HESI NSG 123: Medical Surgical Nursing DUE 25TH MARCH 2024

HESI NSG 123: Medical Surgical Nursing DUE 25TH MARCH 2024 Ulcerative Colitis - CORRECT ANSWER-Ulcerative colitis is a chronic ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum that is characterized by unpredictable periods of remission and exacerbation with bouts of abdominal cramps and bloody or purulent diarrhea. The inflammatory changes typically begin in the rectum and progress proximally through the colon Crohn's Disease - CORRECT ANSWER-Crohn's disease is characterized by periods of remission and exacerbation. It is a subacute and chronic inflammation of the GI tract wall that extends through all layers (i.e., transmural lesion). Although its characteristic histopathologic changes can occur anywhere in the GI tract, it most commonly occurs in the distal ileum and the ascending colon. The onset of symptoms is usually insidious in Crohn's disease, with prominent right lower quadrant abdominal pain and diarrhea unrelieved by defecation Crohn's Disease Diet - CORRECT ANSWER-Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet nutritional needs, reduce inflammation, and control pain and diarrhea. Fluid and electrolyte imbalances from dehydration caused by diarrhea are corrected by IV therapy as necessary if the patient is hospitalized or by oral fluids if the patient is managed at home. Any foods that exacerbate diarrhea are avoided. Milk may contribute to diarrhea in those with lactose intolerance. Cold foods and smoking are avoided because both increase intestinal motility. Parenteral nutrition may be indicated. Ulcerative Colitis-Goal - CORRECT ANSWER-The major goals for the patient include attainment of normal bowel elimination patterns, relief of abdominal pain and cramping, prevention of fluid volume deficit, maintenance of optimal nutrition and weight, avoidance of fatigue, reduction of anxiety, promotion of effective coping, absence of skin breakdown, increased knowledge about the disease process and self-health management, and avoidance of complications. Bariatric Surgery Post Op - CORRECT ANSWER-After surgery, the nurse assesses the patient for complications from the bariatric surgery, such as hemorrhage, venous thromboembolism, bile reflux, dumping syndrome, dysphagia, and bowel or gastric outlet obstruction. Eat smaller but more frequent meals that contain protein and fiber; each meal size should not exceed 1 cup. Eat only foods high in nutrients (e.g., peanut butter, cheese, chicken, fish, beans). Eat slowly and chew thoroughly Assume a low Fowler position during mealtime and then remain in that position for 20- 30 minutes after mealtime—this delays stomach emptying and decreases the likelihood of dumping syndrome. Do not drink fluid with meals; instead, consume fluids up to 30 minutes before a meal and 30-60 minutes after mealtime. Cholelithiasis- Jaundice - CORRECT ANSWER-Jaundice occurs in a few patients with gallbladder disease, usually with obstruction of the common bile duct. The bile, which is no longer carried to the duodenum, is absorbed by the blood and gives the skin and mucous membranes a yellow color. This is frequently accompanied by marked pruritus (itching) of the skin. Gallbladder Risk Factors - CORRECT ANSWER-The risk of developing such stones is increased in patients with cirrhosis, hemolysis, and infections of the biliary tract. Cholesterol stones account for most of the remaining 75% of cases of gallbladder disease in the United States Two to three times more women than men develop cholesterol stones and gallbladder disease Stone formation is more frequent in people who use oral contraceptives, estrogens, or clofibrate (Atromid-S); these medications are known to increase biliary cholesterol saturation. The incidence of stone formation increases with age as a result of increased hepatic secretion of cholesterol and decreased bile acid synthesis. Peptic Ulcer Disease Complication - CORRECT ANSWER-Although vomiting is rare in an uncomplicated peptic ulcer, it may be a symptom of a complication of an ulcer. It results from gastric outlet obstruction, caused by either muscular spasm of the pylorus or mechanical obstruction from scarring or acute swelling of the inflamed mucous membrane adjacent to the ulcer. Seizure Precautions - CORRECT ANSWER-Seizure precautions are maintained, including having available functioning suction equipment with a suction catheter and oral airway. The bed is placed in a low position with two to three side rails up and padded, if necessary, to prevent injury to the patient. The patient may be drowsy and may wish to sleep after the seizure; they may not remember events leading up to the seizure and for a short time thereafter. Rheumatoid Arthritis S/S - CORRECT ANSWER-The initial clinical manifestations of RA include symmetric joint pain and morning joint stiffness lasting longer than 1 hour. Over the course of the disease, clinical manifestations of RA vary, usually reflecting the stage and severity of the disease. Symmetric joint pain, swelling, warmth, erythema, and lack of function are classic symptoms. Palpation of the joints reveals spongy or boggy tissue. Often, fluid can be aspirated from the inflamed joint. Characteristically, the pattern of joint involvement begins in the small joints of the hands, wrists, and feet. In the early stages of disease, even before the presentation of bony changes, limitation in function can occur when there is active inflammation in the joints. Joints that are hot, swollen, and painful are not easily moved. SLE Exacerbation - CORRECT ANSWER-The lesions often worsen during exacerbations (flares) of the systemic disease and possibly are provoked by sunlight or artificial ultraviolet light. Oral ulcers, which may accompany skin lesions, may involve the buccal mucosa or the hard palate, occur in crops, and are often associated with exacerbations. Other cutaneous manifestations include splinter hemorrhages, alopecia, and Raynaud's phenomenon Pre-Op Lab - CORRECT ANSWER-Routine laboratory tests used to detect infection include the white blood count (WBC) and the urinalysis. Surgery may be postponed in the presence of infection. Ambulation Post-Op - CORRECT ANSWER-The patient should be taught that early and frequent ambulation postoperatively, as tolerated, will help prevent complications. Malignant Hyperthermia - CORRECT ANSWER-Malignant hyperthermia is a rare inherited muscle disorder that is chemically induced by anesthetic agents The initial symptoms of malignant hyperthermia are often cardiovascular, respiratory, and abnormal musculoskeletal activity. Tachycardia (heart rate greater than 150 bpm) may be an early sign. Sympathetic nervous stimulation also leads to ventricular dysrhythmia, hypotension, decreased cardiac output, oliguria, and, later, cardiac arrest. Hypercapnia, an increase in carbon dioxide (CO2), may be an early respiratory sign. With the abnormal transport of calcium, rigidity or tetanus-like movements occur, often in the jaw. Generalized muscle rigidity is one of the earliest signs. The rise in temperature is actually a late sign that develops rapidly; body temperature can increase 1°C to 2°C (2°F to 4°F) every 5 minutes, and core body temperature can exceed 42°C (107°F) Post-Op Bowel Sounds Assessment - CORRECT ANSWER-The nurse detects bowel sounds by listening to the abdomen with a stethoscope. Bowel sounds are documented so that diet progression can occur. The nurse should assess the abdomen for distention and the presence and frequency of bowel sounds. If the patient does not have a bowel movement by the second or third postoperative day, the primary provider should be notified and a laxative or other test or intervention may be needed. Wound Dehiscence & Evisceration - CORRECT ANSWER-Wound dehiscence (disruption of surgical incision or wound) and evisceration (protrusion of wound contents) are serious surgical complications. Dehiscence and evisceration are especially serious when they involve abdominal incisions or wounds. They may also occur because of increasing age, anemia, poor nutritional status, obesity, malignancy, diabetes, the use of steroids, and other factors in patients undergoing abdominal surgery. An abdominal binder can provide support and guard against dehiscence and may be used along with the primary dressing, especially in patients with weak or pendulous abdominal walls or when rupture of a wound has occurred. Galantamine hydrobromide (Razadyne, Razadyne ER): Contraindications & Common Adverse Effects - CORRECT ANSWER-Contraindications include severe hepatic or renal impairment. The most common adverse effects are insomnia, tremor, dizziness, somnolence, headache, bradycardia, and syncope. Galantamine hydrobromide (Razadyne, Razadyne ER): Indications & Similar to what drug? - CORRECT ANSWER-Galantamine hydrobromide (Razadyne, Razadyne ER) is similar to donepezil in its action. Indications include mild to moderate dementia. Teaching Galantamine hydrobromide (Razadyne, Razadyne ER) - CORRECT ANSWER-Patients and families should receive instructions about reporting any changes in mental status. To decrease gastric upset, it is necessary to take the medication with food. Sinemet: What two medications combined? What disease? What diet to avoid? - CORRECT ANSWER-Levodopa and carbidopa are usually given together in a fixed-dose formulation called Sinemet Levodopa-carbidopa is not administered with a high-protein diet. Adequate hydration is also necessary. Given to patients with Parkinson's Sinemet Teaching - CORRECT ANSWER-Take the medication as prescribed. Do not crush the sustained-release preparation. Do not take multivitamin preparations containing pyridoxine. Understand that there are adverse effects of medication, such as drowsiness, dizziness, and orthostatic hypotension. Change positions slowly to prevent drop in blood pressure. Avoid alcohol. Take the medication with food to prevent nausea and vomiting. Do not take the medication with a high-protein meal. Report fainting, light-headedness, irregular heart rate, uncontrolled facial movements, urinary retention, nausea, and vomiting to the prescriber. Notify the prescriber of any increase in symptoms such as static gait, altered mobility, and "pill rolling." Parkinson's Diet - CORRECT ANSWER-Patients may have difficulty maintaining their weight. Eating becomes a very slow process, requiring concentration due to a dry mouth from medications and difficulty chewing and swallowing. These patients are at risk for aspiration because of impaired swallowing and the accumulation of saliv. Monitoring weight on a weekly basis indicates whether caloric intake is adequate. Supplemental feedings increase caloric intake. As the disease progresses, a nasogastric or percutaneous endoscopic gastrostomy (PEG) tube may be necessary to maintain adequate nutrition. A dietitian can be consulted regarding nutritional needs. Pre-Op Teaching: Incentive Spirometry - CORRECT ANSWER-The patient is educated about breathing exercises and the use of an incentive spirometer, if indicated, to achieve optimal respiratory function prior to surgery. The potential compromise of ventilation during all phases of surgical treatment necessitates a proactive response to respiratory infections Pneumonia Breath Sounds - CORRECT ANSWER-Crackles Pursed-Lip Breathing - CORRECT ANSWER-Deep inspiration followed by prolonged expiration through pursed lips. Pursed-lip breathing helps slow expiration, prevents collapse of small airways, and helps the patient control the rate and depth of respiration. It also promotes relaxation, enabling the patient to gain control of dyspnea and reduce feelings of panic. COPD S/S - CORRECT ANSWER-Although the natural history of COPD is variable, it is generally a progressive disease characterized by three primary symptoms: chronic cough, sputum production, and dyspnea Prolonged expiratory phase, wheezes, decreased breath sounds, ↑ Anterior-posterior diameter (barrel chest), tripod position, pursed lip breathing Distinguishing symptoms can be difficult with comorbidities Asthma Trigger - CORRECT ANSWER-Allergic asthma usually develops in childhood and is triggered by allergens such as pollen, dust mites, and certain foods. Non-allergic asthma usually develops in patients over the age of forty and can have various triggers, such as cold air, medication (e.g., aspirin), exercise, and viral infection Exercise induced/cold air exposure May be seasonal or year-round Cockroaches, furry animals, fungi, mold Underlying respiratory infection Steroids in Asthma - CORRECT ANSWER-Glucocorticoids — Glucocorticoids are a class of medication that has anti-inflammatory properties. Glucocorticoids can be taken in different forms, including with an inhaler, as a pill, or through an IV. A spacer should be used with inhaled corticosteroids, and patients should rinse their mouth after administration to prevent thrush, a common complication associated with the use of inhaled corticosteroids. A systemic preparation may be used to gain rapid control of the disease; to manage severe, persistent asthma; to treat moderate to severe exacerbations; to accelerate recovery; and to prevent recurrence.