NSG 331 Final Exam Study Guide

NSG 331 Final Exam Study Guide NSG 331 Final Exam Study Guide If we’re asking for what would you DO make sure it’s an INTERVENTION If we’re asking for what would you CHECK make sure it’s an ASSESSMENT The final exam is considered comprehensive in concepts that overarch the different disorders covered in this course. The following is a list of the modules and specific topics included in this 75-question exam. Please refer to previous study guides from exam 1, 2, 3, and 4. New content on the exam covers the GI module. Plus four (4) math questions. Module 13 - Gastrointestinal • Assessment Lewis table 38.11, 38.12 o o • Intestinal obstruction o Types and causes ▪ Mechanical – Physical obstruction mostly in Small intestine • Small intestine o Adhesions (Most Common Cause) Interprofessional Care Treatment of a bowel obstruction depends on the cause. If a strangulated obstruction or perforation is present, the patient will need emergency surgery to relieve the obstruction and survive. In some, especially those due to surgical adhesions, an obstruction may 1 resolve without surgery. e Surgery may involve simply resecting the obstructed segment of bowel and anastomosing the remaining healthy bowel back together. Partial or total colectomy, colostomy, or ileostomy may be done when extensive obstruction or necrosis is present. Sometimes, an obstruction can be removed nonsurgically. Colonoscopy offers a means to remove polyps, dilate strictures, and remove and destroy tumors with a laser. The initial treatment includes placing the patient on NPO status, providing IV fluid therapy with either normal saline or lactated Ringer’s solution, and giving IV antiemetics. If needed, insert an NG tube for decompression and give ordered electrolyte replacement. Obtain blood cultures and start IV antibiotic therapy. Some patients need PN to allow bowel rest and improve nutritional status before surgery. The treatment goal for a patient with a malignant obstruction is to regain patency and resolve the obstruction. Stents can be placed via endoscopic or fluoroscopic procedures. They are used for palliative purposes or as “a bridge to surgery,” allowing a patient to avoid emergency surgery.19 This gives the interprofessional team time to correct fluid volume problems and treat other problems, thus improving surgical outcomes. Corticosteroids with antiemetic properties that decrease edema and inflammation may be used with stent placement. Obstipation = severe or complete constipation ▪ The 4 hallmark clinical manifestations of an obstruction are (colicky pain first symptoms of SBO) • Abdominal pain • nausea and vomiting • distention • constipation. o Interprofessional management ▪ NPO ▪ Nasogastric tube (NG) to low intermittent suction ▪ IV fluids and Electrolyte replacement ▪ Encourage ambulation ▪ Prepare for possible surgery NSG 331 Final Exam Study Guide Nursing Assessment Intestinal obstruction is a potentially life-threatening condition. Major concerns are preventing fluid and electrolyte deficiencies and early recognition of deterioration in the patient’s condition (e.g., • hypovolemic shock, sepsis, bowel strangulation). Nursing assessment begins with a detailed patient history and physical examination. Determine the location, duration, intensity, and frequency of abdominal pain. Record the onset, frequency, color, odor, and amount of vomitus. Assess bowel function, including the passage of flatus. Auscultate for bowel sounds and document their character and location. Inspect the abdomen for scars, visible masses, and distention. Assess whether abdominal tenderness or rigidity is present. Measure the abdominal girth. Check for signs of peritoneal irritation (e.g., muscle guarding, rebound pain). If the HCP decides to wait to see if the obstruction resolves on its own, assess the patient regularly. Notify the HCP of changes in vital signs, changes in bowel sounds, decreased urine output, increased abdominal distention, and pain. Maintain a strict intake and output record, including emesis and tube drainage. A urinary catheter allows for hourly monitoring of urine output. Report if the urine output is less than 0.5 mL/kg of body weight per hour. This indicates inadequate vascular volume and the potential for acute kidney injury. Rising serum creatinine and BUN levels are other indicators of acute kidney injury. Nursing Diagnoses Nursing diagnoses for the patient with intestinal obstructions include: • Acute pain • Fluid imbalance Planning The overall goals are that the patient with an intestinal obstruction will have (1) relief of the obstruction and return to normal bowel function, (2) minimal to no discomfort, and (3) normal fluid and electrolyte and acid-base status. Nursing Implementation Monitor the patient closely for signs of dehydration and electrolyte imbalances. Give IV fluids as ordered. Assess for signs and symptoms of fluid imbalance. Some patients, especially older adults, may not tolerate rapid fluid replacement. Monitor serum electrolyte levels closely. A patient with a high intestinal obstruction is more likely to have metabolic alkalosis. A patient with a low obstruction is at greater risk for metabolic acidosis. The patient is often restless and constantly changes position to relieve the pain. Provide comfort measures and promote a restful environment. Nursing care of the patient after surgery for an intestinal obstruction is similar to care of the patient after a laparotomy (see p. 935). With an NG tube in place, oral care is extremely important. Vomiting leaves an unpleasant taste in the patient’s mouth, and fecal odor may be present. The patient breathes through the mouth, drying Colorectal cancer o Risk factors Lewis table 42.21 o o Manifestations ▪ Early disease: • Asymptomatic • Nonspecific (fatigue, weight loss) ▪ More advanced disease: • Abdominal tenderness • Palpable abdominal mass • Hepatomegaly • Ascites NSG 331 nal Exam Study Guide o Interprofessional care Lewis table 42.22 NSG 331 Final Exam Study Guide o ▪ Screening for ages 50 - 75 • Colonoscopy every 10 years • Flexible sigmoidoscopy • Double-contrast barium enema ▪ CT colonography ▪ Carcinoembryonic antigen (CEA) level ▪ Colorectal Cancer:Treatment • Surgery o Hemicolectomy or partial colon resection o Colostomy • Chemotherapy • Targeted therapy • Radiation therapy SG 331 inal Exam Study Guide o o o Nur sin o o Lewis table 42.27, 42.28 g management NSG 331 Final Exam Study Guide TABLE 42.28 Patient & Caregiver Teaching Ostomy Self-Care Include the following points when teaching the patient and/or caregiver about self-care of an ostomy: 1. Explain what an ostomy is and how it functions. 2. Describe the underlying condition that resulted in the need for 31 an ostomy. de 3. Demonstrate and allow the patient and caregiver to practice the following aOcstitvoimtieys: • Remove the old skin barrier, cleanse the skin, and correctly apply new skin barriers. • Apply, empty, clean, and remove the pouch. • Empty the pouch before it is one-third full to prevent leakage. 4. Irrigate the colostomy to regulate bowel elimination (optional). 5. Explain how to contact the wound, ostomy, and continence nurse (WOCN) with questions. 6. Describe how to obtain ostomy supplies. 7. Explain dietary and fluid management. • Diverticulosis and diverticulitis • Identify a well-balanced diet and dietary supplements o Lewis table 42.30 to prevent nutritional deficiencies. • Contributing factors o Constipation o Diet – low fiber, high fat, red meat • Clinical Manifestations • Asymptomatic o Advancing age NSG 331 Final Exam Study Guide • Abdominal pain, bloating, flatulence, changes in bowel habits • Diverticular bleeding • May develop diverticulitis • LLQ pain • Palpable abdominal mass • Nausea and vomiting • Fever • Cholelithiasis and cholecystectomy o Cholelithiasis ▪ Most common disorder of biliary system ▪ Stones in the gallbladder • Bile supersaturated with cholesterol • Stasis of bile in the gallbladder • Stones either o remain in gallbladder o leave gallbladder without problems o lodge in cystic or common bile duct ▪ Clinical Manifestations • Asymptomatic to severe • Pain o Cholecystitis o More intense with stone movement or obstruction o Biliary colic: Steady, excruciating o RUQ, epigastric, right shoulder o 3–6 hours after high-fat meal or when person lies down ▪ Inflammation of gallbladder wall ▪ Usually associated with cholelithiasis ▪ Acute or Chronic • Acute or chronic inflammation caused by o Gallstone obstruction in cystic duct o Acalculous (absence of obstruction) ▪ older adults, critically ill persons, prolonged immobility ▪ fasting, prolonged parenteral nutrition ▪ Clinical Manifestations: • Acute cholecystitis o Indigestion, nausea/vomiting o Pain and tenderness in RUQ o Fever with leukocytosis • Chronic cholecystitis o Fat intolerance