CA 2 EXAM 1(WITH CORRECTLY REVIEWED ANSWERS).

CA 2 EXAM 1(WITH CORRECTLY REVIEWED ANSWERS). A nurse is providing teaching to a parent f a child who has Hirschsprung Disease is scheduled for initial surgery. Which of the following statements by the parent indicates an understanding of the teaching? - CORRECT ANSWER-I'm glad that my child's ostomy is only temporary A nurse is caring for a child who is admitted with suspected acute appendicitis. Which of the following manisfestations should indicate to the nurse that the child's appendix is perforated? - CORRECT ANSWER-Sudden decrease in abdominal pain A nurse is caring or a child who has suspected appendicitis. Which of the following provider prescriptions should the nurse clarify? - CORRECT ANSWER-Administer sodium biphosphate/sodium phosphate A nurse is caring for a 6-month old infant who has a prescription for clear liquids by mouth after a repair of an intussesception. Which of the following fluids should the nurse select for the infant? - CORRECT ANSWER-Oral Electrolyte Solution A nurse is caring for a child who has acute gastroenteritis but is able to tolerate oral fluids. The nurse should anticipate providing which of the following types of fluid? - CORRECT ANSWER-Oral Rehydration Solution A nurse is caring for an infant who has inadequate motility of part of an intestine resulting in a mechanical obstruction. The nurse should identify this finding as a manisfestation of which of the following disorders? - CORRECT ANSWERHirschsprung's Disease A nurse is caring for an infant who has gastroesophageal reflux. The nurse should recognize that which of the following finding's are associated with this condition? - CORRECT ANSWER-Vomiting, Weight Loss, Wheezing A nurse is caring for a male infant who has a palpable mass in the upper right quadrant and stools mixed and mucus. The nurse should recognize that which of the following diagnoses is associated with these findings? - CORRECT ANSWER-Intussusception Psoriasis of the liver can result in - CORRECT ANSWER-Esophageal varicies What position is most beneficial for a patient with Ascities? - CORRECT ANSWER-High Fowlers Position LES (Lower Esophageal Sphincter) - CORRECT ANSWER- Increase of Amonia is related to - CORRECT ANSWER-build up of stool in the body Too much Amonia can lead to - CORRECT ANSWER-A coma Serum Amylase and Lipase should be monitored to confirm - CORRECT ANSWERPancreatitis Normal Amylase findings for Adult - CORRECT ANSWERBorborygmi- - CORRECT ANSWER-waves of loud, gurgling sounds r/t eating (bowel movement) Cheilosis - CORRECT ANSWER--softening, fissuring, and cracking of lips at angles of mouth r/t decreased B2 (riboflavin) Deglutition - CORRECT ANSWER--(swallowing) mechanical component of ingestion Endoscopy - CORRECT ANSWER--direct visualization of a body structure through a lighted fiberoptic instrument. Hematemesis - CORRECT ANSWER-vomiting of blood Hepatocytes - CORRECT ANSWER--hepatic cells r/t liver Pyorrhea - CORRECT ANSWER-recessed gingivae, purulent pockets r/t periodontitis Pyrosis - CORRECT ANSWER-heartburn, burning in epigastric or substernal area Steatorrhea - CORRECT ANSWER--fatty, frothy, foul-smelling stool r/t chronic pancreatitis, malabsorption (cystic fibrosis) Tenesmus - CORRECT ANSWER-painful and ineffective straining at stool. Sense of incomplete evacuation r/t IBS, inflammatory bowel syndrome, food poisoinin Valsalva maneuver - CORRECT ANSWER-facilitating defecation (heart conditions, brain issues, fresh post-op pt.'s) the parasympathetic (cholinergic) system is mainly - CORRECT ANSWER-excitatory sympathetic (adrenergic) system is mainly - CORRECT ANSWER-inhibitory enteral nutrition - CORRECT ANSWER--through the mouth, tube feeding to the stomach, provided by tube, catheter, or stoma malabsorption syndrome, - CORRECT ANSWER-impaired absorption of nutrients from the GI tract. malnutrition - CORRECT ANSWER--a deficit, excess, or imbalance of essential nutrients parenteral nutrition - CORRECT ANSWER--refers to the administration of nutrients by a route other than the GI tract tube feeding - CORRECT ANSWER--enteral nutrition, nutritionally balanced liquefied food or formula. Carbohydrates - CORRECT ANSWER--primary source of energy (simple: soda, sugar, white bread, complex: sweet potatoes, oatmeal) Fats - CORRECT ANSWER-major source of energy Proteins - CORRECT ANSWER-build muscle, repair tissues (animal, plant sources) Vitamins - CORRECT ANSWER-water soluble: B, C and fat soluble: K, A, D, E Minerals- - CORRECT ANSWER-necessary for building tissues and regulation of body fluids. Electrolytes Xerostomia - CORRECT ANSWER-decreased saliva (dry mouth) can lead to dysphagia Collaborative Care- Vomiting - CORRECT ANSWER-Contents of emesis: Emesis containing partially digested food several hours after a meal is indicative of gastric outlet obstruction or delayed gastric emptying. Color of emesis: Vomitus with a "coffee ground" appearance is related to gastric bleeding, where blood changes to dark brown as a result of its interaction with HCl acid. Bright red blood indicates active bleeding. Time of day: Early-morning vomiting is a frequent occurrence in pregnancy. Emotional stressors with no evident pathologic disorder may elicit vomiting during or immediately after eating. Collaborative Care - Nutritional therapy - CORRECT ANSWER-IV fluids to replace fluids and electrolytes NG tube suction to decompress stomach If hospitalized- may be NPO until diagnosis confirmed Adults-Clear liquids started first 5 to 15 mL fluid every 15 to 20 minutes No extremely hot/cold liquids Warm tea May advance to dry toast, crackers Infants & children- Adequate ORT, SEE WONG'S Collaborative Care - Drug Therapy - CORRECT ANSWER-Examples Serotonin Antagonists Ondansetron (Zofran) Antihistamines Dimenhydrinate (Dramamine) Meclizine (Antivert) Hydroxyzine (Vistaril) Phenothiazines Prochlorperazine (Compazine) Chlorpromazine (Thorazine) Promethazine (Phenergan) Nursing Management - Acute intervention - CORRECT ANSWER-NG tube may be used for possible obstruction Zofran 8 mg IVP every 6 hrs PRN N/V Use relaxation techniques Cleanse face/hands with a cool washcloth Provide mouth care between episodes IVF and record I & O Monitor VS ORAL DISORDERS p 928 - CORRECT ANSWER-Stomatitis- inflammation of the mouth- many causes (trauma, pathogens, irritants like tobacco and alcohol, side effect of cancer treatment, renal disease, etc.). Topical meds and treat the cause. Herpes Cold Sores- caused by virus and will lay dormant until times or stress, sunlight, menstruation. Painful vesicles that need antiviral med. Oral candidiasis- Thrush- can be cause by antibiotic therapy- white lesions on nucosa of mouth. Take anti-fungal. Oral cancer could be found by dentist, scraping of suspicious lesion and view under microscope. Also can perform dye tests that only cancer cells will absorb blue dye. Will then do MRI to stage the oral cancer. Treatment is radiation, chemo, and surgery- usually a combo. Lifestyle modifications & Nutritional therapy - CORRECT ANSWER-Avoid triggers Stop smoking HOB elevated- at least 30 degrees Decrease high-fat foods Take fluids between rather than with meals Small frequent meals Avoid late-night snacking Weight reduction Most patients with GERD can successfully manage this condition through lifestyle modifications and drug therapy. These long-term approaches require patient teaching and compliance with therapies. With regard to triggers, give particular attention to diet and drugs that may affect the LES, acid secretion, or gastric emptying. Avoid chocolate, peppermint, caffeine, tomato products, orange juice Esophageal Achalasia - CORRECT ANSWER-Dysphagia- difficult swallowing Regurgitation (esp. nocturnal) Substernal chest pain (during/after a meal) Halitosis Inability to belch Weight loss Achalasia - Treatment: Esophageal dilatation - CORRECT ANSWER-Smooth muscle relaxants before meals Semisoft bland diet and eating slow Drinking with meals Sleeping with head of bed elevated GASTRITIS - CORRECT ANSWER-Inflammation of gastric mucosa due to a local irritant with breakdown in gastric mucosal barrier Stomach tissue unprotected from auto digestion by HCl acid and pepsin Many causes Table 42-12 The mucosal barrier normally protects the stomach tissue from the corrosive action of HCl acid and pepsin. When the barrier is broken, HCl acid and pepsin can diffuse back into the mucosa. Nursing Management - For any post-op GI patient - CORRECT ANSWER-Prevention of respiratory complications Assessment for bleeding, complications, worsening S/S, change in condition, vital signs, LOC, IV fluids, maintenance of fluid/electrolyte balance Prevention of infection Deep breathing techniques Accurate I/O Pain medication Medications to prevent nausea/vomiting Assessment for return of peristalsis, gradually resume normal diet once peristalsis returns For some patients, the laparoscopic fundoplication is performed as an outpatient procedure. However, patients at risk for complications, including those with prior upper abdominal surgeries and those with co-morbidities (e.g., cardiac disease, obesity), are hospitalized after the procedure.