Exam 2: NSG123/ NSG 123 (Latest 2024/ 2025 Update) Med Surg 1| Guide with Questions and Verified Answers| 100% Correct- Herzing
Exam 2: NSG123/ NSG 123 (Latest 2024/
2025 Update) Med Surg 1| Guide with
Questions and Verified Answers| 100%
Correct- Herzing
Q: What is an abdominal x-ray used for?
Answer:
Useful for determining the cause of symptoms. Free air in the peritoneum and bowel dilation or
obstruction should be excluded as a source of the presenting symptoms.
Q: Ulcerative Colitis Assessment Findings
Answer:
The stool is positive for blood
Laboratory test results reveal low hematocrit and hemoglobin levels, elevated white blood cell
count, low albumin levels, and an electrolyte imbalance. C-reactive protein levels are elevated.
Elevated antineutrophil cytoplasmic antibody levels are common. Careful stool examination for
parasites and other microbes is performed to rule out dysentery caused by common intestinal
organisms, especially Entamoeba histolytica, C. difficile and Campylobacter, Salmonella,
Shigella, and Cryptospora species.
Q: Crohn’s Disease Assessment Findings
Answer:
A CBC is performed to assess hematocrit and hemoglobin levels (which may be decreased) as
well as the white blood cell count (may be elevated). The erythrocyte sedimentation rate (ESR) is
usually elevated. Albumin and protein levels may be decreased, indicating malnutrition.
Q: Definite Diagnostic Study for Ulcerative Colitis
Answer:
Colonoscopy
Q: What is an abdominal MRI used for?
Answer:
It is highly sensitive and specific in terms of identifying pelvic and perianal abscesses and
fistulae.
Q: What surgery can cure Ulcerative Colitis?
Answer:
Proctocolectomy (removal of colon and rectum)
Q: Describe a Strictureplasty
Answer:
Blocked or narrowed sections of the small intestine are widened, leaving the intestines intact.
Q: Describe an Intestinal Transplant
Answer:
A newer surgical procedure developed for patients with severe Crohn’s disease is intestinal
transplant. This technique is now available to children and to young and middle-aged adults who
have lost intestinal function from disease. It may provide improvement in quality of life for some
patients.
Q: Describe a Total Colectomy
Answer:
Excision of the entire colon
Q: S/S of Perforation
Answer:
Acute increase in abdominal pain
Rigid abdomen
Vomiting
Hypotension
Q: S/S of Toxic Megacolon
Answer:
Abdominal distention
Decreased or absent bowel sounds
Change in mental status
Fever
Tachycardia
Hypotension
Dehydration
Electrolyte imbalances
Q: Patient teaching about diet for IBD
Answer:
There are no universal food triggers for IBD, but some may find that certain foods cause
diarrhea.
A food diary helps to identify problem foods to avoid.
Because many patients with IBD are lactose intolerant, avoiding milk and milk products
improves symptoms. Lactose-intolerant patients can use yogurt as a substitute.
High-fat foods, cold foods, and high-fiber foods may trigger diarrhea.
Q: Nursing Interventions for a Patient with IBD
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Manifestations of Crohn’s Disease Insidious onsetPeriods of remission and exacerbationProminent right lower quadrant abdominal pain (crampy)Diarrhea unrelieved by defecation Abdominal tenderness and spasmCrampy pain occurs after mealsPatient tends to limit food intake leading to weight loss, malnutrition, severe diarrhea, and secondary anemia
What part of the GI tract does Crohn’s Disease affect? The whole GI tract from mouth to anus to small/large intestine
Manifestations of Ulcerative Colitis Periods of remission and exacerbationAbdominal crampsDiarrhea, with passage of mucus, pus, or blood (due to ulcers)Left lower quadrant abdominal painIntermittent tenesmus.The patient may have anorexia, weight loss, fever, vomiting, and dehydration, cramping, tenesmus, and the passage of 6+ liquid stools each day.
Manifestations of Cholecystitis Pain, tenderness, and rigidity of the upper right abdomen that may radiate to the mid-sternal area or right shoulder and is associated with nausea, vomiting, and the usual signs of an acute inflammation.
What is the Definite Diagnostic Study for Crohn’s Disease? CT Scan
What is an abdominal x-ray used for? Useful for determining the cause of symptoms. Free air in the peritoneum and bowel dilation or obstruction should be excluded as a source of the presenting symptoms.
Ulcerative Colitis Assessment Findings The stool is positive for bloodLaboratory test results reveal low hematocrit and hemoglobin levels, elevated white blood cell count, low albumin levels, and an electrolyte imbalance. C-reactive protein levels are elevated. Elevated antineutrophil cytoplasmic antibody levels are common. Careful stool examination for parasites and other microbes is performed to rule out dysentery caused by common intestinal organisms, especially Entamoeba histolytica, C. difficile and Campylobacter, Salmonella, Shigella, and Cryptospora species.
Crohn’s Disease Assessment Findings A CBC is performed to assess hematocrit and hemoglobin levels (which may be decreased) as well as the white blood cell count (may be elevated). The erythrocyte sedimentation rate (ESR) is usually elevated. Albumin and protein levels may be decreased, indicating malnutrition.
Definite Diagnostic Study for Ulcerative Colitis Colonoscopy
What is an abdominal MRI used for? It is highly sensitive and specific in terms of identifying pelvic and perianal abscesses and fistulae.
What surgery can cure Ulcerative Colitis? Proctocolectomy (removal of colon and rectum)
Describe a Strictureplasty Blocked or narrowed sections of the small intestine are widened, leaving the intestines intact.
Describe an Intestinal Transplant A newer surgical procedure developed for patients with severe Crohn’s disease is intestinal transplant. This technique is now available to children and to young and middle-aged adults who have lost intestinal function from disease. It may provide improvement in quality of life for some patients.
Describe a Total Colectomy Excision of the entire colon
S/S of Perforation Acute increase in abdominal painRigid abdomenVomitingHypotension
S/S of Toxic Megacolon Abdominal distentionDecreased or absent bowel soundsChange in mental statusFeverTachycardiaHypotensionDehydrationElectrolyte imbalances
Patient teaching about diet for IBD There are no universal food triggers for IBD, but some may find that certain foods cause diarrhea.A food diary helps to identify problem foods to avoid.Because many patients with IBD are lactose intolerant, avoiding milk and milk products improves symptoms. Lactose-intolerant patients can use yogurt as a substitute.High-fat foods, cold foods, and high-fiber foods may trigger diarrhea.
Nursing Interventions for a Patient with IBD · Maintaining normal elimination patterns· Relieving pain· Maintaining optimal nutrition· Promoting rest· Reducing anxiety· Enhancing coping measures· Preventing skin breakdown· Monitoring and managing potential complications· Promoting home, community-based, and transitional care
Assessments for Patients on PN for CD With parenteral nutrition, the nurse maintains an accurate record of fluid I&O as well as the daily weight. The patient should gain 0.5 kg (1.1 lb) daily during parenteral nutrition therapy. Because parenteral nutrition is very high in glucose and can cause hyperglycemia, blood glucose levels are monitored every 6 hours.
What medication is used for severe IBD? Oral Corticosteroids – First Line Treatment Medication
When would anti-peristaltic medications be used in IBD? Sedatives, antidiarrheal, anti-peristaltic medications are used to minimize peristalsis in order to rest the inflamed bowel. They are continued until the patient’s stools approach normal frequency and consistency.
When would antibiotics be used in IBD? Antibiotics (e.g., metronidazole [Flagyl]) are used for complications such as abscesses or fistula formation.
Barrett’s Esophagus: Definition A condition in which the lining of the esophageal mucosa is altered and occurs in association with GERD.
Barrett’s Esophagus: What can Develop as a Result Long Term? Reflux eventually causes changes in the cells lining the lower esophagus. The cells that are laid to cover the exposed area no longer form the normal, squamous mucosa, but instead form columnar-lined epithelium that resembles the intestines. BE is the only known precursor to esophageal adenocarcinoma (EAC).
Definition of GERD A fairly common disorder marked by back flow 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.
Management of GERD and What should the Patient Avoid Management begins with educating the patient to avoid situations that decrease lower esophageal sphincter pressure or cause esophageal irritation. The patient is instructed to eat a low-fat diet; avoid caffeine, tobacco, beer, milk, foods containing peppermint or spearmint, and carbonated beverages; avoid eating or drinking 2 hours before bedtime; maintain normal body weight; avoid tight-fitting clothes; and elevate the head of the bed by at least 30 degrees
Nursing Interventions that Patient can do to Reduce GERD Symptoms · Encouraging adequate nutritional intake· Decreasing risk of aspiration· Relieving pain· Providing patient education· Promoting home, community-based, and transitional care
What medication requires a serum lab value check before administering? Magnesium hydroxide/aluminum hydrate (MAALOX) to avoid hypermagnesemia
H2RA/Antacid (PPIs): Indications, Side Effects, and Action H2RA-Indications: Ulcers-SE: Loss of protective flora and an increased risk of infection, esp C. diff-Action: decrease gastric acid productionAntacid (PPIs)-Indications: Ulcers-SE: Loss of protective flora and an increased risk of infection, esp C. diff.May increase risk of hip fractures and interfere with some vitamin and mineral absorption (B12, iron, Mg).-Action: decrease gastric acid production
Populations at High Risk for Obesity African Americans of both genders have the highest risk of obesity. Hispanic women have the next highest risk followed by white female Americans and lastly Asian females
BMI Values <18.5 = Underweight18.5-24.9 = Normal 25-29.9 = Overweight30-34.9 = Obesity class 135-39.9 = Obesity class 2>40 = Obesity class 3 (extreme/severe obesity)
Plan for Obese Patients A patient with obesity should be counseled to plan a caloric deficit of between 500 and 1000 calories daily from baseline, in order to achieve a 5% to 10% reduction in weight within about 6 months. This can be achieved through increasing physical activity and decreasing caloric dietary intake.Assess patient willingness and readiness to make changes.
What is Vagal Blocking Therapy? Vagal blocking therapy involves placement of a pacemaker-like device (vBloc™) into the subcutaneous tissue in the lateral thoracic cavity with two leads that are laparoscopically implanted at the point where the vagus nerve truncates, at the gastroesophageal junction. This suppresses the hunger sensation.(Minimally Invasive)
What is Intragastric Balloon Therapy? Intragastric balloon therapy involves endoscopic placement of a saline-filled balloon (ORBERA™) or a saline-filled dual balloon (ReShape™) into the stomach.(Minimally Invasive)
Three Surgical Options for Bariatric SurgeryAre they Restrictive or Malabsorptive procedures? Roux-en-Y gastric bypass (RYGB): restrictive and malabsorptiveGastric banding: restrictiveSleeve gastrectomy: restrictiveThese procedures may be performed by laparoscopy or by an open surgical technique
Dietary Teaching after Bariatric Surgery:-Meal Size?-Meal Frequency?-Main Consumption?-How to Prevent Dumping Syndrome?-When to Drink Fluids? Eat smaller but more frequent (6-8/day) meals that contain protein and fiber. Each meal size should not exceed 1 cup.Eat foods high in nutrients (peanut butter, cheese, chicken, fish, beans)Assume a low Fowler position during mealtime and then remain in that position for 20-30 minutes after mealtime—this delays stomach emptying and decreases the likelihood of dumping syndrome.Do not drink fluid with meals; instead, consume fluids up to 30 minutes before a meal and 30-60 minutes after mealtime.
Dumping Syndrome: Definition, Cause, and S/S? Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that commonly occurs in patients who have had bariatric surgery. Symptoms of dumping syndrome typically occur 15 minutes to 2 hours after eating and include tachycardia, dizziness, sweating, nausea, vomiting, bloating, abdominal cramping, and diarrhea.
Medication Therapy for Severe Obesity Noradrenergic Sympathomimetic Anorexiants are adrenergic drugs that stimulate the release of norepinephrine and dopamine in the brain. This action in nerve terminals of the hypothalamic feeding center suppresses appetite. FDA approved for short-term use for weight loss, these agents include benzphetamine (Schedule III), diethylpropion (Schedule IV), phendimetrazine (Schedule III), and phentermine (Schedule IV). Phentermine, the most frequently prescribed noradrenergic sympathomimetic anorexiant, is the prototype.
Teaching to help ensure the patient will lose weight Need to implement lifestyle changes along with medication regimen to have successful weight loss.
Gastric Lipase Inhibitor (Orlistat) Mechanism of Action Diminishes intestinal absorption and metabolism of fats, particularly triglycerides
Selective Serotonergic 5-HT2C Receptor Agonist (Locaserin) Mechanism of Action Stimulates central 5-HT2C receptors, causing appetite suppression
GLP-1 Receptor Agonist (Liraglutide) Mechanism of Action Mimics the effects of incretins, resulting in delayed gastric emptying, thus curbing appetite
Which weight loss drug requires a fat soluble vitamin (ADEK) supplement? Orlistat (Xenical) is a lipase inhibitor which diminishes intestinal absorption and metabolism of fats. Clients taking orlistat should take a multivitamin containing fat-soluble vitamins (A, D, E, and K) daily, at least 2 hours before or after taking orlistat. Orlistat prevents absorption of fat-soluble vitamins from food or multivitamin preparations if taken at the same time.
Patient Teaching for Phentermine SE – palpitations and tachycardia, tremors, hypertension, dizziness, insomnia, diarrhea or constipation, mouth dryness, restlessness, alterations in tasteConsiderations – only FDA approved for no more than 12 weeks. Contraindications include heart disease, uncontrolled hypertension, hyperthyroidism, and glaucoma. Caution patients to not drink alcohol.
Patient Teaching for Liraglutide SE – nausea, diarrhea or constipation, headache, tachycardiaConsiderations – must be given subq every day in the abdomen, thigh, or upper arm. Dosages increase weekly until week 5. Discontinue in patients who expressed suicidal ideations. May be associated with pancreatitis.
Patient Teaching for Orlistat SE – diarrhea, flatus, oily stools, fecal incontinenceConsiderations – may have problem with malabsorption, take daily multivitamin. Caution in patients with renal insufficiency, liver disease, or gallbladder disease. Do not administer with cyclosporin.
Patient Teaching for Lorcaserin SE – dizziness, fatigue, nausea, headaches, cough, dry mouth, constipationConsiderations – can be associated with deficits in attention or memory. Can cause hypoglycemia. Patients taking antidepressants or migraine medications can have synergistic effects. Discontinue in patients who express suicidal ideations. Serotonin syndrome may develop.
Definition of Constipation Fewer than three bowel movements weekly or bowel movements that are hard, dry, small, or difficult to pass.
Clinical Manifestations of Constipation Fewer than three bowel movements per week, abdominal distention, pain and bloating, a sensation of incomplete evacuation, straining at stool, and the elimination of small-volume, lumpy, hard, dry stools.
Complications Arising from Constipation and Clinical Manifestations of each Fecal impaction, which may lead to fecal incontinence, hemorrhoids (dilated portions of anal veins), anal fissures (tearing the lining of the anal canal causing ulceration), rectal prolapse, and megacolon.Steatorrhea: fatty stoolTenesmus: the feeling that you need to pass stool even though your bowels are empty
How to Prevent Constipation ExerciseBowel habit trainingIncreased fiber and fluid intakeJudicious use of laxativesAvoid holding BMDon’t need to have a BM every day
Complications of Diarrhea Dehydration and electrolyte imbalance (esp K+)
How would you assess a patient with suspected C. diff? The possibility of C. difficile infection should be considered in all patients with unexplained diarrhea who are taking or have recently taken antibiotics.
What precautions are put in place for a patient with C. diff? Contact Precautions (gown and gloves)
What can cause chronic diarrhea? How long does it last? Chronic diarrhea persists for more than 4 weeks and may return sporadically. Chronic diarrhea may be caused by adverse effects of chemotherapy.
What can cause persistent diarrhea? How long does it last? Persistent diarrhea typically lasts between 2 and 4 weeks. Acute and persistent diarrheas are frequently caused by viral infections (e.g., Norwalk virus). In addition, some drugs can cause acute or persistent diarrhea, including some antibiotics (e.g., erythromycin) and magnesium-containing antacids (e.g., magnesium hydroxide [Milk of Magnesia]).
What tests should be performed when the cause of the diarrhea is not obvious? Complete blood cell count (CBC)Serum chemistriesUrinalysisRoutine stool examinationStool examinations for infectious or parasitic organisms, bacterial toxins, blood, fat, electrolytes, and white blood cellsEndoscopy or barium enema may assist in identifying the cause.
Bulk Forming, Stimulant, and Osmotic Laxative Examples and Mechanism of Action Bulk forming: methylcellulose (Citrucel), psyllium (Metamucil), wheat dextrin (Benefiber). Polysaccharides, cellulose, and wheat derivatives mix with intestinal fluids, swell, and stimulate peristalsisStimulant: Bisacodyl (Dulcolax), senna (Senokot). Irritates the colonic epithelium by stimulating sensory nerve endings and increasing mucosal secretions and decreasing large intestinal water absorption. Action occurs within 6 to 8 hours.Osmotic: polyethylene glycol (PEG) and electrolytes (CoLyte, GoLYTELY). Stimulates chloride channels in the colonic mucosa, causing passive passage of sodium and fluid into the colon
Fecal softener example and who should use it Docusate is a fecal softener that can be used safely by clients who should avoid straining, like when having anal fissures.
Diphenoxylate with Atropine:Indication?How does it work?Side Effects?Contraindications? Used to treat moderate to severe diarrhea.It works by slowing peristalsis by acting on the smooth muscles in the intestine.Severe constipation, stomach pain, worsening diarrhea, fever, flushing, hallucinations, seizuresContraindicated in children under 2, patients with severe electrolyte imbalances, and patients with diarrhea associated with organisms that penetrate intestinal mucosa.
What do you give to treat travelers diarrhea? Bismuth Salts-pepto bismol
What is the nurse’s priority assessment on a patient with diarrhea? Figure out the cause of the diarrhea first before treating it with Imodium
A patient is experiencing diarrhea secondary to ulcerative colitis. Do you treat it? No, their body is flushing out the infection
What medications are appropriate for patients who have diarrhea associated with CD or surgical incision of the ileum? Cholestyramine (Questran) and colestipol (Colestid) are useful in treating diarrhea due to bile salt accumulation in conditions such as Crohn’s disease or surgical excision of the ileum.
What medications are appropriate for enzyme deficient diarrhea? In diarrhea caused by enzyme deficiency, pancreatic enzymes are given rather than antidiarrheal drugs. Practitioners recommend pancreatin or pancrelipase (Viokase, Pancrease, Cotazym) when a deficiency of pancreatic enzymes results in malabsorption of nutrients and steatorrhea.
Nursing Management for a patient with a Small Bowel Obstruction Maintaining the function of the NG tube, assessing and measuring the NG output, assessing for fluid and electrolyte imbalance, monitoring nutritional status, and 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).
Peritonitis Complications Decrease in circulatory volume and hypovolemic shockSeverely decreased circulatory volume can result in insufficient perfusion of the kidneys, leading to acute kidney injury with impaired fluid and electrolyte balance
Biggest complication of an untreated appendix infection Peritonitis
Large Bowel Obstruction S/S Differs clinically from small bowel obstruction in that the symptoms develop and progress relatively slowly. In patients with obstruction in the sigmoid colon or the rectum, constipation may be the only symptom for weeks. The shape of the stool is altered as it passes the obstruction that is gradually increasing in size. Blood loss in the stool may result in iron deficiency anemia. The patient may experience weakness, weight loss, and anorexia. Eventually, the abdomen becomes markedly distended, loops of large bowel become visibly outlined through the abdominal wall, and the patient has crampy lower abdominal pain.
A patient needs to receive enteric feeding. What type of tube should be placed? Dobhoff Tube
Why, when, and how much water flushed through an NG tube? To ensure patency and to decrease the chance of bacterial growth, sludge build-up, or occlusion of the tube, at least 30 mL of water is given in each of the following instances:-Before and after intermittent tube feeding and medication administration (with at least 5 mL of water in between each individual medication)-After checking for gastric residuals and gastric pH-Every 4 hours with continuous feedings-When the tube feeding is discontinued or interrupted for any reason-When the tube is not being used, where a minimum of once daily flushing is recommended
What types of tubes are used for short term? Any tubes through the nares
Feeding Tube used for a Long Period of Time A jejunostomy tube is placed for the purpose of administering nutrition, fluids, and medications and is indicated when the gastric route is not accessible, or to decrease aspiration risk when the stomach is not functioning adequately to process and empty food and fluids.
Administration Route of Parenteral Feeding Parenteral nutrition (PN) is a method of providing nutrients to the body by an IV route.
What do you give a patient receiving a TPN to prevent hypoglycemia? D5W or D10W
What testing would you expect to see from a patient receiving parenteral nutrition? Blood Glucose
At what temp should PN be administered? Room Temp
Nursing Assessment for TPN Blood glucose every 4 to 6 hours.Increased urine output = hypermetabolic = hypertonicity – Let pharmacy know to change contentObserve for weight gain and increased serum albumin
Adverse Reactions to TPN Usually attributed to the hypertonicity of the preparations: TachycardiaHypotensionDehydrationNauseaVomitingDiarrheaIncreased urine outputThe risk of aspiration is a consideration with tube feedings
Purpose of Adding Fat Emulsion (lipids) to TPN Fat emulsions (lipids) are usually given to clients receiving TPN to provide supplemental kilocalories and prevent fatty acid.Fat emulsions can also control hyperglycemia during periods of stress.
A patient has a NG tube placed and running suction. What lab should the nurse monitor? BMP – fluid and electrolytes
What are gallstones comprised of? Cholesterol (75%)Pigment (25%)
Causes of Cholelithiasis In gallstone-prone patients, there is decreased bile acid synthesis and increased cholesterol synthesis in the liver, resulting in bile supersaturated with cholesterol, which precipitates out of the bile to form stones. 2-4 times more common in women than men. Stone formation is more frequent in people who use oral contraceptives, estrogens, or clofibrate (Atromid-S); these medications are known to increase biliary cholesterol saturation
S/S of Cholelithiasis Gallstones may be silent, producing no pain and only mild GI symptoms. The symptoms may be acute or chronic. Epigastric distress, such as fullness, abdominal distention, and right upper quadrant abdominal pain or epigastric pain that radiates to the right shoulder especially after meals when the gallbladder is stimulated to release bile. Jaundice can occur.
Cholelithiasis Dietary Teaching The diet immediately after an episode is usually low-fat liquids. These can include powdered supplements high in protein and carbohydrate stirred into skim milk. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non-gas-forming vegetables, bread, coffee, or tea may be added as tolerated. The patient should avoid eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming vegetables, and alcohol. It is important to remind the patient that fatty foods may induce an episode of cholecystitis.
Medication Administered for Decreasing Gallstones Ursodeoxycholic acid (UDCA [Urso, Actigall]) and chenodeoxycholic acid (chenodiol or CDCA [Chenix]) have been used to dissolve small, radiolucent gallstones composed primarily of cholesterol. UDCA has fewer side effects than chenodiol and can be given in smaller doses to achieve the same effect.Six to 12 months of therapy is required in many patients to dissolve stones, and monitoring of the patient for recurrence of symptoms or the occurrence of side effects (e.g., GI symptoms, pruritus, headache) is required during this time. The effective dose of medication depends on body weight
GERD Risk Factors ObesityPregnancyHiatal herniaConnective tissue disordersDelayed stomach emptyingAcid Reflux Risk Factors:SmokingEating fatty or fried foodsDrinking coffee or alcoholEating large meals or eating late at nightMedications such as aspirin
What can GERD lead to? Esophageal stricture (narrowing)Esophageal ulcersBarrett’s Esophagus
Teaching for a patient after an open cholecystectomy Instructions and explanations are given before surgery about turning and deep breathing. Postoperative pneumonia and atelectasis can be avoided by deep-breathing exercises, frequent turning, and early ambulation. The patient should be informed that drainage tubes and a nasogastric tube and suction might be required during the immediate postoperative period if an open cholecystectomy is performed.
Education for T-tube use at home Usually, only a small amount of serosanguineous fluid drains in the initial 24 hours after surgery; afterward, the drain is removed.The drain is typically maintained if there is excess oozing or bile leakage.Empty the drainage bag attached at least every 8 hours and as needed, to prevent reflux back into the bile duct.Take showers not baths to prevent infection of the incision site.
Patient Education for after a Laparoscopic Cholecystectomy Provide patient education about managing postoperative pain and reporting signs and symptoms of intra-abdominal complications, including loss of appetite, vomiting, pain, distention of the abdomen, and temperature elevation.
Preoperative Assessment for Open Cholecystectomy Priority assessment should focus on the client’s respiratory status.If a traditional surgical approach is planned, the high abdominal incision required during surgery may interfere with full respiratory excursion.The nurse notes a history of smoking, previous respiratory problems, shallow respirations, a persistent or ineffective cough, and the presence of adventitious breath sounds.Avoid aspirin and NSAIDs – can alter coagulation
What baseline assessments should the nurse identify as possible risk factors for cholecystectomy surgery? Nutritional statusCBC BMP
Carbon Dioxide in Laparoscopic Cholecystectomy Carbon dioxide is used during the procedureExplain to the patient that they might feel pain in the right shoulder or scapular area (from migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure).
Laparoscopic Colecystectomy: 3 Things to do After 1) Recommend a heating pad for 15 to 20 minutes hourly2) Encourage the client to ambulate frequently to reduce the bloating3) Manage nausea, assess bowel sounds for further complications.
Postoperative Complications of Cholecystectomy The client is observed for indications of infection, leakage of bile into the peritoneal cavity, and obstruction of bile drainage.If bile is not draining properly, an obstruction is probably causing bile to be forced back into the liver and bloodstream.Because jaundice may result, the nurse should assess the color of the sclerae and skin.Clay-colored stool should be reported as this indicates a complication.
Duodenal vs. Gastric Ulcers S/S The patient with an ulcer complains of dull, gnawing pain or a burning sensation in the mid-epigastrium or the back. The pain associated with gastric ulcers most commonly occurs immediately after eating, whereas the pain associated with duodenal ulcers most commonly occurs 2 to 3 hours after meals. In addition, approximately 50% to 80% of patients with duodenal ulcers awake with pain during the night, whereas 30% to 40% of patients with gastric ulcers voice this type of complaint. Patients with duodenal ulcers are more likely to express relief of pain after eating or after taking an antacid than patients with gastric ulcers.
What disease does H. Pylori Cause? Peptic Ulcer Disease
Testing to Monitor Peptic Ulcer Disease Hemoglobin and hematocritTesting the stool for gross or occult bloodRecording hourly urinary output to detect anuria or oliguria (absence of or decreased urine production).
Dietary Recommendations for patients with Peptic Ulcer Disease These can be minimized by avoiding extremes of temperature in food and beverages and overstimulation from the consumption of alcohol, coffee (including decaffeinated coffee, which also stimulates acid secretion), and other caffeinated beverages. In addition, an effort is made to neutralize acid by eating three regular meals a day. Small, frequent feedings are not necessary as long as an antacid or an H2 blocker is taken. Diet compatibility becomes an individual matter: The patient eats foods that are tolerated and avoids those that produce pain.
What should patients with peptic ulcer disease avoid? Smoking decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum. Continued smoking is also associated with delayed healing of peptic ulcers. Therefore, the patient is encouraged to stop smoking.
Medications to Avoid with Peptic Ulcer Disease The patient should avoid aspirin and other NSAIDs as well as alcohol.
Medications administered to treat H. pylori Combination drug therapy that includes at least two antibiotics and an acid reducer (triple therapy), as well as occasionally bismuth subsalicylate, is recommended for patients with peptic ulcer disease who are known to be infected with H. pylori.In situations where the first-line therapy is ineffective, rescue H. pylori therapy with esomeprazole, moxifloxacin, and amoxicillin has been effective and well tolerated.
Medications administered to treat peptic ulcer disease and how long is the therapy needed Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton pump inhibitors, and sometimes bismuth salts that suppress or eradicate H. pylori. Recommended combination drug therapy is typically prescribed for 10 to 14 days and may include triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [AcipHex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton pump inhibitor and bismuth salts.
Medication that creates a protective barrier to heal peptic ulcers Sucralfate is effective even though it does not inhibit secretion of gastric acid or pepsin, and it has little neutralizing effect on gastric acid. Its mechanism of action is unclear, but it is thought to act locally on the gastric and duodenal mucosa. Possible mechanisms include binding to ulcer and forming a protective barrier between the mucosa and gastric acid, pepsin, and bile salts; neutralizing pepsin; stimulating prostaglandin synthesis in the mucosa; and exerting healing effects through the aluminum component.
Common assessment findings in patients with appendicitis and the difference between expected appendicitis findings and ruptured appendix findings Typical signs of appendicitis include low-grade fever, nausea and vomiting. Vague periumbilical pain (i.e., visceral pain that is dull and poorly localized) with anorexia progresses to right lower quadrant pain (i.e., parietal pain that is sharp, discrete, and well localized) and nausea in approximately 50% of patients with appendicitis. Local tenderness may be elicited at McBurney point when pressure is applied. Rebound tenderness (i.e., production or intensification of pain when pressure is released) may be present. Rovsing sign may be elicited by palpating the left lower quadrant; this paradoxically causes pain to be felt in the right lower quadrant.If the appendix has ruptured, the pain becomes consistent with peritonitis; abdominal distention develops as a result of paralytic ileus, and the patient’s condition worsens.
Plan of Care for a patient being admitted with appendicitis Goals include relieving pain, preventing fluid volume deficit, reducing anxiety, preventing or treating surgical site infection, preventing atelectasis, maintaining skin integrity, and attaining optimal nutrition.The nurse prepares the patient for surgery, which includes an IV infusion to replace fluid loss and promote adequate renal function, antibiotic therapy to prevent infection, and administration of analgesic agents for pain. An enema is not given because it can lead to perforation.After surgery, the nurse places the patient in a high Fowler position. This position reduces the tension on the incision and abdominal organs, helping to reduce pain. It also promotes thoracic expansion, diminishing the work of breathing, and decreasing the likelihood of atelectasis. The patient is educated on the use of an incentive spirometer and encouraged to use it at least every 2 hours while awake. A parenteral opioid (e.g., morphine) is typically prescribed to relieve pain; this is switched to an oral agent when the patient is able to tolerate oral fluids and foods. Any patient who was dehydrated before surgery receives IV fluids. When tolerated, oral fluids are given. Food is provided as desired and tolerated on the day of surgery when bowel sounds are present. The nurse auscultates for the return of bowel sounds and queries the patient for passing of flatus. Urine output is monitored to ensure that the patient is not hampered by postoperative urinary retention and to ensure that hydration status is adequate. The patient is encouraged to ambulate the day of surgery to reduce risks of atelectasis and venous thromboemboli (VTE) formation.
Peritonitis S/S The early clinical manifestations of peritonitis frequently are the signs and symptoms of the disorder causing the condition (e.g., manifestations of infection). At first, pain is diffuse but then becomes constant, localized, and more intense over the site of the pathologic process (site of maximal peritoneal irritation). Movement usually aggravates it. The affected area of the abdomen becomes extremely tender and distended, and the muscles become rigid. Rebound tenderness may be present. Usually, anorexia, nausea, and vomiting occur and peristalsis is diminished, followed by paralytic ileus. An initial temperature of 37.8° to 38.3°C (100° to 101°F) can be expected, along with an increased pulse rate. With progression of the condition, patients may become hypotensive. Without swift and decisive intervention, clinical manifestations will mirror those of sepsis and septic shock.
Diverticulitis S/S Some patients may have mild signs and symptoms that include bowel irregularity with intervals of alternating constipation and diarrhea, with nausea, anorexia, and bloating or abdominal distention.With diverticulitis, up to 70% of patients report an acute onset of mild to severe pain in the left lower quadrant. This may be accompanied by a change in bowel habits, most typically constipation, with nausea, fever, and leukocytosis. Acute complications of diverticulitis may include abscess formation, bleeding, and peritonitis