinal cord lesion; vascular causes
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| show | Acute phase-NPO graduating to liquids; recovery phase- no fiber or bowel irritating foods; maintenance-high fiber w/bulk laxatives to prevent pooling of foods & avoid small poorly digested foods such as popcorn, nuts, seeds
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| Bowel Obstruction mechanical vs non mechanical (hesi Hint) | show 🗑
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| NA for Bowel Obstruction | show 🗑
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| show | alkalotic state if obstruction is high blocking gastric acid secretion; acidotic state if obstruction is low blocking base secretion
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| NI for bowel obstruction | show 🗑
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| show | degeneration of liver tissue causing enlargement d/t alcoholism, viral hepatitis, hepatoxins, infections, congenital abnormalities. Initially hepatomegaly then liver hardens and becomes nodular
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| show | hx alcohol or drug use, work hx of exposure to chemicals medication hx of hepatoxic drugs, family hx.
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| NA for cirrhosis - physical | show 🗑
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| Clinical manifestations of jaundice (hesi hint) | show 🗑
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| Fetor Hepaticus | show 🗑
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| treatment of ascites (hesi hint) | show 🗑
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| show | may rupture and cause hemorrhage. insertion of balloon tamponade, vasopressors, vitamin K, coagulation factors and blood transfusions
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| show | elevated bilirubin, AST, ALT, alkaline phosphate; decreased Hct, Hgb, albumin
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| Encephalopathy (hesi hint) | show 🗑
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| Complications of Cirrhosis | show 🗑
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| show | adm vit supplements (ABCK) observe 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
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| NI for cirrhosis (continued) | show 🗑
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| show | lactulose
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| show | inflammation of liver cells
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| show | known exp (sex, blood, parenteral, oral-fecal) recent transfusions,
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| show | homosexual males, iv drug users, piercings/tattoos, living in crowded conditions, health care workers
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| Physical assessment for hepatitis | show 🗑
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| show | provide environment conducive to eating d/t n/v- remove odors, encourage pt to sit up while eating, small frequent meals, antiemetic b4 eating
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| show | rest & adequate nutrition, monitor drug therapy d/t drugs being metabolized in liver, do not resume drugs or use OTC during tx for hepatitis w/out dr approval
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| show | non bacterial inflammation of pancreas. acute- digestions of the pancreas by its own enzymes d/t alcohol ingestion & biliary tract disease. chronic-progressive destructive w/permanent dysfunction
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| show | 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 amylase, lipase or glucose levels
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| show | continuous burning or gnawing abd pain, ascites, steatorrhea, diarrhea, weight loss, jaundice, dark urine, s/s of DM
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| NI acute pancreatitis | show 🗑
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| NI Chronic Pancreatitis | show 🗑
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| show | acute pain located retroperitoneally. any enlargement of pancreas causes the peritoneum to stretch tightly. sitting up or leaning forward reduces pain
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| Hyperthyroidism (graves disease) | show 🗑
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| show | thyroid ablation by medication, radiation, thyoidectomy, adenectomy (removing anterior portion of pituitary (tsh)
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| show | enlarged thyroid (goiter), weight loss, diarrhea, heat intolerance, tachycardia, Inc BP, diaphoresis, exopthalmos
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| Labs for Hyperthyroidism | show 🗑
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| NI for hyperthyroidism | show 🗑
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| Thyroid storm (hesi hint) | show 🗑
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| teach for hyperthyroidism | show 🗑
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| tx for hyperthyroidism | show 🗑
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| show | be prepared for laryngeal edema. trach kit with O2 and suction machine. calcium gluconate accessible; check for bleeding, support neck,
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| calcium implications w/thyroidectomy d/t removal of parathyroid glands (hesi hint) | show 🗑
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| show | monitor calcium level, check for tingling of toes, fingers and circumoral; check for chovsteks & trousseaus sign
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| show | can be precipitated by acute illness, withdrawal of meds, anesthesia, sedatives or hypoventilation. airway must be kept patent and ventilator support if needed
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| show | weight gain, constipation, bradycardia, fatigue, cold intolerance, thin brittle hair, think brittle nails, goiter, periorbital edema.
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| show | medication regimen, effects, s/s of myxedema coma, 3L fluid intake, increase activity, high fiber diet. avoid sedation (leads to resp distress)
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| show | autoimmune disorder - lack of cortisol, aldosterone & androgens. diagnosis made by ACTH stimulation test.
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| Teaching in Addisons' disease (hesi hint) | show 🗑
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| show | fatigue, weakness, weight loss, anorexia, postural hypotension, hypOglycemia, hypOnatremia, HypErkalemia, hyperpigmentation, alopecia (loss of body hair), hypovolemia
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| NI for Addisons disease | show 🗑
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| show | sudden withdrawal of steroids or stress. vascular collapse - fast IV of fluids; IV glucose for hypOglycemia, essential to administer Hydrocortisone and aldosterone replacement
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| show | excess adrenocorticoid caused by chronic corticosteroid administration, adrenal, pituitary or hypothalamus tumors
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| show | moon face, buffalo hump, truncal obesity, abd stiae, muscle atrophy, hirsuitism, hyperpigmentation, amenorrhea, thinning of skin
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| Lab findings in Cushings | show 🗑
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| show | protect from infection, monitor for s/s of infection, teach safety measures, low sodium diet, encourage vit D & calcium, wean from steroids.
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| show | teach clients to take steroids with meals to prevent gastric irritation. dont skip doses,
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| show | glucose >350, ketonuria, venous PH 6.8-7.2
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| TX of DKA | show 🗑
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| non ketotic hyperosmolar hyperglycemia | show 🗑
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| show | isotonic IV fluids, IV insulin (if needed)
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| Why do diabetics have trouble with wound healing? (hesi hint) | show 🗑
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| show | indicates glucose control over previous 120 days (life of red blood cells). valuable measure of diabetic
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| show | lift skin/90degree angle; refrig or room temp (28 days); rotate injection sites, clear(reg) before cloudy)
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| show | carb counting/exchange lists; time meals to med peak times; 55-60% carbs/12-15% protein/ 30% or less fat. choose complex carbs, fiber low fat. Bedtime snack prevent insulin reaction to long acting insulin peaks.
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| show | keep taking insulin; monitor glucose more frequently, watch for hypEr glycemia
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| Body response to illness & stress regarding Blood sugar (hesi hint) | show 🗑
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| show | regular non strenuous exercise; after mealtime & with someone; snack might be needed before or during exercise;
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| what to do if unable to determine if client is hypO or hypEr glycemic (hesi hint) | show 🗑
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| Rapid acting insulin (humalog/novolog) | show 🗑
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| Short Acting (regular) | show 🗑
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| show | 1-2hr onset, 6-12 hr peak; mix with rapid acting
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| show | 4-8hr onset, 14-20 hr peak, once daily @bedtime, do not mix
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| show | 3 P's, blurred vision (type2), weaknness, weight loss, syncope
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| Tx of hypErglycemia | show 🗑
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| S/S of hypOglycemia | show 🗑
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| tx of of hypOglycemia | show 🗑
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| show | provides tight glucose control to prevent long term complications; monitor before meals, bedtime and when symptoms occur; record results and report to provider
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| show | checked daily, washed with mild soap & warm water dried well esp between toes; moisturize but not between toes; clean socks, nails filed straight across.
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| Urinary tract obstruction-BPH | show 🗑
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| show | TURP
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| show | increaed freq of voiding; nocturia, dribbling, hesitancy, decrease size/force of stream, acute urinary retention, bladder distention
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| Bladder spasm with Turp (hesi hint) | show 🗑
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| show | use only sterile saline to prevent cellular fluid shifts
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| Drainage after TURP | show 🗑
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| Prostate Cancer | show 🗑
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| NA for prostate cancer | show 🗑
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| show | rest with scrotal elevation, application of ice, admin of analgesics and antibiotics. Treat partner if bacterial, mumps vaccine, nsaids or antiinflammatories
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| show | decreased hormone 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
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| Identify nursing assessments related to toxic shock syndrome (TSS)? | show 🗑
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| Uterine Prolapse | show 🗑
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| show | relaxation of anterior vaginal wall with prolapse of bladder
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| Rectocele | show 🗑
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| Benign Tumors - uterine | show 🗑
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| Cervical cancer | show 🗑
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| Hesi hints for Cervical cancer | show 🗑
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| show | transmission precautions; isolation (provide support); leadlined container; client must remain in bed; limit time with client
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| ovarian cancer | show 🗑
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