NSG 123 Medical Surgical Nursing Exam 2 Questions With Correct Solutions, Already Passed!!

Main Cause of Cholelithiasis - Answer-Cholesterol stones account for most of the remaining 75% of cases of gallbladder disease in the United States. Symptoms of Cholelithias - Answer-Nausea Vomiting Right upper quadrant abdominal pain or epigastric pain that radiates to the right shoulder especially after meals when the gallbladder is stimulated to release bile. Patient Teaching for Cholelithiasis - Answer-The diet immediately after an episode is usually low-fat liquids. These can include powdered supplements high in protein and carbohydrate stirred into skim milk. Purpose of Medication in Cholelithiasis - Answer-Purpose of Medications: reduces hepatic production of cholesterol. Lowers the cholesterol content of bile, which in turn facilitates the gradual dissolution of cholesterol gallstones. Examples : Chenodiol (Chenodal, Chenix) is a naturally occurring bile acid . Purpose of Adding Fat to Emulsion to TPN - Answer-Fat emulsions (lipids) are usually given to clients receiving TPN to provide supplemental kilocalories and prevent fatty acid Fat emulsions can also control hyperglycemia during periods of stress. Carbon Dioxide in Laparoscopic Cholecystectomy - Answer-Carbon dioxide is used during the procedure Explain to the patient that they might feel pain in the right shoulder or scapular area (from migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure). Laparoscopic Colecystectomy 3 Things to do After - Answer-Recommend a heating pad for 15 to 20 minutes hourly orEncourage the client to ambulate frequently to reduce the bloating. Manage nausea assess bowel sounds for further complications. Preoperative Assessment for Open Cholecystectomy - Answer-Priority assessment should focus on the client's respiratory status. If a traditional surgical approach is planned, the high abdominal incision required during surgery may interfere with full respiratory excursion. The nurse notes a history of smoking, previous respiratory problems, shallow respirations, a persistent or ineffective cough, and the presence of adventitious breath sounds. CBC and BMP should also be assessed 4 Postoperative Complications of Cholecystostomy - Answer-After these surgical procedures, the client is observed for indications of infection, leakage of bile into the peritoneal cavity, and obstruction of bile drainage. If bile is not draining properly, an obstruction is probably causing bile to be forced back into the liver and bloodstream. Because jaundice may result, the nurse should assess the color of the sclerae. Yellow-colored sclerae or skin can indicate jaundice. Clay-colored stool should be reported as this indicates a complication. Discharge Teaching for Open Cholecystectomy - Answer-Usually, only a small amount of serosanguineous fluid drains in the initial 24 hours after surgery; afterward, the drain is removed. The drain is typically maintained if there is excess oozing or bile leakage. Empty the drainage bag attached at least every 8 hours and as needed, to prevent reflux back into the bile duct. Take showers not baths to prevent infection of the incision site. What disease is characterized by possible malnourishment (anemic) and frequenct diarrhea? - AnswerCrohn's disease The disease characterized by blood sools and left lower quadrent pain - Answer-Ulcerative ColitisWhat GI disease would be best diagnosed with colonoscopy? - Answer-Ulcerative Colitis What testing would you expect to see from a patient recieving parenteral nutrition? - Answer-Blood Glucose What time of day should Famotidine (pepcid) be administered? - Answer-Bed time What is an intragastric balloon used for? - Answer-Non-invasive weight loss The nurse needs to check Mg++ before administration of what drug? - Answer-Magnesium hydroxide/aluminum hydrate MAALOX Which weight loss drug requirres a fat soluble vitamin supplement? - Answer-Orlistat (XENICAL) What do you give to treat travelers diarrhea? - Answer-Bismuth Salts-pepto bismol This conditon is charcterized by perianal vascular congestion from straining to have a bowel movement? - Answer-Hemorrhoids How often should 30mL of water be flushed through an NG tuve for assessment of function - AnswerEvery 4 hours A patient is experiencing diarrhea secondary to ulcerative colitis, do you treat it? - Answer-No, their body is flushing out the infection Bulk forming laxative - Answer-Citrucel or Metamucil A patient has a NG tube placed and running suction. What lab should the nurse monitor? - Answer-BMP, fluid and electrolytes What do you give a patient recieving a TPN to prevent hypoglycemia? - Answer-D5W or D10WWhat are most gallstones comprised of? - Answer-Cholesterol A patient needs to recieve enteric feeding, what type of tube should be placed? - Answer-Dobhoff Tube What condition will you administer the drug Chenodiol? - Answer-Cholesterol Gallstones. 2 Key S/S of Crohn's Disease - Answer-Malnourishment Anemia Definite Diagnostic Study for Crohn's Disease - Answer-CT Scan Definite Diagnostic Study for Ulcerative Colitis - Answer-Colonoscopy What surgery can cure Ulcerative Colitis? - Answer-Protocholectomy (removal of colon and rectum) Nursing Assessment for TPN - Answer-Blood glucose every 4 to 6 hours. If there is increased urination you need to call pharmacy. Increased urine output = hypertoxicity First Line Treatment Medication for IBD - Answer-Corticosteriods Bolus vs. Cyclic Feeding - Answer-Bolus feedings are administered into the stomach in large amounts and at designated intervals. Cyclic feedings are periodic feedings given over a short period of time Complication of UC - Answer-Toxic Megacolon The inflammatory process extends into the muscularis, inhibiting its ability to contract and resulting in colonic distention. Symptoms include fever, abdominal pain and distention, vomiting, and fatigue. If the patient with toxic megacolon does not respond within 72 hours to medical management with NG suction, IV fluids with electrolytes, corticosteroids, and antibiotics, surgery is required.What happens to the bowel in Ulcerative Colitis? (power point bolded note) - Answer-The mucosa becomes edematous and inflamed. The lesions are contiguous, occurring one after the other. Eventually, the bowel narrows, shortens, and thickens because of muscular hypertrophy and fat deposits. Crohn's Disease Affects: (power point bolded note) - Answer-Affects the whole GI tract from mouth the anus to the small/large intestine...most common is in the terminal ileum and start of the colon Feeding Tube used for Long Period of Time - Answer-A jejunostomy tube is placed for the purpose of administering nutrition, fluids, and medications and is indicated when the gastric route is not accessible, or to decrease aspiration risk when the stomach is not functioning adequately to process and empty food and fluids. Used for long term use. At what temp should formula be adminstered at? - Answer-Room Temp Large Bowel Obstruction - Answer-Large bowel obstruction: differs clinically from small bowel obstruction in that the symptoms develop and progress relatively slowly. In patients with obstruction in the sigmoid colon or the rectum, constipation may be the only symptom for weeks. Diagnosis is based on symptoms and on imaging studies Medications for Constipation - Answer-A bulk forming laxative includes methylcellulose, psyllium, and wheat dextrin. Senna and bisacodyl are both stimulant laxatives and polyethylene glycol is an osmotic agent used to cleanse the colon rapidly, usually before a diagnostic study like a colonoscopy. Docusate is a fecal softener that can be used safely by clients who should avoid straining, like when having anal fissures. Laxative osmotic: Polyethylene glycol and electrolytes (Colyte) Traveler's Diahhea Treatment - Answer-Bismuth salts have antibacterial and antiviral activity and are over-the-counter. This medication also has antisecretory and possibly anti-inflammatory effects because of its salicylate component and is recommended for traveler's diarrhea. Complications of Diarrhea - Answer-dehydration and electrolytes (BMP) The most common complication of diarrhea is dehydration. Dehydration with electrolyte loss (especially loss of potassium) may cause cardiac dysrhythmias which can be life threatening. Inspection of theabdomen, mucous membranes, and skin is important to determine hydration status. Stool samples are obtained for testing. The perianal area should also be assessed for skin excoriation.The priority assessment should be labs CBC and BMP Anal Fissures vs. Hemorrhoids - Answer-Anal fissures may result from the passage of the hard stool through the anus, tearing the lining of the anal canal causing ulceration in the anal canal . Hemorrhoids develop as a result of perianal vascular congestion caused by straining. What medication requires a patient take A, D, E, & K supplements? - Answer-Orlistat is a lipase inhibitor which diminishes intestinal absorption and metabolism of fats. Clients taking orlistat should take a multivitamin containing fat-soluble vitamins (A, D, E, and K) daily, at least 2 hours before or after taking orlistat. Orlistat prevents absorption of fat-soluble vitamins from food or multivitamin preparations if taken at the same time. S/S of Dumping Syndrome - Answer-Symptoms of dumping syndrome typically occur 15 minutes to 2 hours after eating and include tachycardia, dizziness, sweating, nausea, vomiting, bloating, abdominal cramping, and diarrhea. These symptoms typically resolve once the intestine has been evacuated (i.e., with defecation). Later, blood glucose rises rapidly, followed by increased insulin secretion. This results in a reactive hypoglycemia, which also is unpleasant for the patient