283 - Transition to Registered Nurse Practice - Comp 1Details on inserting NG tube for gastric decompression - pg. 1013 Saunders - - correct answer patient should be in high-fowlers position
measure & tape tube to indicate length to be inserted
lubricate tip before inserting in nasopharynx & a...
283 - Transition to Registered Nurse
Practice - Comp 1
Details on inserting NG tube for gastric decompression - pg. 1013 Saunders - - correct answer ✦ patient
should be in high-fowlers position
✦ measure & tape tube to indicate length to be inserted
✦ lubricate tip before inserting in nasopharynx & advancing
✦ as tube enters back of throat - have pt swallow sip of water (unless contraindicated) - flex head toward
chest while passing tube down throat into the stomach
✦ secure tube
✦ confirm placement w/ x-ray
✦ connect to suction
Patients experiencing a PE - heparin therapy is prescribed for at least 5 days - warfarin is also started on
most patients on day 1 or 2 of heparin therapy - the patient will receive both heparin & warfarin until the
INR reaches 2-3. Heparin is infused for 24 hours after the INR is greater than 2, then the Heparin is
discontinued. The overlap period of at least 5 days for Warfarin & Heparin is necessary because the drug
action of each is different. Warfarin works in the liver to inhibit the synthesis of Vit K-dependent clotting
factors and takes 3-4 days before a therapeutic effect is realized. - correct answer
As an entry level nurse, it is important that you understand monitoring of lab values for patient
prescribed anticoagulants such as Heparin and Warfarin. What are normal values for PT/INR, PTT and
aPTT for these patients? - correct answer ✦ PT - prothrombin time -
- normal is 11-12.5 seconds
- 1.5 to 2.5 times the normal control (*16-31) for patients receiving Warfarin
✦ INR - international normalized ratio -
- normal is 0.9-1.2 seconds
- desirable therapeutic level is 2-3 times the normal for patients receiving Warfarin
- for patients w/ mechanical heart valve replacement an INR of 3-4 may be the goal
✦ PTT - partial thromboplastin time -
, - 1.5-2.5 times the normal control (*30-75) for patients receiving Heparin
✦ aPTT - activated partial thromboplastin time -
- normal is 30-40 seconds
- 5-2.5 times the normal control (*40-100) on Heparin
Post-op abdominal surgery patients often have an NG placed for decompression of the stomach, it's
important for entry level nurses to understand care of patients w/ an NG tube. This includes post-op
colorectal cancer patients, who may also have a colostomy depending on procedure performed.
You learned about cancers, include colon cancer in med surg. Colorectal cancer (CRC) is cancer of the
rectum or colon. Colorectal cancer is the 3rd most common cause of cancer death in this country.
Most CRCs are adenocarcinoma, a tumor that arises from a gland in the epithelial layer of the colon.
Adenocarcinoma begins as a polyp and is benign in the early stages. If left untreated, the polyp will
grown and the risk of malignancy increases.
CRC can metastasize (through blood or lymph) to the liver (most common site), lungs, brain, or bones.
Spreading can occur as a result of peritoneal seeding (during surgical resection of tumo - correct answer
✦ Major risk factors for colon cancer are:
✦ Over the age of 50
✦ Family Hx of cancer
✦ First degree relative w/ colon cancer increases risk 3-4x
✦ Crohn's disease & ulcerative colitis
✦ Pylori and HPV increase risk
✦ African Americans are at higher risk
✦ Smoking, obesity, high-fat diet, inactivity, and alcohol consumption
✦ Screening recommendations for those over the age of 50 without a family Hx:
- Fecal occult blood yearly AND one of the following:
** Colonoscopy every 10 years
** Sigmoidoscopy every 5 years
** Double-contrast barium enema every 5 years
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