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NUR 2392 Multidimensional Care 2 MDC II Final Exam Quiz Study Guide with Verified Solutions
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- Rasmussen College
NUR 2392 Multidimensional Care 2 MDC II
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lOMoARcPSD|46339803MDC2 Final Exam Study Guide
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ATI Adaptive Quizzes- Endocrine and GI
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Med Surge Success book (found in library)= ch 7 # 13-24,37-144, ch 8 # all questions
*The exam questions are not limited to only what is listed on this guide. Please refer to your chapter
readings, recordings, and module materials. ATI has additional practice questions for review in Learning
Systems RN 3.0.
Ch. 56 – Care of Patients with Noninflammatory Intestinal Disorders
● Nonmechanical (ileus) vs. mechanical obstruction (intussusception, volvulus, etc.)
o Non-mechanical: results from neurological disturbances that affect the muscles.
Can be primary or secondary (often based on anesthesia medications).
Remember to assess the patient's bowel tones for complications from this!
▪ Paralytic Ileus: the bowel is not impacted by a physical obstruction, but
because of a lack of peristalsis as a result of neuromuscular disturbance,
causing backup of fecal contents and abdominal distention and potentially
leakage of stool contents into the peritoneum space can occur, causing
inflammation and infection, decreased electrolyte levels and reduced
blood volume.
o Mechanical: from a structural disturbance of the bowel.
▪ Adhesions: scar tissue from surgery that builds up and causes obstruction
▪ Benign or malignant tumors
▪ Appendicitis complications: if the appendix bursts, often the contents will
cause disruptions in fecal matter flow.
▪ Hernia: protrusion of the bowel through an opening that should not be
there, causing pain and blockages.
▪ Fecal impactions: from constipation
▪ Strictures: from crohns or radiation
▪ Intussusception: telescoping of the bowel into itself.
▪ Volvulus: twisting of the bowels, allowing nothing to go through.
o Physical Assessment
▪ Obstipation: severe constipation that may last for days without any
passage of stools. Diarrhea may be present in partial obstructions
▪ Failure to pass gas
▪ Vomiting that may be foul smelling or coffee ground like.
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▪ Abdominal Distention: abdominal when assess will be firm, swollen, and
painful
▪ Peristaltic waves: movement of the intestine, then stopping
▪ Borborygmi: high pitch gurgling bowel sounds
o Diagnostics:
▪ Barium Swallow
▪ CT with contrast
▪ Ultrasound
o Nursing Care:
▪ Monitor vitals
▪ Assess abdomen 2 times a day for bowel tones, distention, and passing
for gas
▪ Monitor F/E,I/O, lab values for disturbances- may need to give IV fluid
replacement due to potential loss of electrolytes such as NS
▪ Manage NG tube- often will be a salem sump tube
▪ Ensure tube patency
▪ Check initial tube placement with XRAY
▪ May need suction and decompression for the obstruction
● Metabolic alkalosis is a concern
▪ Check for tube placement (pH 0-4)
▪ Irrigate tube
▪ NPO status
▪ Perform mouth and nare care
▪ Place patient in a semi fowler's position
▪ Give pain medications
▪ Give alvimopan.
o Surgery
▪ Exploratory laparotomy: will allow the provider to relieve and locate the
obstruction. may be large or small incisions.
▪ The RN should teach the patient about what to expect after such as NG
tube insertion and a clear liquid diet that will advance as tolerated.
Potential N and V.
o Patient Teaching
▪ Patients should eat high fiber foods, like raw fruits and veggies.
▪ Drink lots of water
▪ Do not use routine laxatives as they have a potential to become abused.
and cause damage to the abdominal muscles.
▪ Daily exercise needed to promote gastric motility
▪ Take bulk forming products and a stool softener.
▪ Sit on the toilet or commode rather than the bedpan.
▪ Must report and abdominal pain, distention, N,V,constipation
▪ Teach about incision care
▪ Drug therapy will often include percocet, stool softener.
● Polyps
o Small growths that are attached to the intestinal mucosa that are often benign but
can become malignant.
o Adenomatous: polyps that have the potential to become malignant
▪ Villious
▪ Tubular
o Hyperplastic: little chance to become cancerous polyps
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o Malignant: those polyps that are cancerous when developed
o Familial adenomatous polyposis and hereditary nonpolyposis are inherited that
will eventually progress to colorectal cancer
o Assessment:
▪ Asymptomatic and usually discovered on a routine colonoscopy
screening
▪ May cause bleeding, obstruction or intussusception
o Diagnostics: biopsy and will often be removed at time of finding.
o Patient teaching: follow ups may be needed for complete polyp removals. Teach
about bleeding, abdominal distention and pain and blood in the stool after the
procedure.
● Colorectal cancer labs (CEA), diagnostics
o Fecal occult blood test (FOBT) – positive test indicates bleeding in the GI tract
▪ Patient needs to avoid aspirin, vitamin C, iron and red meat for 48 hours
before giving stool specimen
▪ Also, assess whether the patient is taking anti-inflammatory drugs, need
to be discontinued
▪ Negative results do not completely rule out the possibility of CRC
o Carcinoembryonic antigen (CEA) – an oncofetal antigen is elevated in many
people with CRC
▪ Normal value is less than 5 ng/mL
▪ This protein is not specifically associated with the CRC, and it may be
elevated in the presence of other benign or malignant diseases and in
smokers
▪ It is often used to monitor the effectiveness of treatment and to identify
disease recurrence
● Imaging Assessment
○ Sigmoidoscopy – provides visualization of the lower colon using a
fiberoptic scope
○ Colonoscopy – provides better visualization of polyps and small lesions
than does a barium enema alone
● Irritable bowel syndrome health teaching and testing (hydrogen breath test)
o Types
▪ IBS C: constipation
▪ IBS D: diarrhea
▪ IBS M: mixed constipation and diarrhea
▪ IBS A/U: alternating constipation and diarrhea or unknown
o Hydrogen breath test or small-bowel bacterial overgrowth breath test. When
small-intestinal bacterial overgrowth or malabsorption of nutrients is present, an
excess of hydrogen is produced. Some of this hydrogen is absorbed into the
bloodstream and travels to the lungs where it is exhaled. Patients with IBS often
exhale an increased amount of hydrogen.
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o Teach the patient that he or she will need to be NPO (may have water) for at
least 12 hours before the hydrogen breath test. At the beginning of the test, the
patient blows into a hydrogen analyzer. Then, small amounts of test sugar are
ingested, depending on the purpose of the test, and additional breath samples
are taken every 15 minutes for 1 to 5 hours
● Teaching and nutrition
● Dietary fiber and bulk help produce bulky, soft stools and establish regular
elimination habits.
● The patient should consume 30-40 g of fiber each day
● Eating regular meals, drinking 8-10 glasses of water each day, and
chewing food slowly help promote normal bowel function.
● Drug therapy depends on main symptoms of IBS
○ Constipation-predominant IBS treated with bulk forming laxatives
○ Diarrhea-predominant treated with antidiarrheals
● Patient with intestinal bacterial overgrowth are recommended to use
probiotic supplements
● Stress management
Ch. 57 – Care of Patients with Inflammatory Intestinal Disorders
● Peritonitis symptoms
○ Peritonitis is a life-threatening, acute inflammation and infection of the
visceral/parietal peritoneum and endothelial lining of the abdominal cavity.
○ Peritoneal cavity is contaminated by bacteria from peritoneum perforation from
appendicitis, diverticulitis, PUD, penetrating wounds, gangrene gallbladder,
bowel obstruction, tumors, surgery.
○ Inflammation spreads resulting in peritonitis
○ Fluid is shifting into the peritoneal cavity causing a significant decrease in
circulatory volume and hypovolemic shock.
○ Decreased circulatory volume results in insufficient perfusion to kidneys leading
to acute kidney injury and impaired fluid and electrolyte balance.
○ Peristalsis slows or stops
○ Bacteria can enter the bloodstream causing septicemia
○ Respiratory problems can occur as result of increased abdominal pressure
○ Key Features:
■ Rigid, boardlike abdomen is classic sign
■ Abdominal pain (classic)
■ Distended abdomen
■ Nausea, anorexia, vomiting
■ Diminishing bowel sounds
■ inability to pass flatus or feces
■ rebound tenderness in the abdomen
■ high fever
■ tachycardia
■ dehydration from high fever
■ decreased urine output
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