Medical Surgical Nursing 2 - Exam One Questions & Answers

Skills for communicating with seriously ill patients and their families. - ANSWERSDevelop level of comfort and expertise in communicating with seriously/terminally ill patients/families Communication should be tailored to the level of understanding and values Arrangements should be made to have the discussion at a time that is best for everyone Create the right setting Space should be conducive to seating all at the eye level Tenet of palliative and end-of-life care Nurses must be able to assess patient and family responses to serious illness and support their values and choices throughout the continuum of care First, nurses must consider their own experiences and values regarding illness and death Provide culturally and spiritually sensitive care to seriously ill patients and their families. - ANSWERSAssess values, preferences, beliefs, expectations, and practices Nurses set aside own assumptions and attitudes toward death and dying Spiritually contains features of religiosity; however, the two concepts are not interchangeable Implement nursing measures to manage physiologic responses to terminal illness. - ANSWERSAnswer questions honestly and accurately in ways the patient can understand Listen attentively Support patient choices Facilitate communication with family Support imminently dying patients and their families. - ANSWERSGrief refers to the personal feelings that accompany an anticipated or actual loss Mourning refers to individual, family, group, and cultural expressions of grief and associated behaviors Bereavement refers to the period of time during which mourning for a loss takes place GERD Overview - ANSWERSCommon disorder marked by backflow of gastric or duodenal contents into the esophagus that causes troublesome symptoms and/or mucosal injury to the esophagus Excessive reflux may occur because of an incompetent lower esophageal sphincter, pyloric stenosis, hiatal hernia, or a motility disorder Incidence: increases with age; irritable bowel syndrome and obstructive airway disorders (asthma, COPD, cystic fibrosis); Barrett esophagus, peptic ulcer disease, and angina Other risk factors: tobacco use, coffee drinking, alcohol consumption, gastric infection with Helicobacter pylori GERD Manifestations - ANSWERSPyrosis Dyspepsia Regurgitation Dysphagia Hypersalivation Esophagitis **Symptoms may mimic those of a heart attack** Dental Erosion Ulcers, laryngeal damage, pulmonary complications, etc GERD Assessment and Diagnostics - ANSWERSPt. history Endoscopy or barium swallow To evaluate damage to esophageal mucosa Esophageal pH monitoring GERD Management - ANSWERSLow-fat diet Avoid caffeine, tobacco, beer, milk, foods containing peppermint or spearmint, and carbonated beverages Avoid eating or drinking 2 hours before bedtime Elevate the head of the bed by at least 30 degrees Barrett Esophagus - ANSWERSOverview: A condition in which the lining of the esophageal mucosa is altered. Clinical Manifestations: Patients complain of symptoms of GERD, notably frequent heartburn OR patient complains of symptoms related to peptic ulcers or esophageal stricture. Assessment/Diagnostic Findings: Endoscopy (EGD) and Biopsies Management: Individualized to each patient, Endoscopic ablation Gastrostomy (G-Tube) and J-Tube - ANSWERSAssessment of the Patient with a G-Tube or J-Tube - Patient knowledge and ability to learn - Self-care ability and support - Skin condition - Nutrition and fluid status - Inspection of the tube Nursing Interventions - Meet nutritional needs - Prevent infection: proper use of dressing; skin care around the tube; manipulation of stabilizing disk to prevent skin breakdown Esophageal Perforation - ANSWERSClinical Manifestations The patient has excruciating retrosternal pain followed by dysphagia. Infection, fever, leukocytosis, and severe hypotension Assessment/Diagnostic Findings X-ray studies, Fluoroscopy, CT scan Management Immediate treatment, Remain NPO, IV Fluid therapy, Broad-Spectrum Antibiotics, Surgical repair Describe the nursing management of the patient receiving enteral nutrition support. - ANSWERSMeet nutritional requirements when oral intake is inadequate or not possible, and the GI tract is functioning. Administration of Tube Feedings Dependent on Location, Patient education and preparation, Tube insertion, Confirming placement, Clearing tube obstruction, Monitoring the patient, Maintaining the function, Oral and Nasal care, Monitoring, preventing, and managing complications, and Tube removal Peptic Ulcer Disease Overview - ANSWERSErosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus Associated with infection of H. pylori Risk factors include excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, smoking, and familial tendency Peptic Ulcer Disease Clinical Manifestations - ANSWERSDull gnawing pain Burning in the midepigastrium Heartburn Vomiting Peptic Ulcer Disease Medical Management - ANSWERSAntibiotics, H2 Receptor Antagonist (-idine)Proton Pump Inhibitors (-prazole), and sometimes Bismuth salts Smoking Cessation Dietary Modification Surgical Management Use the nursing process as a framework for care of patients with peptic ulcer - ANSWERSAssessment Diagnose Planning and Goals - Relief of pain - Reduced anxiety - Maintenance of nutritional requirements - Absence of complications Irritable Bowel Syndrome - ANSWERSPathophysiology - Chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may include diarrhea, constipation, or both - 15% of adults in the United States report symptoms of IBS;More common in women than men - Triggers: chronic stress, sleep deprivation, surgery, infections, diverticulitis, and some foods Clinical Manifestations - Alterations in bowel pattern - Pain - Bloating - Abdominal distention Irritable Bowel Syndrome Nursing Management - ANSWERSMaintaining normal elimination patterns -Identify relationship between diarrhea and food, activities, or emotional stressors - Provide ready access to bathroom or commode - Encourage bed rest to reduce peristalsis - Administer medications as prescribed - Record frequency, consistency, character, and amounts of stools Assessment and treatment of pain or discomfort, anticholinergic medications before meals, analgesics, positioning, diversional activities, and prevention of fatigue Fluid deficit, I&O, daily weight, assessment of symptoms of dehydration or fluid loss, encourage oral intake, measures to decrease diarrhea Optimal nutrition; elemental feedings that are high in protein and low residue or PN may be needed Reduce anxiety, use a calm manner, allow patient to express feelings, listening, patient education Intestinal Obstruction - ANSWERSPathophysiology -Intestinal obstruction exists when blockage prevents the normal flow of intestinal contents through the intestinal tract -Mechanical obstruction: Intraluminal obstruction or mural obstruction from pressure on the intestinal wall -Functional or paralytic obstruction The intestinal musculature cannot propel the contents along the bowel The blockage also can be temporary and the result of the manipulation of the bowel during surgery Nursing Management - Maintaining the function of the nasogastric tube - Assessing and measuring the nasogastric output - Assessing for fluid and electrolyte imbalance - Monitoring nutritional status - Assessing for manifestations consistent with resolution (e.g., return of normal bowel sounds, decreased abdominal distention, subjective improvement in abdominal pain and tenderness, passage of flatus or stool) Parenteral Nutrition Indications - ANSWERS- Intake is insufficient to maintain anabolic state - Ability to ingest food orally or by tube is impaired - Patient is not interested or is unwilling to ingest adequate nutrients - The underlying medical condition precludes oral or tube feeding - Preoperative and postoperative nutritional needs are prolonged Parenteral Nutrition Nursing Interventions - ANSWERSMaintaining optimal nutrition - Daily weight at same time of day - Accurate I&O - Caloric count - Trace elements included in solution Preventing infection - Appropriate catheter and IV site care - Strict sterile technique for dressing changes - Wear mask when changing the dressing - Assess insertion site - Assess for indicators of infection - Proper IV and tubing care Maintaining fluid balance - Use infusion pump. Flow rate should not be increased or decreased rapidly. If fluid runs out, hang 10% dextrose solution - Monitor indicators of fluid balance and electrolyte levels - I&O - Weights - Monitor blood glucose levels