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N2 Final Exam Study Guide

Nursing 2 Final Exam Study Guide 1. Upper GI Tract Dysphagia – Difficulty swallowing. Major concern for older adult & victims of stroke. Has trouble swallowing liquids or solids, coughs after eating or drinking, speech difficulty (dysphonia) • Barium Swallow – Swallows radioactive dye that shows areas of dysfunction. • Endoscopic Evaluation TX = Thickened liquids/foods. Elevate HOB 30-45 degrees. 2. Lower GI Tract Obstruction – Poop can’t go forward . ABG: HCO3 up, pH up = metabolic alkalosis • Small Bowel S/S = Abdominal pain, distention, N/V, constipation, electrolyte imbalances, metabolic alkalosis • LARGE Bowel S/S = Lower abdominal cramping, constipation, ribbon like stools. What is contraindicated?! BARIUM ENEMA TX= Possible Surgery, NG Tube Suction, NPO, IV Therapy (fluids), Pain Control IBS (Irritable Bowel Syndrome) – Chronic diarrhea and/or constipation ABG: HCO3 low, pH low – metabolic acidosis • S/S = excess farting (flatulence), distention, cramps, pain, diarrhea/constipation, LLQ pain. • Treatment = AVOID triggers or fruit, berries, lettuce, lactose, caffeine, & alcohol. Increase fiber, relax, less stress, and exercise • Meds = Constipation (Metamucil, Fibercon), Diarrhea (Imodium, Lomotil) TX = Educate on avoiding triggers & fibrous foods Appendicitis – Infection of appendix organ • S/S = RLQ pain (McBurney’s Point), rebound tenderness, relief of pain after ruptured. o RUPTURED = think infection… chills, increased WBC, guarding, distention, shallow breathing, irritability, & restlessness. TX = Surgical removal, semi-fowler RIGHT side lying, no heat, no laxatives, cold compress Ulcerative Colitis – Inflammation of mucosa in colon & rectum. ABG: HCO3 low, pH low = metabolic acidosis • S/S = > 10 liquid stools per day, abdominal pain, dehydration, tachycardia, anemia, distention. o Complications = hemorrhage, abscess, TOXIC MEGACOLON, obstruction, perforation Meds - sulfasalazine (Azulfidine), mesalamine (Asocol), azathioprine (Imuran) to alter immune response; antidiarrheal for symptom management TX = Avoid trigger foods, may require NPO & TPN treatment Chohn’s Disease – inflammation of mucosa in terminal ilium ABG: HCO3 low, pH low = metabolic acidosis • S/S = diarrhea 5-6x daily, abdominal pain, low-grade fever, weight loss, electrolyte imbalance. TX = High calorie, high protein, antidiarrheal, corticosteroids, immunomodulators, TPN during exacerbation (promotes rest) Diverticulitis – Inflammation of the sac-like pouches known as diverticula in the colon. • S/S = changing from constipation to diarrhea constantly, LLQ pain o Perforation = fever, chills, tachycardia, gen. abdominal pain TX = Dietary modifications, colon resection, antibiotics, pain relief, stool softeners. Educate on low Fiber diet & avoid nuts! 3. Urinary Dysfunction • Stress incontinence: loss of urine with increased abdominal pressure • Reflex incontinence: involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached • Urge incontinence: involuntary passage of urine soon after strong urge to void • Functional incontinence: involuntary, unpredictable passage of urine • Total incontinence: continuous and unpredictable loss of urine UTI – Inflammation of bladder, ureters, or urethra. Cystitis = infection of bladder (lower) Pyelonephritis = Infection of kidneys (upper) Most commonly caused by…. E. Coli • S/S = frequency, urgency, dysuria, low back pain, nocturia, incont. Hematuria, retention • Older adults = confusion, no appetite, frequent falling. TX – Antibiotics, increase fluid to 3L/day, antispasmodics Urinary Tract Calculi (Urolithiasis) – Calculi stone formed in the urinary tract Nephrolithiasis – Kidney Stone Calcium Phosphate is the most common type of kidney stone • S/S – severe pain, flank pain radiating to groin, distention, fever, & chills Main Cause: DEHYDRATION = Prevent by drinking fluids TX – Stones 5mm or smaller usually pass on their own. Stones greater than 5mm diameter require surgery. Monitor renal function, strain urine, diuretics may be orders, FLUIDS. Educate – Diet, increase fluid intake, report signs of UTI, report increased pain. Pyelonephritis – Infection of kidneys Most commonly caused by E.Coli • S/S – hematuria, urinary frequency, dysuria, flank pain, costovertebral tenderness, tachypnea, GI symptoms, muscle tenderness TX – Antibiotics for specific organism, increase fluid intake to 3L/day, antispasmodics for bladder spasms Glomerulonephritis – Inflammation of capillary loops in glomeruli of kidney that typically follows an infection of A-beta-hemolytic streptococcus. • S/S – Pharyngitis, fever, malaise, weakness, fatigue (early signs), anorexia, nausea, vomiting, peripheral edema, hypertension, hypoalbuminemia. • Recent URI, UTI, pericarditis, or skin infection • Labs may reveal increased BUN & Creatinine, hyponatremia, hyperkalemia, hypophosphatemia. TX – Antimicrobials (Penicillin’s), pain relief, electrolyte replacement, strict I&O. Urinary Retention – Bladder is not emptying all of the way and urine is staying. • Causes – Benign prostatic hyperplasia, surgery, anticholinergic, antidepressants, antipsychotics, antiparkinsonian, and antihypertensive.........................Continued

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