NURS202 ExamII Pt2 Word Scramble
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Question | Answer |
What would assessment concerns be for a patient with a nursing diagnosis of "imbalanced nutrition: less than body requirements"? | baseline data- weight, lab values, muscle tone of muscle required for swallowing and mastication, GI, oral, GU(abnormal or absent menses), nutritional history, etiology factors, patients attitude towards eating/food |
What baseline data would you need to get a patient's overall nutritional status? | dietary data, medical and socioeconomic data, anthropometric data, BMI and waist circumference, clinical data, biochemical data |
What does the acronym DETERMINE mean and how is it used? | Disease, Eating poorly, Tooth loss/mouth pain, Economic hardship, Reduced social contact, Multiple medicines, Involuntary weight loss/gain, Needs assistance in self-care, Elder >80 yrs,it is dietary data used to detect signs of poor or malnutrition |
What should be assessed regarding bowel elimination? | recent changes in bowel elimination, usual patterns of bowel elimination, problems with bowel elimination, aids to elimination, presence of artificial orifices (ostomy sites) |
What should be assessed regarding nutrition? | BMI,meds,hydration,disease/metabolic processes(stress),medical Hx,diagnostic procedures,illnesses,therapies,treatments,vitamins,signs of malnutrition,I&O,allergies,GI hx,alcohol/caffeine use,intolerances/avoidances,oral/dental,economics,exercise |
How is nutrition related to wound healing? | adequate proteins,carbs,fats,vits and minerals are required. calories and proteins:rebuild cells and tissue, vit A & C:regrowth of epithelial tissue and collagen synthesis, zinc:production of cells, fluids:optimal functionality of cells |
What ways can correct NG tube placement be verified? | x-ray(best), assess aspirate visually and for pH level(>7), insufflation and ascultation, measure length of exposed tubing to compare with initial placement measurement, verify mark made on tube at time of initial placement |
What nursing interventions are involved with placement of an NG tube? | explain to patient purpose/procedure/expected sensations, inserting tube, confirm placement, monitor patient and maintain tube function, provide oral/nasal hygiene/care, monitor for potential complications, remove tube |
How is the length of the NG tube determined? | measuring distance from tip of nose to earlobe and from earlobe to xiphoid process; add 6 in for NG placement |
If a patient with an NG tube has poor or no drainage what does this indicate and what should be done? | possibly blocked or malpositioned tube. check suction equipment for proper function, verify no anastomoses nearby, attempt to reposition the tube, irrigate tube, air check the patency |
What are nursing interventions for a patient undergoing an endoscopy? | NPO for 8hrs pre-exam,admin of local anesthetic,possible admin of sedative,anticholinergic or glucagon,patient in L lateral position,post-exam assessments:LOC,VS,oxygen saturation,pain,signs of perforation,need someone to take home/receive discharge info |
What would you educate a patient about who just had a colostomy procedure? | skin care and it's importance,how to apply/remove drainage pouch,empty/change pouch when 1/3 to 1/4 full,irrigation,encourage patient to express any concerns,know when to call physician/which complications need prompt attention,nutrition and impact,meds |
What is the correct positioning for an enema? | L side, semi-prone, L leg extended, R leg flexed, L arm along back, chest forward (Sim's position) |
What diagnostic tests/studies are associated with the GI system? | stool collection,endoscopy,radiography,UGI and small bowel series,barium enema,abdominal ultrasound,MRI,abdominal CT scan |
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kgrabo99
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