Exam 3: NSG233/ NSG 233 (New 2023/ 2024 Update) Med Surg 3 Exam| Questions and Verified Answers| 100% Correct| Graded A- Herzing
Exam 3: NSG233/ NSG 233 (New 2023/ 2024
Update) Med Surg 3 Exam| Questions and
Verified Answers| 100% Correct| Graded AHerzing
QUESTION
Post-op care after esophageal varices endoscopy:
Answer:
aspiration pneumonia
vagotomy syndrome
QUESTION
What to avoid if you have esophageal varies? SATA
Answer:
lifting heavy objects
trainig with stolling, sneezing, coughing, vomitng
irritating foods/fluids
reflux
alcohol intake
aspirin intake
QUESTION
Dallon tamponade therapy for esophageal varies:
Answer:
REMAIN bedside
- due to risk of displacement or threateningobstruction of the airway
QUESTION
What drug promotes motility after esophogeal resection:
Answer:
metoclopramide (monitor heart closely)
QUESTION
Esophageal resection interventions: SATA
Answer:
sit up in char
encourage incentive spirometry every hour
monitor temp q4hr
water cardiac for vagus nerve due to irriation
avoid ensure and boost
QUESTION
Pathophysiology of ascities:
Answer:
increase pressure in portal system with vasodilation causes fluid to leak from capillaries into
abdominal cavity
QUESTION
Symptoms of ascities:
Answer:
enlarged abdomen
distended abdominal veins
SOB
abd distention
(signs fo portal hypertension)
QUESTION
Dietary restriciton in ascities:
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Trouble shooting ventilator alarms: – can pause- NEVER turn off- check pt safety first- check alarm if pt is okay (not in distress)
Non-invasive postiive pressure ventiatlion type patients: COPD, chronic heart failure, sleep disordersPP during inspiration keeps airway and trachea open during sleep Signs of ventilator intolerance? restless, tachycardic Expected assessments when vented: ???? VAP ventilator bundle SATA: “elevate head 30-45″”sedation vacation””PPI prophylaxisDVT prophylaxisDaily oral care” Ventilator weaning criteria: vital capacity 10-15mL/kgMax inspiratory pressure (MIP) at least -20cm H2OTidal volume (TV): 7-9mL/kgMinute ventilation: 6L/minRapid/Shallow breathing index: below 100breaths/min/L: PaO2>60mm Hg w/ Fi)2 <40% Complications of mechanical ventilation: Alterations in cardiac functionBarotrauma/PneumothoraxPulmonary InfectionsDelirium Plan of care for vented trach patients: care every 8hr or more as neededtrach cuff pressure 20-25mm Hgassist of 2 ppl w/ trach strapobdurator @ bedside all times (keeps hole open) Chest tube intervention for accdiental disconnection from drainage system: Air can enter pleural space, producing a pneumothorax- prevent by immersion of chest tube in sterile water will temporarily reestablish a water seal and prevent collape or restore lung function Excessive bubbling in the water seal compartment of the chest tube: leak in drainage system Normal water level in chest drainage system 20cm level Steps to chest tube insertion: 1. Insertion of chest tube = consent needed before action taken2. discuss the procedure with the patient3. provide pain medication, the procedure is not pleasant4. gather all supplies needed to assist with procedure5. assist the client into position-supine High frequency oscilator support ventilor- understanding of: delievers rapid, small pulses of air down the center of the airways to open up alveoli allowing alveolar air to exit the lungs along the margins of the airways Effective coughing techniques after a thoracotomy: clear sounds after cough Assessment finding for pulmonary edema: pink frothy sputum What is propofol infusion syndrome? ????????????? Why pantoprazole when on a vent? ???????????????????? Post-op care after esophageal varices endoscopy: aspiration pneumoniavagotomy syndrome What to avoid if you have esophageal varies? SATA lifting heavy objectstrainig with stolling, sneezing, coughing, vomitngirritating foods/fluidsrefluxalcohol intakeaspirin intake Dallon tamponade therapy for esophageal varies: REMAIN bedside- due to risk of displacement or threateningobstruction of the airway What drug promotes motility after esophogeal resection: metoclopramide (monitor heart closely) Esophageal resection interventions: SATA sit up in charencourage incentive spirometry every hourmonitor temp q4hrwater cardiac for vagus nerve due to irriationavoid ensure and boost Pathophysiology of ascities: increase pressure in portal system with vasodilation causes fluid to leak from capillaries into abdominal cavity Symptoms of ascities: enlarged abdomendistended abdominal veinsSOBabd distention(signs fo portal hypertension) Dietary restriciton in ascities: low sodiumwatch salt for ammonia/potassiumdiuretic choice if diet not followed Purpose of lactulose in hepatic encephalopathy: increase stooling to help get out ammonia due to it causing the encephalopathy Assessment fidning that indicates ascities is getting worse: no weight loss Plan of care for portal hypertension/cirrhosis: SATA assess abd tympanic wavemonitor electrolytesweigh daily Heaptic encephalopathy- what do you assess: neuro assessmentpt confused, unkemptalterations in mood and sleep patterns Stages of Encephalopathy: 1. mild confusion, agitation, irritability, sleep disturbance, decreased affection2. lethargy, disorientation, inappropriate behavior, drowsiness3. somolent but arousable, slurred speech, confused, aggresisve4. coma Heaptic encephalopathy phenomenon: neuo psychiatric manifestation of hepatic failure associated with portal hypertension and shunting of blood from portal venous system into the systemic cirulation Paracentesis procedure: removal of fludi from peritoeal cavity through puncture with small surgical incision through abd wall under sterile conditions Role of low sodium albumin in paracentesis: prevents re-accumulation of fluid by increase blood volume. if colloid not used as well, kidneys will try to correct by absorbing sodium causing water retention
What is hepatocellular jaundice? mobility of damaged liver cells to clear billirubin from blood
A renal contusion nursing diagnosis: ineffective renal tissure perfusion
Modifiable bladder cancer risk: smoking tobacco
Stoma and appliance care for cutaneous urinary diversion for bladder cancer? SATA – monitor stomach for infection, irriation, decreased cirulation- take vit c- limit eggs, cheese, asparagus- shower in non-moisturizing soap
What is a ureterosigmoidostomy? continent diversion procedure in which urine is viserted into the rectum
“””disturbed body image”” bursing disgnosis goal:” are they acceptance of it, get pt to talk and verabilize about it
Pre-procedure instructions for intravesical chemotherapy for bladder cancer? INSTILLS MEDICATIONS INTO BLADDER, HOLD SOLUTIONFOR 2 HOURS
Cachexic cancer patient- best solution for their eating food: let them choose
prostate cancer- reducing risks: reduce red meat or dietary produces high in fat
Gleason score of 3 follow up with prostate cancer? external beam radiation therapy need for grade 3
Dischage transurethral resection education: water s/s DVT (pain/redness lower extremeties)retrograde ejaculationheamturiabladder spasms
Goserelin (Zoladex) hormone replacement treatment education: increase blood glucoseincrease risk myocardial infactions** bone pain first week and bone density loss over time