Final Exam: NUR2392/ NUR 2392 (New 2023/ 2024) Multidimensional Care II/ MDC 2 Exam| Questions and Verified Answers| 100% Correct| Grade A- Rasmussen

Final Exam: NUR2392/ NUR 2392 (New 2023/ 2024) Multidimensional Care II/ MDC 2 Exam| Questions and Verified Answers| 100% Correct| Grade A- Rasmussen

Final Exam: NUR2392/ NUR 2392 (New
2023/ 2024) Multidimensional Care II/ MDC
2 Exam| Questions and Verified Answers|
100% Correct| Grade A- Rasmussen
QUESTION
Hyperthyroidism aka Grave’s disease
▪ Laboratory Tests
Answer:
INCREASED
▪ T3, T4
DECREASED
▪ TSH
QUESTION
__ is an autoimmune disorder where Beta cells are destroyed
Answer:
type 1 diabetes mellitus
QUESTION
Type I Diabetes
▪ Signs & Symptoms
Answer:
▪ Polyuria
▪ Polydipsia
▪ Polyphagia
▪ Kussmaul Respirations

▪ Fruity breath
▪ Abdominal pain
▪ Ketone bodies
▪ Dehydration
▪ Orthostatic Hypotension
▪ Hypoxia
▪ Weight loss
▪ Fatigue
▪ Nausea
▪ Anxiety
▪ Rashes
▪ Skin infections
▪ Peripheral neuropathy
QUESTION
Type I or Type II Diabetes
▪ Laboratory tests
Answer:
INCREASED:
▪ Hemoglobin A1C
▪ Random blood glucose
▪ Fasting blood glucose
QUESTION
How would you interpret?
▪ A patient has a fasting blood glucose level of 260 mg/dL and a hemoglobin A1C of 6.0%
Answer:
Normal range: fasting glucose <110 mg/dL
Normal range: hemoglobin A1C < 6.5%
▪ They may have eaten poorly the night before (had alcohol or a high carb dinner) but otherwise
have been compliant the past 3 months.

QUESTION
How would you interpret?
▪ A patient has a fasting blood glucose level of 99 mg/dL and a hemoglobin A1C of 9.0%
Answer:
Normal range: fasting glucose <110 mg/dL
Normal range: hemoglobin A1C < 6.5%
▪ They tried to eat well a few days leading up to the test but have not been compliant the past 3
months.
QUESTION
How would you interpret?
▪ A patient has a fasting blood glucose level of 260 mg/dL and a hemoglobin A1C of 10.0%
Answer:
Normal range: fasting glucose <110 mg/dL
Normal range: hemoglobin A1C < 6.5%
▪ They have not been compliant at all!
QUESTION
If we are giving a patient Novolin R, when are they at the greatest risk for hypoglycemia?
p. 1294
Answer:
This is a short-acting, regular insulin
▪ at the peak point (half-life), which for Novolin R is at 2.5-5 hrs
▪ this means they need to plan to eat something at that time
▪ not recommended to take before bedtime b/c of this issue
QUESTION

NPH (intermediate-acting insulin)
▪ Onset, Peak
p. 1294
Answer:
▪ onset: 1-5 hours
▪ peak: 4-12 hours
QUESTION
Long-acting insulin
▪ Onset, Peak
p. 1294
Answer:
▪ onset: 2-4 hours
▪ peak: 6-12 hours
QUESTION
_ is a type of hyperventilation that is the lung’s emergency response to acidosis.
It causes a labored, deeper breathing rate. It is most commonly associated with conditions that
cause metabolic acidosis, particularly diabetes
Answer:
Kussmaul breathing
QUESTION
Diabetic Ketoacidosis
(SATA Q?)
▪ Immediate Treatment
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PT PAP HOT

▪ Pituitary
▪ Thyroid

▪ Pancreas
▪ Adrenals
▪ Parathyroid

▪ Hypothalamus
▪ Ovaries
▪ Testes

What are the glands of the endocrine system? (SATA Q?)

Grave’s disease

an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos

Treatments
▪ Rx: methimazole, atenolol, and iodine-131
▪ radiation therapy

Nursing Interventions
▪ provide a calm environment
▪ keep patients room cool
▪ assess pain
▪ prepare patient for surgery
▪ post-operative care
▪ maintain a patent airway
——– same as hypothyroidism ———
▪ provide periods of rest
▪ continuous cardiac monitoring
▪ monitor vital signs
▪ daily weight
▪ monitor I&O
▪ monitor laboratory tests
▪ apply antiembolism stockings to prevent DVT
▪ provide skin care

HYPERthyroidism aka Grave’s disease

▪ Treatments

pituitary gland

_________ is considered to be the “master gland” as it secretes hormones that control other parts of the endocrine system.

▪ ACTH
▪ TSH

▪ are the most life threatening because they cause a decrease in the secretion of vital hormones from the adrenal and thyroid glands.

Anterior HYPOpituitarism

▪ Deficiencies of which two hormones are the most life threatening?

Bloodwork (all are DECREASED)
▪ T3
▪ T4
▪ Prolactin
▪ Testosterone
▪ Estradiol

Scans (you’ll always draw blood work first for diagnostics though)
▪ CT/MRI – detect bone or soft tissue lesions
▪ Skull X-ray – detect enlargement, erosions, and calcification of the sella turcica

Anterior HYPOpituitarism

▪ Laboratory & Diagnostic Tests

TRUE! We have very small amounts of testosterone or estradiol no matter if we are men or women.

T/F: do both men and women have testosterone and estradiol?

INCREASED:
▪ Prolactin – this might be the answer to the Q
▪ Cortisol
▪ TSH
▪ LH (men)
▪ FSH (men)
▪ Glucose

DECREASED:
▪ Gonadotropin

Anterior HYPERpituitarism

(SATA Q?)

▪ Laboratory Tests

▪ Prevent infection because they are immunosuppressed
▪ handwashing

HYPERcortisolism (aka Cushing’s Disease)

Priority Intervention

diabetes insipidus

▪ Deficiency of ADH resulting in large volumes of dilute urine
▪ A disorder of the posterior pituitary gland

They are losing a lot of water:

• polyuria
• polydipsia
• dehydration
• fluid/electrolyte imbalance
• dilute, low urine specific gravity (<1.005)
• high plasma osmolarity
• output does not decrease when fluid intake decreases

remember! your s/s are going to look like dehydration
• tachycardia
• hypotension
• poor turgor
• dry mucous membranes
• decreased cognition
• ataxia
• irritability

Posterior Pituitary Gland: Diabetes Insipidus:

▪ What will the patient present with?/Key Symptoms

▪ desmopressin acetate (a synthetic form of vasopressin)
▪ can be PO, SL, or intranasal

Posterior Pituitary Gland: Diabetes Insipidus:

▪ Drug Therapy

Addison’s disease

What is adrenal gland hypofunction?

▪ If the patient remains alert and oriented x 3

Addison’s Disease

▪ How do you know the therapy is working?

▪ Glucocorticoid drugs MUST be withdrawn slowly so you don’t wind up with Addison’s or adrenal insufficiency

▪ This allows for pituitary protection of ACTH and activation of the adrenal cortex to produce cortisol

Addison’s Disease

▪ How do you discontinue glucocorticoid therapy to avoid secondary adrenal insufficiency?

▪ Muscle weakness
▪ Muscle/joint pain
▪ Fatigue

Addison’s Disease

▪ Neuromuscular S/S

▪ Hypertension
▪ Dependent edema
▪ Bruising
▪ Petechiae

Cushing’s Disease aka hypercortisolism

▪ Cardiovascular S/S

INCREASED
• blood glucose level
• sodium level
• late-night salivary cortisol
*• urine cortisol*

DECREASED
• lymphocyte count
• calcium level

Cushing’s Disease aka hypercortisolism

▪ Laboratory Tests

INCREASED
▪ potassium (K)
▪ calcium (Ca)
▪ BUN

DECREASED
▪ serum cortisol
▪ salivary cortisol
▪ fasting blood glucose
▪ sodium (Na)

Addison’s Disease

▪ Laboratory Tests

Sodium increases
Potassium decreases

In hyperaldosteronism what happens with potassium and sodium? (Remember…it’s the opposite of Addison’s disease)

Heat intolerance – they are sweaty!

Hyperthyroidism aka Grave’s disease

▪ Hallmark assessment

Pheochromocytoma

a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine, so you are in a constant fight/flight state.

▪ Do not smoke
▪ Do not drink caffeine
▪ Do not change position suddenly
▪ Eat a diet rich in calories, vitamins, and minerals (avoid tyramine foods)

Any of the above can cause a hypertensive crisis (closely monitor their BP!)

never palpate or can give pt a massive rush of catecholamines (epinephrine)

Pheochromocytoma

▪ Patient Education

Cold intolerance

Other S/S:
▪ think dehydration: fatigue, weakness, lethargy, constipation, dry skin
▪ poor memory
▪ fatigue
▪ lack of energy -> sleeping more frequently
▪ muscle aches
▪ stiff muscles

Hypothyroidism

▪ Hallmark assessment

Improvement usually occurs within 2 weeks

Thyroid Therapy

▪ When will a patient feel therapeutic effects?

iatrogenic hypoparathyroidism

What does a thyroidectomy cause?

Thyroid surgery can cause parathyroid gland injury which results in tetany and hypocalcemia

Assess for:
▪ muscle twitching
▪ muscle spasms
▪ tingling around the mouth
▪ tingling of the toes and fingers
▪ hoarseness
▪ stridor
▪ suture line pressure
▪ thyroid storm

Thyroid Surgery (thyroidectomy)

▪ What is the biggest thing we are watching for post-op?

Think hypocalcemia S/S

▪ muscle cramps
▪ muscle spasms of the hands and feet.
▪ Mild tingling/numbness to muscle tetany
▪ Seizures w/o loss of consciousness
▪ Irritability
▪ Positive Chvostek’s and Trousseau’s Signs

Hypoparathyroidism

▪ Signs & Symptoms

thyroid storm

priority: maintain a patent airway and adequate ventilation.

▪ a relatively rare, life-threatening condition caused by exaggerated hyperthyroidism

▪ an individual’s heart rate, blood pressure, and body temperature can soar to dangerously high levels.

Even with treatment may lead to death.

DECREASE – hypothyroidism

As a person ages, thyroid levels may ______________.

INCREASED
▪ TSH
▪ Serum thyroglobulin level (Thyroid Cancer)

DECREASED
▪ T3, T4

Hypothyroidism

▪ Diagnostic Labs

Treatments
▪ Rx: levothyroxine sodium or liothyronine sodium

Nursing Interventions
▪ maintain fluid restriction
▪ provide warm blankets
▪ assess bowel sounds and elimination patterns
▪ assess for changes in neurological status
▪ monitor for S/S of myxedema coma: bradycardia, hypotension, decreased RR, hypothermia, change in LOC
——— same as hyperthyroidism ———-
▪ provide periods of rest
▪ continuous cardiac monitoring
▪ monitor vital signs
▪ daily weight
▪ monitor I&O
▪ monitor laboratory tests
▪ apply antiembolism stockings to prevent DVT
▪ provide skin care

HYPOthyroidism

▪ Treatments

Hashimoto’s disease

▪ an autoimmune disease in which the body’s own antibodies attack and destroy the cells of the thyroid gland

▪ chronic hypothyroidism

▪ triggered by bacterial or viral infection

INCREASED
▪ T3, T4


DECREASED
▪ TSH

Hyperthyroidism aka Grave’s disease

▪ Laboratory Tests

type 1 diabetes mellitus

____________ is an autoimmune disorder where Beta cells are destroyed

▪ Polyuria
▪ Polydipsia
▪ Polyphagia
▪ Kussmaul Respirations
▪ Fruity breath
▪ Abdominal pain
▪ Ketone bodies
▪ Dehydration
▪ Orthostatic Hypotension
▪ Hypoxia
▪ Weight loss
▪ Fatigue
▪ Nausea
▪ Anxiety
▪ Rashes
▪ Skin infections
▪ Peripheral neuropathy

Type I Diabetes

▪ Signs & Symptoms

INCREASED:
▪ Hemoglobin A1C
▪ Random blood glucose
▪ Fasting blood glucose

Type I or Type II Diabetes

▪ Laboratory tests

Normal range: fasting glucose <110 mg/dL
Normal range: hemoglobin A1C < 6.5%

▪ They may have eaten poorly the night before (had alcohol or a high carb dinner) but otherwise have been compliant the past 3 months.

How would you interpret?

▪ A patient has a fasting blood glucose level of 260 mg/dL and a hemoglobin A1C of 6.0%

Normal range: fasting glucose <110 mg/dL
Normal range: hemoglobin A1C < 6.5%

▪ They tried to eat well a few days leading up to the test but have not been compliant the past 3 months.

How would you interpret?

▪ A patient has a fasting blood glucose level of 99 mg/dL and a hemoglobin A1C of 9.0%

Normal range: fasting glucose <110 mg/dL
Normal range: hemoglobin A1C < 6.5%

▪ They have not been compliant at all!

How would you interpret?

▪ A patient has a fasting blood glucose level of 260 mg/dL and a hemoglobin A1C of 10.0%

This is a short-acting, regular insulin

▪ at the peak point (half-life), which for Novolin R is at 2.5-5 hrs
▪ this means they need to plan to eat something at that time
▪ not recommended to take before bedtime b/c of this issue

If we are giving a patient Novolin R, when are they at the greatest risk for hypoglycemia?

p. 1294

▪ onset: 1-5 hours
▪ peak: 4-12 hours

NPH (intermediate-acting insulin)

▪ Onset, Peak

p. 1294

▪ onset: 2-4 hours
▪ peak: 6-12 hours

Long-acting insulin

▪ Onset, Peak

p. 1294

Kussmaul breathing

_____________ is a type of hyperventilation that is the lung’s emergency response to acidosis. It causes a labored, deeper breathing rate. It is most commonly associated with conditions that cause metabolic acidosis, particularly diabetes

▪ IV normal saline
▪ regular, short-acting insulin
▪ hydration

“Hydration…Insulin…Electrolyte Replacement”

▪ assess airway, LOC, hydration, electrolytes, and blood glucose
▪ check vitals every 15 minutes
▪ Insulin IV (regular) bolus, then infusion

Diabetic Ketoacidosis

(SATA Q?)

▪ Immediate Treatment

▪ hypokalemia as potassium drops very quickly (potassium fluctuations!)

Diabetic Ketoacidosis

▪ Common Cause of Death

Assessment
▪ Sudden onset
▪ Kussmaul respirations
▪ “rotting fruit” breath
▪ nausea
▪ abdominal pain
▪ polyuria
▪ polydipsia
▪ dehydration or electrolyte loss:
▪ weight loss
▪ dry skin
▪ sunken eyes
▪ soft eyeballs
▪ lethargy
▪ coma

Laboratory Tests
▪ Serum glucose >300 mg/dL
▪ Positive urine ketones

Diabetic Ketoacidosis

(SATA Q?)

▪ Signs & Symptoms

▪ tight glycemic control and prevention of hyperglycemia

What helps to control or delay macrovascular and microvascular disease?

push IV dextrose bolus (D50W)

If your severely hypoglycemic patient is not alert and oriented, what drug therapy are you giving them?

▪ Give 10-15 g of glucose (tablets/gels)
▪ Repeat in 15 min if glucose is <60mg/dL or they have not improved.

If your hypoglycemia patient is alert and oriented and can swallow, what drug therapy are you giving them?

▪ Carbohydrate count
▪ Medical Alert Bracelet
▪ Carry a snack, especially if exercising

Hypoglycemia

▪ Patient Education

▪ How to do fingersticks or give injections
▪ S/S of hypoglycemia and DKA
▪ Inspect feet at least once a day
▪ Wear closed-toed shoes that are sturdy

Diabetes in General

▪ Patient Education

▪ dehydration
▪ electrolyte loss
▪ fluid loss

Observe for fungal or yeast infections, which appear as dark red rashes with “satellite” lesions.

What do you monitor for in a patient with diarrhea?

▪ chronic or recurrent diarrhea
▪ constipation
▪ abdominal pain
▪ bloating

remember! it’s unique bc you get both diarrhea and constipation

Irritable Bowel Syndrome

▪ Signs & Symptoms

▪ diet modification
▪ stress reduction
▪ adhere to medications such as bulk forming laxatives, antidiarrheal agents

Irritable Bowel Syndrome

▪ Treatment/Nursing Interventions/Education

non-mechanical bowel obstruction

If someone is post-op and they have no bowel sounds and have not passed gas, what would you suspect?

Call the MD, this indicates a lack of tissue perfusion (ischemia)

If a patient is post-op from a colostomy or ileostomy and you discover a blue stoma what would you do?

beefy red

What color is a stoma supposed to be?

• Appearance of a normal stoma (beefy red)
• Signs and symptoms of complications
• Measurement of the stoma
• Choice, use, care, and application of the appropriate appliance to cover the stoma
• Measures to protect the skin adjacent to the stoma
• NUTRITION changes to control gas and odor
• What to expect in terms of stool consistency
• Resumption of normal activities, including work, travel, and sexual intercourse

Stoma

▪ Patient Education

▪ pain management
▪ sitz baths
▪ keep their stool as liquid as possible (use bulk producing agents)
▪ administer medications as prescribed (i.e. antibiotics)
▪ post-operative care (i.e. incision and drainage)

Anorectal Abscess

▪ Nursing Interventions & Treatments

anorectal abscess

Collection of perianal pus resulting from an infection in the anal glands. Usually a result of an obstruction (feces, foreign bodies, or trauma)

▪ increase dietary fiber, fluids
▪ cold packs
▪ sitz baths
▪ stool softeners
▪ manage pain: topical anesthetics (ex: lidocaine)
▪ cleanse anal area with moistened cleansing tissues
▪ avoid sitting for long periods
▪ surgical intervention: hemorrhoidectomy

Hemorrhoids

▪ Nursing Interventions & Treatments

chronic pancreatitis

inflammation of the pancreas resulting from continuous damage to the pancreas over time

▪ r/t long-term heavy smoking and alcohol use
▪ remissions and exacerbations

pancreatectomy

after this procedure they will be on insulin for the rest of their lives

Chronic Pancreatitis

▪ Surgical procedure

▪ amylase
▪ lipase

Pancreatitis

▪ Which labs will be elevated?

▪ NPO
▪ pain management
▪ histamine receptor antagonists
▪ PPIs
▪ NG tube
▪ IV fluids as prescribed
▪ monitor electrolytes
▪ monitor vitals signs for fever, tachycardia, hypotension
▪ monitor blood glucose
▪ oral care
▪ skin care
▪ surgical interventions: exploratory laparotomy, sphincterotomy

Pancreatitis

▪ Treatment/Nursing Interventions

ulcerative colitis

▪ classified as an inflammatory bowel disorder that can occur anywhere in the GI tract
▪ inflammation and ulceration of the mucosa of the colon

▪ nutritional therapy
▪ antidiarrheal
▪ salicylates
▪ steroids
▪ modify diet
▪ psychological support
▪ surgical interventions: restorative proctocolectomy with ileo pouch-anal anastomosis, total proctocolectomy with a permanent ileostomy

Ulcerative Colitis

▪ Treatment

Stools: 10-20 liquid, bloody stools
Rectum –> Cecum

If a patient has ulcerative colitis, what are the stools like and where is the inflammation generally at?

Crohn’s disease

▪ classified as an inflammatory bowel disease in which part of the GI tract becomes inflamed and can result in the development of abscesses, fistulas, and fissures

▪ weight loss
▪ fever
▪ abdominal pain
▪ blood in the stool
▪ diarrhea
▪ steatorrhea

malabsorption syndrome is a complication, treated with TPN

Crohn’s Disease

▪ Signs & Symptoms

Stools: 5-6 soft stools
Terminal ileum –> all bowels

If a patient has Crohn’s disease, what are the stools like and where is the inflammation located?

Think of fluid volume overload for S/S

▪ weight gain (fluid retention)
▪ N/V
▪ tachycardia
▪ hypertension
▪ bounding pulse
▪ confusion
▪ increased thirst
▪ muscle weakness
▪ weakness
▪ fatigue
▪ seizures

SIADH

▪ Signs & Symptoms

Diuretics, 3% hypertonic saline, declomycin

-Want to remove fluid and add sodium

SIADH

▪ Medications to Treat

▪ decreased urine osmolarity (becoming less concentrated)
▪ increased urination (water is finally leaving)
▪ weight loss (water is finally leaving)

SIADH

▪ How do we know treatment is effective?

INCREASED
▪ urine osmolarity (concentrated urine)
▪ GFR

DECREASED
▪ serum sodium (hyponatremia r/t fluid retention)

SIADH

▪ Lab Values

Free water (not salt) is retained; dependent edema not usually present, even though water is retained.

What kind of water is retained in SIADH?

Cholecystitis

inflammation of the gallbladder; usually associated with gallstones; can be acute or chronic

▪ upper abdominal pain – radiates to right shoulder
▪ tachycardia
▪ pain triggered by eating
▪ anorexia
▪ N/V
▪ dyspepsia
▪ fever
▪ rebound tenderness
▪ jaundice

Cholecystitis

▪ Signs & Symptoms

appendicitis

inflammation of the appendix; if left untreated, appendix may rupture and result in infection

▪ N/V
▪ abdominal pain
▪ epigastric pain
▪ periumbilical pain

Appendicitis

▪ Signs & Symptoms

▪ administer IV fluids
▪ administer antibiotics
▪ monitor fluid and electrolytes
▪ manage pain
▪ post-operative care
▪ discharge education for wound management
▪ no laxatives/enemas
▪ no heat
▪ place in Semi-Fowler’s position for comfort

Appendicitis

▪ Nursing Interventions

CBC to check the hemoglobin and hematocrit

If someone is bleeding out, whether it’s GI bleed or trauma, what lab are you ordering?

melena

black, tarry stool with occult blood indicates minimal bleeding from ulcers

diverticular disease

herniation or outpouchings of the mucosa membrane of the bowel caused by an increase of pressure within the colon

▪ stool softeners
▪ fiber
▪ fluids

avoid: laxatives, enemas

Diverticulitis

▪ Treatment

▪ monitor vital signs (BP) to determine fluid volume status
▪ monitor fluid and electrolytes
▪ monitor intake and output
▪ assess abdomen for bowel sounds, distention, flatus
▪ manage nasogastric (NG) tube
– monitor drainage
– ensure tube patency
– check tube placement
– irrigate tube as prescribed
▪ keep patient NPO
▪ provide frequent oral and nares care
▪ ambulate patient
▪ semi-fowler’s position
▪ administer medication for pain

Small Bowel Obstruction

▪ Nursing Interventions

malabsorption syndrome

the small intestine is unable to absorb nutrients

INCREASED
▪ fecal fat analysis (steatorrhea)

DECREASED
▪ MCV
▪ MCH
▪ MCHC

▪ hydrogen breath test
▪ lactose tolerance test
▪ Schilling test (B-12)

Malabsorption Syndrome

▪ Laboratory Tests

▪ weight loss
▪ bloating
▪ bruising
▪ + hydrogen breath test

Malabsorption Syndrome

▪ Signs & Symptoms

computed tomography (CT)

What diagnostic test is used to determine distention, abscess, or perforation?

▪ Severe pain that then stops and changes to tenderness on palpation
▪ Abdominal pain (often severe and diffuse)
▪ Severe abdominal cramping.
▪ Bloating.
▪ N/V
▪ A change in bowel movements or habits.
▪ Rectal bleeding.
▪ Fever (usually not immediately)
▪ Chills.

GI medical emergency: Perforation

▪ Signs & Symptoms

▪ Retinopathy
▪ Neuropathy
▪ Nephropathy

Microvascular complications of Diabetes

▪ Coronary artery disease
▪ Cerebrovascular disease
▪ Peripheral vascular disease
▪ Reduced immunity
All lead to morbidity and mortality

Macrovascular complications of Diabetes

Myxedema coma

nursing interventions: treat cardiac and respiratory issues

Flabby heart muscle & chambers increase in size= decreased cardiac output w/ decreased perfusion and gas exchange in the brain; results in organ failure.

life threatening emergency and serious complication of untreated or poorly treated hypothyroidism

HbA1c

average blood glucose level over the past 3 months

altered mental status

What is your first sign of hypoglycemia?

Increased Carcinoembryonic Antigen (CEA)

Which lab value confirms the diagnosis of colorectal cancer?

▪ Diet modification: reduce refined carbs, red meats, and fat. increase fiber
▪ Smoking cessation
▪ Alcohol cessation
▪ Fecal occult blood test every year
▪ Colonoscopy every 10 years, or double-contrast barium enema every 5 years after age 50.

Colorectal Cancer

▪ Patient Education

▪ age > 50
▪ diet (red meat, fat, refined carbs, low fiber)
▪ genetic predisposition
▪ family history (1st degree relative)
▪ Inflammatory Bowel Disease (Crohn’s or U.C.)

Colorectal Cancer

▪ Risk Factors

assess patency of the NG tube

Patient with NG tube is uncomfortable, what intervention would you do first?

abdominal x-ray

Gold standard to confirm placement of NG tubes

▪ Explain procedure
▪ Checking Placement
▪ Assessing patency
▪ Maintenance of NG tube

Steps of the NG tube process

islets of Langerhans (beta cells)

The region of the pancreas that is responsible for insulin production

Peritonitis

inflammation of the peritoneum (membrane lining the abdominal cavity and surrounding the organs within it)

▪ abdominal pain
▪ abdominal distention
▪ N/V
▪ fever
▪ rebound tenderness
▪ decreased urine output
▪ tachycardia
▪ hypotension
▪ diminished bowel sounds

Peritonitis

▪ Signs & Symptoms

Post-surgical
▪ Monitor the patient’s level of consciousness, vital signs, respiratory status (respiratory rate and breath sounds), and intake and output at least hourly immediately after abdominal surgery.
▪ Maintain the patient in a semi-Fowler’s position to promote drainage of peritoneal contents into the lower region of the abdominal cavity. This position also helps increase lung expansion.

▪ administer IV fluids
▪ administer antibiotics
▪ daily weight
▪ monitor vital signs
▪ monitor fluid & electrolytes
▪ manage nasogastric tube
▪ supplemental oxygen
▪ post-operative care
▪ NG tube
▪ antibiotics
▪ pain management
▪ surgical interventions: exploratory laparotomy, wound exploration

Peritonitis

▪ Nursing Interventions

flatus

How would you know a bowel obstruction is resolving?

▪ N/V
▪ abdominal pain
▪ abdominal distention
▪ decreased bowel sounds

Bowel Obstruction

▪ Signs & Symptoms

Wound ostomy continence nurse (WOCN)

a nurse specially educated to care for ostomy patients

peritonitis

▪ bacteria gains entrance into the peritoneum this way; infection comes next

If you do not treat appendicitis and it perforates, what is this called?

patient stops steroids suddenly

What are some causes of adrenal insufficiency (Addisonian Crisis)

Addisonian crisis

This is a life threatening acute adrenal insufficiency. The body needs more cortisol and aldosterone than it is able to supply.

▪ Dexamethasone 4-12 mg IV bolus

Addisonian Crisis

▪ Emergency Treatment

▪ cortisol replacement
▪ prednisone

Additionally, hydrocortisone sodium and dexamethasone

Addisonian Crisis

▪ Early Detection Treatment

AVOID:
▪ milk (it’s high in phosphate)

SHOULD EAT:
▪ green leafy vegetables

Hypoparathyroidism

▪ Food to avoid

▪ Metformin (Glucophage)
▪ Glyburide
▪ Pioglitazone
▪ Repaglinide
▪ Diet
▪ Exercise

Type II Diabetes

▪ Treatments (including medications)

▪ dietician
▪ diabetes educator
▪ cultural assessment
▪ interpreter

Type II Diabetes

▪ Multidimensional Care

Glucose is the main fuel for the CNS because the brain cannot produce or store glucose

Why is it important to keep glucose maintained?

loss of muscle tissue.
It can also result in Cushing’s syndrome (aka hypercortisolism), which can lead to: a fatty hump between your shoulders, etc. (think of Cushing’s S/S)

Side effects of long-term glucocorticoid use

Aging

hormone excess/deficiency or poor hormone-receptor interactions resulting in decreased responsiveness of the target tissue

What are contributing factors to endocrine changes?

▪ diuretic and hydration therapy to help reduce serum calcium levels. Ex: LASIX
▪ Monitor for: tingling/numbness in extremities, cardiac function during rehydration
▪ Pt high risk for fractures

Hyperparathyroidism

▪ Treatments

▪ Laxatives are products that help people to poop by causing bowel movements.
▪ Stool softeners are a type of laxative that works by drawing water into the stool, making it softer and more comfortable to pass.

Answer: Stool softeners, such as docusate sodium (Colace)

What is the difference between a laxative and a stool softener?
Which one should a healthcare provider prescribe before and after surgery?

sources;
https://www.gcu.edu/
https://yaveni.com/
https://www.rasmussen.edu/