Mdc 2 Final Exam With Complete Solutions

OA prevention of fecal impaction: - Answer- --Consume high-fiber foods (raw fruit/vegetables/whole grain), --drink adequate amounts of fluid (water), --do not routinely administer laxatives, --exercise regularly, --use natural foods to stimulate peristalsis (warm juice/prune juice), --take bulk-forming products, --monitor output and frequency, --implement toilet/commode rather than bedpan. =Mechanical obstruction includes adhesions, --Crohn's disease --tumors. =Non-mechanical obstructions tend to be paralytic ileus. Colostomy care - Answer- --Normal appearance of stoma, =S&S of complications, measurement of stoma, choice/use/care/application of appropriate appliance to cover stoma, measures to protect skin, dietary measures to control gas and odor, and resumption of normal activities. Stoma Care: - Answer- strict attention to skin care/peristomal skin assessment, monitor type and frequency of effluent, be attentive to client's psychosocial needs (attend to odor control and address client participation in ostomy care), and client teaching for home care (wound ostomy continence nurse) What are hemorrhoids? - Answer- Hemorrhoids are unnaturally swollen or distended veins in anorectal regions. Can be internal or external. Internal means it can not be visibly seen on the peritoneum. External means it CAN be seen on the peritoneum below the anal sphincter. hemorrhoid prevention - Answer- PREVENTION of constipation is ESSENTIAL, so increase fiber and fluid intake and exercising. No straining and maintain a healthy weight! hemorrhoid care - Answer- Care: Local treatment and NUTRITION~ cold pack on anorectal region, Tepid sitz bath ¾ times per day, topical anesthetics (lidocaine), dibucaine ointment, cleanse the area with moist cleansing tissues, avoid sitting for long periods and remove symptomatic hemorrhoids. Nursing Care for Anorectal Abscesses: - Answer- Maintain comfort and peritoneal hygiene! Encourage the use of warm sitz bath, analgesics, bulk-forming agents and stool softeners. Anal Fissure Care: - Answer- Warm sitz baths, analgesics, bulk-forming, stool softeners, topical anti-inflammatory agents (hydrocortisone), externally applied nitroglycerin (Rectiv) to promote blodd supply to fissure and increase healing, and BP meds such as nifedipine (Procardia) or diltiazem (cardizem) to help relax the anal sphincter. GI bleed interventions - Answer- CBC/H&H labs, pos occult stool test means blood in GI tract, upper bleed usually treated with Protonix IV to treat bleeding ulcer, and blood transfusion if needed. What are the clinical manifestations of Irritable Bowel Syndrome (IBS)? - Answer- Cramping, abdominal pain, diarrhea, constipation, and bloating. What are the clinical manifestations of Malabsorption Syndrome? - Answer- Unintentional weight loss, bloating/flatulence, and easy bruising (pupura) (Additional: steatorrhea, decreased libido, anemia, bone pain, and edema) What are the lab/diagnostic tests for malabsorption syndrome? - Answer- Quantitative fecal fat analysis and hydrogen breath test (Additional: Lactose tolerance test, Schilling test, Ultrasonography, X-Rays and CTs Chronic Inflammatory Bowel Disease(IBD) - Answer- Crohn's or Ulcerative Colitis PERITONITIS is a life-threatening infection: S&S - Answer- --rigid/board-like abdomen, abdominal pain, high fever, tachycardia (Additional: Distended abdomen, N/V, anorexia, diminishing bowel sounds, inability to pass flatulence/feces, rebound tenderness in the abdomen, dehydration, decreased urine output, hiccups and possible compromise in respiratory status) =In some cases, laparoscopic distal pancreatectomy may be appropriate for resection of the distal pancreas or pancreas head what is the only palpable glad ? - Answer- thyroid which gland is the master gland ? - Answer- pituitary Diabetes Insipidus (DI) - Answer- Increase in frequency of urination~4-30 L per day!!: Dehydration clinical manifestations :) Diabetes Insipidus (DI) Nursing Care - Answer- Lifelong Desmopressin acetate (Vasopressin) Therapy Syndrome of Inappropriate Antidiuretic Hormone (SIADH): - Answer- --Water is retained, results in delusional hyponatremia (decreased serum sodium levels) =Fluid overload precautions (monitor I&Os, daily weight, fluid restriction), administer drugs (diuretics, 3% hypertonic saline, declomycin), monitor pulmonary edema, and dilute with saline instead of water! Adrenal gland Hypofunction (Addison's) - Answer- Acute adrenal insufficiency (addison's crisis) is life threatening; the need for cortisone and aldosterone is greater than body's supply Addison's S/S - Answer- lethargic, muscle weakness (additional: fatigue, N/V/D, abdominal pain) Addison's nursing care - Answer- Prednisone or dexamethasone tx; In crisis stage, the patient should start responding to treatment and become more alert; NOTE: Steroid drugs must be withdrawn gradually to allow for pituitary production of ACTH and activation of adrenal cells to produce cortisol. Adrenal Gland Hyperfunction (Cushing's Syndrome) - Answer- From chronic use of corticosteroids. Cushing's syndrome S/S - Answer- Elevated BP, elevated BG, weight gain, increased appetite, and patient or loved ones may voice concerns about outbursts/screaming/crying (emotional instability) Cushing's nursing care - Answer- There is potential fluid overload, potential for injury, potential for infection (WASH HANDS to prevent spread of infection), and potential for acute adrenal insufficiency In Pheochromocytoma - Answer- (tumor on the adrenal medulla release epinephrine/norepinephrine): Do not smoke or drink caffeinated beverages or change positions suddenly Hyperthyroidism: - Answer- autoimmune disease (Graves' disease) resulting in Hashimoto's thyroiditis producing a goiter, exophthalmos (protruding eyes), pretibial myxedema hyperthyroidism assessment - Answer- HEAT INTOLERANCE; T3/T4 Increased, TSH low hyperthyroidism nursing care - Answer- Educate patient that iodine preparations usually show improvement within 2 weeks, but it may be weeks before metabolism returns to normal. A post-op complication can be hypocalcaemia if parathyroid was resected. Thyroid Storm: - Answer- High fever, HTN, tachy, abd pain, N/V/D Treat Thyroid Storm: - Answer- methimazole (Tapazole) and propylthiouracil (Propyl-Thyracil), sodium iodide solution, propranolol, glucocorticoids, cardiac monitoring, no aspirin, and give normal saline infusions Thyroid Storm: - Answer- Hypothyroidism: - Answer- Thyroid hormone secretion decreases with age *know the difference* =Hallmark signs of thyroid cancer is elevated serum thyroglobulin level Hypothyroidism S/S - Answer- Low T3/T4, High TSH, fatigue, cold intolerance Myxedema coma: Life-threatening complication of poorly treated hypothyroidism hypothyroidism treatment - Answer- Life treatment of levothyroxine sodium (T4) Hyperparathyroidism - Answer- (HYPERCALCEMIA/HYPOPHOSPHATEMIA): Same clinical manifestations of hypercalcemia (bone deposits) hyperparathyroidism treatment - Answer- diuretic and hydration therapy; in emergencies phosphate IV is administered. Hypoparathyroidism - Answer- (HYPOCALCEMIA/HYPERPHOSPHATEMIA): Hypoparathyroidism S/S - Answer- muscle cramps and spasms, pos chvostek's(face) and trousseau's(BP cuff) sign Hypoparathyroidism nursing care - Answer- Treat the electrolyte imbalance. Educate to avoid milk, yogurt and processed cheeses because of high phosphorus content Diabetes Type II: - Answer- The brain cannot produce or store glucose; the brain needs a constant supply DM type 2 S/S - Answer- Polyuria, polydipsia, polyphagia Chronic High BG Leads to: - Answer- --Macrovascular complications --Microvascular complications Macrovascular complications of diabetes - Answer- coronary heart disease, cerebrovascular disease, peripheral vascular disease, reduced immunity, and all lead to morbidity/mortality. Microvascular complications of diabetes - Answer- retinopathy, nephropathy, and neuropathy Diabetic foot care: - Answer- Apply moisturizing cream to your feet after bathing. Do not apply to the area between your toes. Hypoglycemia - Answer- 1 mg of glucagon IM/SubQ or D50 if unable to swallow/unconscious; if patient is conscious and can swallow, give 15-20 g of glucose. Educate client on not using excess insulin, to have sufficient intake of food, to not exercise at the peak of insulin action, and controlling alcohol intake (4 common causes) Hyperglycemia: - Answer- Insulin IV Regular bolus immediately then infusion, replace K once urine output adequate, assess airway/LOC/hydration/electrolytes/BG; most common precipitating factor is infection Dawn Phenomenon: - Answer- Abnormal increase in BG between 2am-8am without night hypoglycemia. Somogyi Effect: - Answer- Take insulin at night and wake up with high BG. BG was lowered too much and trigger release of hormones that causes BG to go high Treatment Options: DM type 2 - Answer- Monitor BG, maintain tight glycemic control, prevent hyperglycemia, adhere to dietary changes, increase physical activity, and exercise with a partner or friend to keep accountable. IBS teaching: - Answer- Modify diet: 30-40 grams of fiber daily, drug therapy, stress reduction, avoid GI stimulants/caffeine/alcohol/milk/milk products/manage stress, and peppermint oil capsules can be effective in reducing symptoms Non-Insulin Medications(oral): Metformin (Glucophage) - Answer- --Class~biguanide: decrease glucose production, increase tissue response to insulin, and reduces glucose absorption in the gut --Monitor kidney function closely: excreted unchanged by kidneys --Side Effects: GI disturbances (most common) --Great drug choice for patients who skip meals, little risk of hypoglycemia, and doesn't cause weight gain --Metformin therapy should not be held for 48 hours before and after tests using IV contrast dye to prevent acute renal failure. (2nd Gen) Glyburide: Class~Sulfonura - Answer- --Glipizide, Glyburide, Glimepride --Promote insulin secretion by the pancreas, increase tissue response to insulin and includes 1-2 doses/day --More potent than 1st gen, fewer drug interactions, and alcohol may produce disulfiram-like reaction --Should not be used in patients with liver or kidney disease: can cause severe hypoglycemia Repaglinide: Class~meglitinides(Glinides) - Answer- --Promote insulin secretion by the pancreas --More short-acting (1hr half-life and taken with each meal) --Should not be used in patients with liver disease (can causes severe hypoglycemia) --Side effects: hypoglycemia and weight gain Pioglitazone: Class~ Thiazolideniones (Glitazones) - Answer- --Decrease insulin resistance and thereby increases glucose uptake (muscle and fat) --Decreases glucose production by the liver --Side effects: upper respiratory infection, headache, hypoglycemia (when excess insulin present), heart failure (secondary to fluid retention), bladder cancer, fractures (in women), and ovulation (can lead to unintended pregnancy Acarbose: Class~ alpha-Glucosidase inhibitors - Answer- --Delay carbohydrate digestion and absorption, thereby decreasing the postprandial rise in BG: Acts locally in the intestine and not systemically absorbed --Side effects: GI symptoms (from bacterial fermentations of unabsorbed carbs in the colon): flatulence, cramps, abdominal distention, and diarrhea --Does not cause hypoglycemia when used alone Sitagliptin: Class~ Dipeptidyl Peptidase-4 inhibitors (Gliptins) - Answer- --Enhance activity of incretins (by inhibiting their breakdown of DPP-4), and thereby increase insulin resistance --Reduce glucagon release; decrease hepatic glucose production --Side effects: pancreatitis and hypersensitivity reaction (Anaphylaxis), angioedema and Stevens-Johnson syndrome) Cholecystitis teachings - Answer- Promoting proper nutrition ( high-fiber, low-fat, small frequent meals), and pain management with drug therapy and lithotripsy (may need laparoscopic cholecystectomy) IBD teachings: - Answer- Patient is at higher risk for cancer and encourage patient to self manage their disease by learning about the illness, drug therapy, treatment and complications Patient education for diabetes: - Answer- --Inspect feet daily, especially area between the toes. --Do not treat any infections or fungi on the feet alone, seek medical attention. --Seek medical attn immediately if you notice any sores, blisters or infections. --Wear shoes that give your toes plenty of room. --Wear socks that keep your feet warm. --Change into clean cotton socks everyday. --Trim nails straight across and smooth with an emery board. --Do not smoke. --Do not use very hot or very cold water. --Do not go barefoot. --Do not wear sandals or open-toed shoes. --Do not cross your legs or wear constrictive pants such as tights that compromises blood flow. --Do not soak your feet Patient Education for Drug Therapy~Type 2: - Answer- Drugs are started at lowest dose and increased every 2 weeks until control is achieved or maximum dose; second and 3rd may be added Patient Education DM type 1 - Answer- REQUIRES INSULIN THERAPY~Assess elderly regarding vision, coordination, and memory for safety issues Patient Education for Diabetes: Insulin Storage - Answer- Refrigerate to maintain potency, prevent exposure to sunlight and inhibit bacterial growth; Can be kept at room temperature for 28 days if in use to prevent cold infusions; Pre Filled needles need to be stored upright so insulin particles don't clog the needle Dose prep: insulin - Answer- NPH is cloudy, ALL THE REST SHOULD BE CLEAR Syringes: Insulin - Answer- Come in units and instruct client to buy the same syringes; come in 100U, 50U and 30U sizes; Disposable needles should only be used once; Use sharps container to dispose Blood Glucose monitoring: - Answer- Sufficient blood drop, proper storage of test strips, make sure to match strips to device, and have patient "teach back" to show understanding Infection control - Answer- Don't share equipment with others. Handwashing. Proper disposal to prevent others from getting stuck/exposed Novolin R (REGULAR) Insulin Peak time: - Answer- 1-5 hours. Short Acting, short duration!! Humalog/Lispro (RAPID ACTING): - Answer- Peak is ½ hr - 2.5 hrs, rapid-acting/short-duration