NURS 4390_ Final Exam Study Guide.

NURS 4390_ Final Exam Study Guide. Nursing 4390; Study Guide Final Exam Winter Quarter 2022 There are 55 questions on the final exam, including multiple-choice, multiple select, matching, and one questions that asks you to put interventions in order in which they should be done. Most are critical thinking questions rather than simple knowledge. These types of questions help prepare you for the NCLEX exam. I suggest that you study the power points and fill in with the book. I also suggest that you review the following tables in the book: Table 48-10 Exercise for patients with diabetes mellitus; Table 48-16 comparison of hyper and hypoglycemia; Table 57-3 Types of strokes; Figure 57-4 Manifestations of right-brain and left-brain damage; Table 57-8 Emergency management; Table 60-7 Autonomic dysreflexia; Table 64-4 Joint protection and energy conservation; comparison of rheumatoid and osteoarthritis; Table 64-11 Protection of small joints; Table 46-12 Comparison of peritoneal and hemodialysis. If you have an older edition you should be able to find the tables by their titles. Inflammatory bowel disease; 4 questions • Antigen initiates the inflammation ◦ Overactive and sustained inflammatory response • Malnutrition ◦ May lead to anemia (decrease Hgb, albumin, and Hct) • TPN (total parental nutrition) ◦ Hard on the liver ◦ Do not put into the peripheral vein ▪ Because it can damage the vein ▪ It has to go in a PICC line • Complication: ◦ Antibiotics: Metronidazole ▪ Infection related to open sores and wounds inside the body which are good reservoirs for bacteria to grow ▪ Steroids are immunosuppressants so patients are at an increased risk for infections • If patient is nauseous and vomiting ◦ You would question NS IV infusion order since patient is most likely losing electrolytes ▪ It should be lactated ringers • Small bowel obstructions ◦ Blood pressure may go down due to water being collected above the obstruction and there is less water circulating • Nutrition for Crohn's disease if patient was not NPO ◦ Easy to digest ◦ Low fiber ◦ Avoid high fat foods • Complications related to Crohn’s Disease ◦ Strictures in inflamed areas can lead to bowel obstruction ◦ Fistulas between organs can occur ◦ Perforations ◦ Ulcers ◦ Malnutrition ◦ Cancer of the small intestine ◦ Bleeding ◦ Systemic ▪ Arthritis ▪ Conjuctivitis ▪ Sclerosing cholangitis, gallstones ▪ Acute pancreatitis ▪ Chronic bronchitis ▪ Tubular proteinuria ▪ Pericarditis ▪ Multiple sclerosis ▪ Osteoporosis • Education for patients with a new ileostomy ◦ Increase fluid intake to at least 2 liters/day to prevent dehydration ◦ Be sure to chew food well to prevent obstruction of the stoma ◦ Empty the ileostomy bag when it is about 1/3 full ◦ Ileostomy = Liquid ◦ Change it every 4 days unless leaking ◦ Don’t change it too often or it will irritate the skin • Post-op assessment findings following surgery for Crohn’s Disease and ileostomy formation on the day of surgery versus a few days later. ◦ Post-Op ▪ Pink/Red, moist, edematous stoma ▪ Absent/rare bowel sounds ▪ Small amount of serosanguinous output ▪ Assessments: • Skin around the stoma • Abdomen • Bowel sounds • Drainage ◦ Complications: ▪ Fluid and electrolyte imbalance ▪ Obstruction of stoma • Couple of days later ◦ 1500cc in a day but will taper off over time ▪ Concern for dehydration ▪ You will hear bowel sounds ▪ Pink and moist, edematous stoma • Ulcerative colitis versus Crohn’s Disease ◦ Ulcerative Colitis ▪ Pain in lower left abdomen ▪ Bleeding common with bowel movements ▪ Inflammation usually in the colon ▪ Continuous inflammation ▪ Colon wall thinned ▪ Ulcers only in the mucus lining of the colon • Only the mucosa ▪ Complications less frequent ◦ Crohn’s Disease ▪ Pain in lower right abdomen ▪ Bleeding not common with bowel movements ▪ Inflammation anywhere in the digestive tract • Mouth to Anus ▪ Inflammation in one or more patches ▪ Colon has a cobble stone appearance ▪ Ulcers are deeper • All layers of the intestine ▪ Complications more frequent