NUR 242 Unit 7 & 8 Test 2 Outline/study notes updated well detailed latest | Study notes Nursing

NUR 242 Unit 7 & 8 Test 2 Outline/study notes updated

well detailed la test

Appendicitis: inflammation of appendix

Common causes : infection (most common), trauma/injury

S/S: pain originating around “belly area”, then localizes in RLQ; Pain increases w/movement, coughing,

bending knees; constipation, N/V, WBC count elevated; low grade temp

Assessment: rebound tenderness is positive in RLQ

Treatment: surgery; pain management, NPO = no peristalsis r/t appendix rupture; begin antibiotics,

surgery prep

Nursing measures: pain management, IV hydration; if NG tube, then suction it/functioning & properly

secured; all post-op nursing care management is r/t whether they had a laparoscopic appendectomy or

an open appendectomy and whether it was ruptured; if ruptured, intensive post-op care of open,

infected wound with drains; pt & family teaching r/t wound & drain care

Complications: peritonitis = if abdominal pain is alleviated, then returns = “red flag for peritonitis”;

distended abdomen then becomes rigid/board-like; pain is relieved when pt pulls knees toward

abdomen/fetal position; progressing signs of shock: tachypnea, tachycardia, drop in BP and O2 sats

GERD: reflux of gastric content into esophagus *usually after a large meal; risk factors: overweight, or

hiatal hernia (anything that effects movement of food); pt positioning becomes “very very” important in

GERD management; looks like severe heartburn; may complain of lump in throat (especially w/hiatal

hernia); may have dry cough, hoarse voice; wakes up at night coughing w/acrid taste in mouth/throat;

higher risk for aspiration = assess for crackles!

Assessment: listen to lungs for crackles (aspiration during sleep)

Lifestyle modifications and diet changes = “bland diet”; restrict fatty spicy foods; sitting upright when

eating & remain for 30 minutes post meal; don’t eat late at night before bed; no restrictive clothing;

lose weight; avoid vigorous exercise/strain; medications

Nursing measures around teaching; prevent attacks of GERD

Complications: esophageal cancer r/t persistent irritation by gastric juices

PUD/peptic ulcer disease: gastric ulcer or duodenal ulcers; gastric ulcer = lower curvature of stomach;

duodenal in duodenum

Causes: H. Pylori infection; mucosal barrier/stomach lining @ duodenum is eroded away by acid;

S/S: duodenal = occurs on an empty stomach, gets gnawing pain and eats/drinks milk and pain subsides

= “nighttime ulcer”; gastric ulcer = “daytime ulcer”, pain upon eating (vs. empty stomach w/duodenal);

gnawing, burning pain in the pit of the stomach when we eat r/t gastric acid secretion & stimulation;

Treatment: treated the same = reduce hostile factors, protect stomach lining while it repairs r/t diet,

minimize Hcl acid production; antacids for coating; antibiotics for H. Pylori, limit production of Hcl acid

= PPI’s and H2 receptor antagonists; may result in surgery with strictures, damage too

great/perforations in stomach or duodenum; vagotomy or partial/total gastrectomy

NUR 242 Unit 7 & 8 Test 2 Outline/study notes updated well detailed latest, Study notes of Nursing

Related documents

Partial preview of the text

Download NUR 242 Unit 7 & 8 Test 2 Outline/study notes updated well detailed latest and more Study notes Nursing in PDF only on Docsity!

NUR 242 Unit 7 & 8 Test 2 Outline/study notes updated

well detailed latest

Elimination (GI)

Cholelithiasis

1. [ in class review] gall stones RUQ pain, right shoulder, mid epigastric or back = acts

differently; Clinical manifestations: typically RUQ pain; vomiting bile; bloating; pain a

couple hours after eating fatty foods; relief of pain = standing and walking only; “cannot

find a position of comfort”, prefer to be standing; narcotics only relieve pain;

2. Management: narcotic; diet : low fat; medications [unless they’re bile gallstones, it only

works on fat]; laporoscopic; open = cholecystectomy (many complications, last resort) =

major abdominal surgery + monitoring bile drained; post-op teaching: splint if open;

TCDB/early ambulation; monitor incision sites; low fat diet again! Avoid foods that cause

gas [eggs, cabbage, beans, nuts, corn];

Diagnostic Tests, Prep/patient education:

3. EGD: NPO 6-8 hours; should not be painful; moderate sedation; pain = call physician;

4. ERCP: NPO 6-8 hours

5. Colonoscopy: prep = golitely; no red/orange liquids; no steak before you start prepping;

b) After

c) Teach

pancreatitis. (severe pain if any complications occur) (Fever occurs with

sepsis)

returning home.

3) Colonoscopy (1st^ one at age 50, then q10 years if normal or q5 years if polyps found)

An endoscopic examination of the entire large bowel, during which tissue biopsy specimens or

polyps may be removed through the colonoscope.

a) Prep

o Avoid with elderly

o Watery diarrhea usually begins 1 hr after drinking

b) After

Malnutrition

Promoting eating in the patient:

1) [in class review] Promoting eating: ask what they like; build around preferences; small

frequent meals (pleasing, easily digestible); protein snacks; diet: high protein, high

calorie; make sure patient can see it [stroke patient, put on glasses]; avoids meds that

upset stomach, don’t give bronchodilators around mealtime; make sure ready to eat =

prepared r/t sitting, oral care, no distractions, relaxed environment; COPD = no

bronchodilators, well-rested S O2 is on; pain controlled [comfortable];

a) Malnourished ill patients often need to be encouraged to eat.

b) Assess for other needs, such as pain management

c) Make the patient comfortable, including an environment conducive to eating.

d) Family may bring in favorite or ethnic foods that the patient may be more likely to eat.

e) Sit patient upright

f) Make sure patient is toileted and Provide oral care (A clean mouth makes food

taste better) before eating

g) Avoid Medication that increase the work load such as bronchodilators

h) Make sure the patient is well rested and has energy reserves to eat. COPD

and Emphysema can make eating tiring.

i) If the patient cannot take in enough nutrients in food, fortified medical

nutrition supplements (MNSs) may be given, especially to older adults.

2) Tube feedings (continuous & bolus)

a) [in class review] continuous: canned formulas = how long should this formula hang up

there for? Change tubing q24 hours; flush, check residual, flush q4 hours; HOB >

degrees; stop feeding if need to lower HOB; Bolus: flush with 20-30ml before and after;

both feedings and medications; same w/continuous feedings you stop S flush before/after

meds admin;

a) Tube feedings are administered by bolus feeding at set intervals, continuous feeding,

or cyclic feeding, stopped for a specified time period in each 24-hour period.

o Check gastric residual volumes every 4 to 6 hours. Abdominal distention,

nausea, and vomiting during tube feeding are often caused by overfeeding.

o New formula every 4 hours even if old is not finished (Formulas will spoil

if longer)

o Use a feeding pump when the patient receives continuous

o Check for residual before giving

(a) If > ½ the feeding then hold

o Flush 20ml – 30ml before/after feeding and each med

o Feed or give meds while patient is sitting up and leave upright for at least

30 minutes

b) Use gloves when changing tubing or adding product, and use sterile gloves when

working with critically ill or immunocompromised patients.

Gastroenteritis : = infection of entire GI system from stomach to end = “food poisoning”

creating an infection; s/s: diarrhea, vomiting, temp; tachycardia; rapid respirations; pain

1) [in class review] Treatment: IV hydration, antibiotics

2) Complications (dehydration, hypokalemia, metabolic acidosis); hypokalemia S

dehydration leads to death in very young and elderly

3) Respiratory assessment (breath and heart sound identification of abnormal);

4) Gastroenteritis is an increase in frequency and water content of stools or vomiting related