What is irritable bowel syndrome usually called?
Answer:
Ulcerative Colitis or Crohn’s Disease
QUESTION
What is the etiology of chron’s disease and ulcerative colitis?
Answer:
unknown
most likely genetic
QUESTION
What does ulcerative colitis affect?
Answer:
affects large colon
progressing distally to proximally
QUESTION
What does chron’s disease affect?
Answer:
patchy involvement of small intestine
QUESTION
What do the abscesses from ulcerative colitis lead to?
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<\/a>What is the function of the kidneys?
function to maintain volume and composition of body fluids by filtering blood<\/p>\n\n\n\n
What is urine?
What is it composed of?
waste product excreted by the kidneys.<\/p>\n\n\n\n
Composed of nitrous wastes, inorganic salts and water.<\/p>\n\n\n\n
What is the function of the urinary system?
rids the body of waste products<\/p>\n\n\n\n
What is the function of ureters?
2 tubes (one from each kidney) that carry the urine from the kidneys to the bladder<\/p>\n\n\n\n
What type of muscle is the bladder made up of?
smooth muscle<\/p>\n\n\n\n
How many layers of muscles does the bladder have? What are they known as?
Composed of 3 layers of muscles known as detrusor muscles<\/p>\n\n\n\n
When does the urge to void come about?
When bladder pressure increases enough to stimulate the stretch receptor – urge to void occurs<\/p>\n\n\n\n
What is the urethra?
Does the male or female have a longer urethra?
What does that mean?
Tube that carries urine from the bladder to the exterior of the body<\/p>\n\n\n\n
male<\/p>\n\n\n\n
the male is at a decreased risk for developing a UTI<\/p>\n\n\n\n
What is the nephron?
the functional unit of the kidney<\/p>\n\n\n\n
How many mL of urine\/min does the kidney produce normally?
1 mL\/min<\/p>\n\n\n\n
What is the minimum amount of urine production for an hour?
30 mL\/hour<\/p>\n\n\n\n
Where are water, electrolytes, glucose, and protein reabsorbed within the kidney?
proximal tubule<\/p>\n\n\n\n
Where are sodium and chloride reabsorbed within the kidney?
loop of henly<\/p>\n\n\n\n
How does urine move from the kidneys through the ureters into the bladder?
by peristaltic waves<\/p>\n\n\n\n
How many mL of urine are usually in the bladder of an adult when they feel the urge to urinate?
200-300 mL<\/p>\n\n\n\n
What is micturation?
urinating<\/p>\n\n\n\n
What are the geriatric considerations of the urinary system?
-decreased ability of kidney to concentrate<\/p>\n\n\n\n
-decreased size and elasticity of bladder<\/p>\n\n\n\n
-decreased muscle tone, contractility, and stasis
-increased urgency and frequency
-nocturia
-incomplete emptying<\/p>\n\n\n\n
-increase in a chance of UTI’s<\/p>\n\n\n\n
-possible change in cognition and mobility which results in an increase of incontinence issues<\/p>\n\n\n\n
What is the pH range of urine?
What is the average pH?
4.5-8.0<\/p>\n\n\n\n
6.0<\/p>\n\n\n\n
What foods make the urine more acidic?
foods high in protein, meds, cranberry juice, meat<\/p>\n\n\n\n
What foods make the urine more alkaline?
What other characteristic makes the urine more alkaline?
standing around, dairy products, citrus fruits, meds<\/p>\n\n\n\n
What is the normal specific gravity of urine?
1.010-1.025<\/p>\n\n\n\n
What is the specific gravity of urine when it is more dilute?
lower than 1.010<\/p>\n\n\n\n
What is the specific gravity of urine when it is more concentrated?
higher than 1.025<\/p>\n\n\n\n
What are the normal constitutes of urine?
Normally composed of urea, creatinine, pigments, Sodium, Potassium, Calcium<\/p>\n\n\n\n
What is likely the cause of fruity smelling urine?
keytones= uncontrolled diabetes<\/p>\n\n\n\n
What is likely the cause of musty smelling urine?
liver disease<\/p>\n\n\n\n
What are the 13 factors that affect voiding?
Food\/fluid intake + loss<\/p>\n\n\n\n
Developmental factors<\/p>\n\n\n\n
Older adults – loss of muscle control<\/p>\n\n\n\n
Retention\/incontinence<\/p>\n\n\n\n
Activity\/Muscle tone<\/p>\n\n\n\n
Stress<\/p>\n\n\n\n
UTI<\/p>\n\n\n\n
Medications (diuretics)<\/p>\n\n\n\n
Prostate issues<\/p>\n\n\n\n
Kidney stones<\/p>\n\n\n\n
Neurological conditions<\/p>\n\n\n\n
Spinal cord injury<\/p>\n\n\n\n
Job\/Lifestyle<\/p>\n\n\n\n
Which kidney is lower?
right kidney<\/p>\n\n\n\n
Which kidney is larger?
left kidney<\/p>\n\n\n\n
What needs to be done when a pt is on a 24 hour urine collection?
Discard first void<\/p>\n\n\n\n
All urine must be kept on ice or refrigerated<\/p>\n\n\n\n
Foley bags kept on ice and emptied regularly into a container that is kept on ice<\/p>\n\n\n\n
How do you get a sterile urine specimen?
straight catherization or indwelling catheterization<\/p>\n\n\n\n
When a person has a urinalysis, what are the abnormal results?
Blood, pus, WBC, RBC, protein, glucose, bacteria, ketones<\/p>\n\n\n\n
What is the normal BUN level?
10-20 mg\/dL<\/p>\n\n\n\n
What causes BUN to increase? and why?
Kidney disease<\/p>\n\n\n\n
causes inadequate excretion of urea<\/p>\n\n\n\n
Many drugs elevate BUN (antibiotics, lasix)<\/p>\n\n\n\n
What causes BUN to decrease? and why?
Liver disease<\/p>\n\n\n\n
causes decreased synthesis of urea<\/p>\n\n\n\n
What is the normal serum creatinine?<\/p>\n\n\n\n
What do increased levels signify?
0.6-1.2 mg\/dL<\/p>\n\n\n\n
kidney impairment<\/p>\n\n\n\n
What is the BUN and creatinine ratio?<\/p>\n\n\n\n
What does it mean when both rise together?
20:1
when both rise together indicates kidney failure or disease<\/p>\n\n\n\n
What is anuria?
failure of kidney function; less than 100 mL\/24 hours<\/p>\n\n\n\n
What is dysuria?
difficult or painful urination<\/p>\n\n\n\n
What is enuresis?
involuntary urination; usually children at night<\/p>\n\n\n\n
What is glycosuria?
glucose in the urine<\/p>\n\n\n\n
What is hematuria?
blood in the urine<\/p>\n\n\n\n
What is nocturia?
urination at night<\/p>\n\n\n\n
What is oliguria?
decreased urine production; scant 100-400 mL\/24 hours<\/p>\n\n\n\n
What is polyuria?
excessive urination<\/p>\n\n\n\n
What is proteinuria?
protein in the urine<\/p>\n\n\n\n
What is pyuria?
pus in the urine<\/p>\n\n\n\n
What is urinary urgency?
need to suddenly void<\/p>\n\n\n\n
What is urinary retention?
unable to urinate; incomplete emptying of the bladder<\/p>\n\n\n\n
What assessment findings would the nurse find if the patient has urinary retention?
Pt voids small amounts often<\/p>\n\n\n\n
firm distended bladder<\/p>\n\n\n\n
felling of fullness<\/p>\n\n\n\n
normal intake\/inadequate output<\/p>\n\n\n\n
What are some nursing interventions for urinary retention?
Straight cath or bladder scan to determine how much urine<\/p>\n\n\n\n
How do you treat urinary retention?
treat the underlying cause; remove obstruction<\/p>\n\n\n\n
What is incontinence?
inability to hold urine in the bladder; involuntary release; brain is not receiving impulse or loss of external sphincter control<\/p>\n\n\n\n
What does incontinence lead to?
impaired skin integrity<\/p>\n\n\n\n
infection<\/p>\n\n\n\n
rashes<\/p>\n\n\n\n
UTI<\/p>\n\n\n\n
social isolation<\/p>\n\n\n\n
depression<\/p>\n\n\n\n
increased risk for falls & injury<\/p>\n\n\n\n
What is functional incontinence?
Inability of a usually continent person to reach the toilet in time to avoid unintentional loss of urine<\/p>\n\n\n\n
What is overflow incontinence?
loss of urine in combination with distended bladder<\/p>\n\n\n\n
What is stress incontinence?
Involuntary loss of small amounts of urine with increased intra-abdominal pressure, in the absence of overactive bladder<\/p>\n\n\n\n
What is reflex incontinence?
due to neurological deficits (neuro signals to\/from the brain)<\/p>\n\n\n\n
What is urge incontinence?
Involuntary loss of larger amounts of urine accompanied by a strong urge to void<\/p>\n\n\n\n
What is total incontinence?
continuous loss of urine due to a fistula<\/p>\n\n\n\n
What are bladder irritants that may make you need to urinate more often?
alcohol<\/p>\n\n\n\n
nicotine<\/p>\n\n\n\n
artificial sweeteners<\/p>\n\n\n\n
citrus<\/p>\n\n\n\n
caffeine<\/p>\n\n\n\n
What are some nursing interventions related to urinary elimination?
-Maintain voiding habits
-Scheduling, positioning, privacy, comfort,
allow adequate time to void, assist with
hygiene<\/p>\n\n\n\n
-Promote fluid intake, at least 2,000 mL\/day<\/p>\n\n\n\n
-Strengthen muscle tone
-kegels 30-80\/day for 6 weeks<\/p>\n\n\n\n
-Stimulate urination
-sound of running water
-warm water over perineum, hands in warm
water, apply warm soaks over pubic area to
decrease muscle tension, sitz bath, apply
cold packs over abdomen to increase
muscle contraction<\/p>\n\n\n\n
-Relaxation: breathing, imagery<\/p>\n\n\n\n
-offer toileting frequently to decrease the risk of falls<\/p>\n\n\n\n
What are some nursing interventions for urinary incontinence?
-bladder training<\/p>\n\n\n\n
-external urinary device
-condom catheter<\/p>\n\n\n\n
-indwelling catheter
-LAST RESORT<\/p>\n\n\n\n
When a person has a condom catheter how often do you need to check on them?
What do you check?
q 2-4 hours<\/p>\n\n\n\n
Maintain skin integrity<\/p>\n\n\n\n
Tubing should be free from kinks\/twists to promote free urinary drainage<\/p>\n\n\n\n
Check for leakage from catheter itself<\/p>\n\n\n\n
Check under patient for leakage (wet sheets\/gown)<\/p>\n\n\n\n
How often do condom catheters need to be replaced?
q 24 hours<\/p>\n\n\n\n
If a pt has a condom catheter, how many inches do you need to leave between the top of the penis and the top of the catheter?
1-2 inches<\/p>\n\n\n\n
Why are catheters used?
Keep bladder deflated during surgery<\/p>\n\n\n\n
Measure residual urine
-PVR (post void residual) should be <50 mL<\/p>\n\n\n\n
Relieve retention<\/p>\n\n\n\n
Obtain sterile urine specimen<\/p>\n\n\n\n
How long can catheters stay in without needing a reason to justify a continuance?
48 hours<\/p>\n\n\n\n
What are the 9 causes for UTI’s?
Baths<\/p>\n\n\n\n
Tight clothes<\/p>\n\n\n\n
Nylon undergarments<\/p>\n\n\n\n
Using powders in perineal area<\/p>\n\n\n\n
Not urinating often enough<\/p>\n\n\n\n
Not drinking enough fluids<\/p>\n\n\n\n
Improper hygiene<\/p>\n\n\n\n
Factors that upset pH<\/p>\n\n\n\n
Catheters<\/p>\n\n\n\n
What decreases the chance of UTI’s?
maintaining a sterile technique<\/p>\n\n\n\n
doing catheter care at least once per shift, but more if perineal area is soiled<\/p>\n\n\n\n
What is cystitis?
Inflammation of bladder<\/p>\n\n\n\n
Most common UTI<\/p>\n\n\n\n
What are the symptoms of cystitis?
Dysuria<\/p>\n\n\n\n
Urinary frequency and urgency (urge to urinate frequently in small amts)<\/p>\n\n\n\n
Nocturia<\/p>\n\n\n\n
Hematuria<\/p>\n\n\n\n
What is pyelonephritis?
Inflammation of the renal pelvis and functional kidney tissue<\/p>\n\n\n\n
What is acute pyelonephritis caused by?
bacterical infection<\/p>\n\n\n\n
What is chronic pyelonephritis caused by?
Continued or repeated infections<\/p>\n\n\n\n
What is a common infection that causes pyelonephritis?
from reflux of infected urine into ureters & kidney<\/p>\n\n\n\n
What can pyelonephritis lead to if left untreated?
Can lead to renal failure if untreated<\/p>\n\n\n\n
Who is at risk for developing pyelonephritis?
Urinary catheter<\/p>\n\n\n\n
DM<\/p>\n\n\n\n
chronic stones<\/p>\n\n\n\n
immunosuppression<\/p>\n\n\n\n
recent history of cystitis<\/p>\n\n\n\n
What are the s\/s of pyelonephritis?
Fever\/Chills<\/p>\n\n\n\n
Flank\/Back pain<\/p>\n\n\n\n
Tenderness along Costoverterbral Angle<\/p>\n\n\n\n
General Malaise<\/p>\n\n\n\n
Urgency, Frequency, Burning<\/p>\n\n\n\n
Nocturia<\/p>\n\n\n\n
How is pyelonephritis diagnosed?
-urinalysis<\/p>\n\n\n\n
-urine C&S to identify the causative organism<\/p>\n\n\n\n
-WBC level (assess if it’s elevated)<\/p>\n\n\n\n
What is glomerulonephritis?
Inflammation of the kidney caused by immunological reaction (not infection) following a strep infection elsewhere<\/p>\n\n\n\n
What is the cause of acute glomerulonephritis?
Immunological complexes get trapped in the glomerulus resulting in swelling and capillary death<\/p>\n\n\n\n
Whats is the cause of chronic glomerulonephritis?
Does it have a history or no?
What results from chronic glomerulonephritis?
Is it a slow or fast onset?
Progressive destruction of glomeruli<\/p>\n\n\n\n
Occurs without previous hx<\/p>\n\n\n\n
3rd leading cause of End Stage Renal Disease<\/p>\n\n\n\n
Slow onset<\/p>\n\n\n\n
What would the nurse be assessing a patient with glomerulonephritis for?
Previous Group A beta-hemolytic strep infection<\/p>\n\n\n\n
Check for lesions or sources of infection<\/p>\n\n\n\n
Decreased urine output<\/p>\n\n\n\n
Red Blood Cells and casts (particles of cells, protein or fat) in urinalysis<\/p>\n\n\n\n
Smoky or coffee-colored urine (hematuria)<\/p>\n\n\n\n
Proteinuria<\/p>\n\n\n\n
Fluid volume overload symptoms<\/p>\n\n\n\n
What are the s\/s of fluid volume overload?
Increased respiratory rate<\/p>\n\n\n\n
shortness of breath<\/p>\n\n\n\n
crackles\/rales in lung fields<\/p>\n\n\n\n
Jugular vein distention<\/p>\n\n\n\n
Bounding, increased pulse<\/p>\n\n\n\n
Increased blood pressure<\/p>\n\n\n\n
Edema<\/p>\n\n\n\n
Weight increase<\/p>\n\n\n\n
What nursing care should be done for a patient with glomerulonephritis?
Monitor fluid volume status<\/p>\n\n\n\n
Monitor S\/S End Stage Renal Failure<\/p>\n\n\n\n
Fluid\/Sodium restriction<\/p>\n\n\n\n
Protein restriction
-Rationale: reduces nitrogen waste and can
slow the progression of renal failure.<\/p>\n\n\n\n
Monitor Blood Pressure and Pulse
-to detect fluid volume overload<\/p>\n\n\n\n
What are nursing interventions for a person with glomerulonephritis?
Treat underlying disorder<\/p>\n\n\n\n
Administer diuretics<\/p>\n\n\n\n
Administer antibiotics<\/p>\n\n\n\n
Typically no treatment or cure<\/p>\n\n\n\n
Plasmapheresis (removes damaging antibodies)<\/p>\n\n\n\n
What is nephrotic syndrome and what is it usually caused by?
Clinical manifestations arising from protein wasting caused by glomerular damage<\/p>\n\n\n\n
Not a primary disorder, but a result of another problem such as glomerulonephritis<\/p>\n\n\n\n
What is involved with nephrotic syndrome?
What are the s\/s of this?
Increased glomerular permeability
-Large molecules pass through the
membrane into the urine
-Proteinuria
-Severe edema, facial swelling
-Hypoalbuminemia<\/p>\n\n\n\n
How is nephrotic syndrome diagnosed?
kidney biopsy to identify the cause<\/p>\n\n\n\n
What is the most common cause of upper urinary tract obstruction?
urinary caliculi<\/p>\n\n\n\n
What is another name for renal caliculi?
nephrolithiasis<\/p>\n\n\n\n
What is a urinary tract stone called?
urolithiasis<\/p>\n\n\n\n
What is a ureter stone called?
ureterolithiasis<\/p>\n\n\n\n
What are the risks for urinary caliculi?
Family history<\/p>\n\n\n\n
dehydration<\/p>\n\n\n\n
excessive intake of calcium<\/p>\n\n\n\n
oxalate and proteins<\/p>\n\n\n\n
previous history of stone formation<\/p>\n\n\n\n
What is renal colic?
What are the s\/s?
acute, severe flank pain on the affected side develops when the stone obstructs the ureter, causing spasm<\/p>\n\n\n\n
N&V, pallor, cool, clammy skin<\/p>\n\n\n\n
What could the obstruction from a renal urinary caliculi lead to?<\/p>\n\n\n\n
What is hydronephrosis?
hydronephrosis<\/p>\n\n\n\n
Increased pressure and distention behind the obstruction, structures are damaged and could lead to loss of renal function and failure<\/p>\n\n\n\n
How do you dx urinary caliculi?
KUB xray
-kidney, ureter, and bladder<\/p>\n\n\n\n
Urinalysis-assess for hematuria, presence of WBCs and crystal fragments<\/p>\n\n\n\n
Chemical analysis of stones<\/p>\n\n\n\n
What are the preventative measures for urinary caliculi?
drink plenty of fluids: at least 3,000 mL\/day<\/p>\n\n\n\n
stay clear of soft drinks
-they contain phosphoric acid which is a
stone inducer<\/p>\n\n\n\n
stay clear of grapefruit juice<\/p>\n\n\n\n
drink and eat citirus products
-you have to stay clear of grapefruit juice if
that is a causative manner for that patient in
urinary calculi formation<\/p>\n\n\n\n
maintain a low oxalate diet<\/p>\n\n\n\n
ensure that the patient has an adequate amount of calcium in their diet
-calcium is needed to bind to the oxalate in
order to prevent stones<\/p>\n\n\n\n
What are 10 food examples that are high in oxalate?
beer<\/p>\n\n\n\n
chocolate milk<\/p>\n\n\n\n
hot cocoa<\/p>\n\n\n\n
tea<\/p>\n\n\n\n
nuts<\/p>\n\n\n\n
strawberries and other berries<\/p>\n\n\n\n
lemon peel, lime peel, and orange peel<\/p>\n\n\n\n
purple or concord grapes<\/p>\n\n\n\n
rhubarb<\/p>\n\n\n\n
wheat bran<\/p>\n\n\n\n
What are the treatment options for urinary caliculi? (8 things)
Analgesia, strain urine<\/p>\n\n\n\n
Special diet depending on stone composition<\/p>\n\n\n\n
Increase fluid intake up to 3L\/day to flush and prevent stone formation<\/p>\n\n\n\n
Allopurinol to lower uric acid levels<\/p>\n\n\n\n
Adrenergic blocker (Flomax) to encourage parasympathetic activity<\/p>\n\n\n\n
calcium channel blocker to relax ureteral muscle and promote passage of stone<\/p>\n\n\n\n
Lithotripsy- shock waves to crush stone<\/p>\n\n\n\n
Cystoscopy & ureteroscopy
-stent may be placed to dilate the ureter in
order to pass the stone<\/p>\n\n\n\n
What parts of the body make up the gastrointestinal system?
Mouth<\/p>\n\n\n\n
Pharynx and Esophagus
Stomach<\/p>\n\n\n\n
Small intestine<\/p>\n\n\n\n
Large intestine<\/p>\n\n\n\n
Ancillary organs: Pancreas, Liver, Gallbladder<\/p>\n\n\n\n
What are the three parts of the small intestine in order?
duodenum, jejunum, ileum<\/p>\n\n\n\n
What are all the components of the large intestine?
appendix, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anus<\/p>\n\n\n\n
What is the function of the esophagus?
How does it work?
transports food to the stomach<\/p>\n\n\n\n
Peristalsis muscles contract in a synchronized way to move the food in one direction<\/p>\n\n\n\n
What is the function of the stomach?
Secretes acid and enzymes that digest food into chyme<\/p>\n\n\n\n
What is the function of the duodenum?
Neutralizes stomach acid with the help of liver, gallbladder and pancreatic enzymes<\/p>\n\n\n\n
What is the function of the jejunum and ileum?
Main areas for absorption of folic acid, cobalamin, iron, fat-soluble vitamins, hormones, neurotransmitters, and absorption of fat<\/p>\n\n\n\n
What are the 4 functions of the large intestine?
Absorption of water and electrolytes; 80% of water is reabsorbed along the passage<\/p>\n\n\n\n
Forms feces<\/p>\n\n\n\n
Feces reservoir until defecation occurs<\/p>\n\n\n\n
Synthesizes Vitamin K and some B vitamins<\/p>\n\n\n\n
What is the function of the pancreas?
pancreatic enzymes aid in digestion of proteins<\/p>\n\n\n\n
What is the function of amylase?
changes starch to disaccharides<\/p>\n\n\n\n
What is lipase needed for?
fat digestion<\/p>\n\n\n\n
what is the liver and gallbladders function in the digestive system?
to produce bile to breakdown fats<\/p>\n\n\n\n
What is the word for painful swallowing?
odynophagia<\/p>\n\n\n\n
What is the word for difficulty swallowing?
dysphagia<\/p>\n\n\n\n
What is the medical term for indigestion?
dyspepsia<\/p>\n\n\n\n
What does the RUQ in the abdomen maintain?
liver, right kidney, gall bladder, colon, pancreas<\/p>\n\n\n\n
What does the LUQ in the abdomen maintain?
stomach, left kidney, spleen, colon, pancreas<\/p>\n\n\n\n
What does the RLQ in the abdomen maintain?
appendix, colon, small intestine, ureter, major vein and artery to right leg<\/p>\n\n\n\n
What does the LLQ in the abdomen maintain?
colon, small intestine, ureter, major vein and artery to left leg<\/p>\n\n\n\n
What does the midline of the abdomen maintain?
aorta, pancreas, small intestine, bladder, spine<\/p>\n\n\n\n
What does the color of feces come from?
comes from yellow bile that bacteria changes to brown<\/p>\n\n\n\n
What is the process of bowel elimination?
Fecal material reaches rectum<\/p>\n\n\n\n
Stretch receptors initiate contraction of sigmoid colon\/rectal muscles<\/p>\n\n\n\n
Internal anal sphincter relaxes<\/p>\n\n\n\n
Sensory impulses cause voluntary “bearing down”<\/p>\n\n\n\n
External sphincter relaxes<\/p>\n\n\n\n
What are the factors affecting bowel elimination? (14 things)
the pt’s developmental stage<\/p>\n\n\n\n
personal factors
-privacy
-taking the time to defecate<\/p>\n\n\n\n
Nutrition\/hydration
-fibrous foods throughout the day
-fluids, activity, supplements<\/p>\n\n\n\n
medications<\/p>\n\n\n\n
infection<\/p>\n\n\n\n
anesthesia<\/p>\n\n\n\n
stress<\/p>\n\n\n\n
surgery<\/p>\n\n\n\n
pregnancy<\/p>\n\n\n\n
spinal cord injury<\/p>\n\n\n\n
food allergies<\/p>\n\n\n\n
diverticulosis<\/p>\n\n\n\n
ileostomy<\/p>\n\n\n\n
colostomy<\/p>\n\n\n\n
What are 7 things that promote regular bowel defecation?
Provide privacy<\/p>\n\n\n\n
Correct position<\/p>\n\n\n\n
timing<\/p>\n\n\n\n
Encourage fluids throughout the day<\/p>\n\n\n\n
Proper diet throughout the day<\/p>\n\n\n\n
exercise<\/p>\n\n\n\n
bowel training<\/p>\n\n\n\n
What are the lab studies for feces?
Stool for occult blood (GI bleeds, colon cancer)<\/p>\n\n\n\n
Stool for fecal fat<\/p>\n\n\n\n
Stool for ova and parasites<\/p>\n\n\n\n
What is gastritis?
inflammation of the stomach lining<\/p>\n\n\n\n
What are the causes of gastritis?
H.pylori infection<\/p>\n\n\n\n
Diet (poor diet and\/or excessive spicy foods, citrus juices)<\/p>\n\n\n\n
Excessive intake: alcohol, aspirin, NSAIDs,
corticosteroids, coffee, caffeine<\/p>\n\n\n\n
Stress<\/p>\n\n\n\n
Smoking<\/p>\n\n\n\n
What are the s\/s of gastritis?
Pain<\/p>\n\n\n\n
Nausea and\/or vomiting and\/or dyspepsia (heartburn)<\/p>\n\n\n\n
Hematemesis and\/or melena<\/p>\n\n\n\n
Worsened by ingestion of food<\/p>\n\n\n\n
What can chronic gastritis lead to?
When chronic gastritis leads to that then what else may happen?
destruction of parietal cells and loss of intrinsic factor production which is needed for absorption of vitamin B12<\/p>\n\n\n\n
pernicious anemia<\/p>\n\n\n\n
What is peptic ulcer disease?
Ulceration in the protective barrier in the stomach and\/or duodenum and tissue is not protected from acid<\/p>\n\n\n\n
What are the main causes of peptic ulcer disease?
H.pylori infection<\/p>\n\n\n\n
Delayed gastric emptying<\/p>\n\n\n\n
what are the s\/s of peptic ulcer disease?
Pain occurs 90 minutes to 3 hours after eating; often wakens patient at night<\/p>\n\n\n\n
Nausea and\/or vomiting and\/or dyspepsia
(heartburn)<\/p>\n\n\n\n
Hematemesis and\/or melena<\/p>\n\n\n\n
Relieved by ingestion of food<\/p>\n\n\n\n
What may untreated peptic ulcer disease lead to?
perforation or peritonitis<\/p>\n\n\n\n
who is appendicitis most common in?
adolescents and young men<\/p>\n\n\n\n
What lab value is used to help dx appendicitis?
WBC<\/p>\n\n\n\n
Where does diverticular disease manifest itself?<\/p>\n\n\n\n
When do outpouchings form?
Small outpouchings of the colon, but not rectum<\/p>\n\n\n\n
Form when increased pressure causes herniations in colon wall<\/p>\n\n\n\n
What factors may lead to diverticular disease?
Possibly lack of fiber<\/p>\n\n\n\n
lack of activity & delaying defecation<\/p>\n\n\n\n
does diverticulosis usually have any symptoms?
typically no, but the one symptom that may present is bleeding<\/p>\n\n\n\n
What is diverticulitis?
What may this lead to?
Infection around diverticular sac<\/p>\n\n\n\n
Undigested food and bacteria may collect in the sac impairing blood supply leading to ischemia & possibly perforation<\/p>\n\n\n\n
What are the s\/s of diverticulitis?
are s\/s usually present?
usually no symptoms<\/p>\n\n\n\n
may have intermittent LLQ pain
constipation
inflammation
low grade temp
rectal bleeding<\/p>\n\n\n\n
What is the tx for diverticulitis?
Broad-spectrum antibiotics<\/p>\n\n\n\n
bowel rest<\/p>\n\n\n\n
surgical resection<\/p>\n\n\n\n
if ruptured<\/p>\n\n\n\n
Where is an intestinal obstruction most common?
in the small intestine<\/p>\n\n\n\n
What is a mechanical intestine obstruction?
conditions that cause a blockage<\/p>\n\n\n\n
What would you hear when you auscultate bowel sounds for a pt that has an intestinal obstruction?
Usually no bowel sounds or occasional splashing sound<\/p>\n\n\n\n
How is an intestinal obstruction treated?
decompression
surgery<\/p>\n\n\n\n
What is the common age group for colorectal cancer patients?
pts 50 and older<\/p>\n\n\n\n
How does colorectal cancer begin?
Begins as an adenomatous polyp (noncancerous growth)<\/p>\n\n\n\n
What risk factors put a pt at higher risk for colorectal cancer?
history of breast and\/or ovarian cancer<\/p>\n\n\n\n
Ulcerative Colitis<\/p>\n\n\n\n
Crohn’s Disease<\/p>\n\n\n\n
Polyps<\/p>\n\n\n\n
What are the s\/s of colon cancer? (2 things)
rectal bleeding<\/p>\n\n\n\n
changes in stool<\/p>\n\n\n\n
what is the treatment for colon cancer?
resection\/colostomy<\/p>\n\n\n\n
What are the s\/s of irritable bowel syndrome?
Abdominal pain<\/p>\n\n\n\n
bloating<\/p>\n\n\n\n
diarrhea and\/or constipation<\/p>\n\n\n\n
hyperactivity of GI tract<\/p>\n\n\n\n
LLQ abd pain<\/p>\n\n\n\n
stool – constipated, hard followed by softer diarrheal, watery with mucus<\/p>\n\n\n\n
What is the tx for irritable bowel syndrome?
diet changes<\/p>\n\n\n\n
increased fiber<\/p>\n\n\n\n
stress reduction<\/p>\n\n\n\n
bulk-forming laxatives for constipation<\/p>\n\n\n\n
antidiarrheal agents (Imodium) for diarrhea<\/p>\n\n\n\n
What is irritable bowel syndrome usually called?
Ulcerative Colitis or Crohn’s Disease<\/p>\n\n\n\n
What is the etiology of chron’s disease and ulcerative colitis?
unknown<\/p>\n\n\n\n
most likely genetic<\/p>\n\n\n\n
What does ulcerative colitis affect?
affects large colon<\/p>\n\n\n\n
progressing distally to proximally<\/p>\n\n\n\n
What does chron’s disease affect?
patchy involvement of small intestine<\/p>\n\n\n\n
What do the abscesses from ulcerative colitis lead to?
lead to necrosis & sloughing of bowel mucosa.<\/p>\n\n\n\n
Inflammation & edema further damages tissue<\/p>\n\n\n\n
Is ulcerative colitis cureable?
no<\/p>\n\n\n\n
what are the s\/s of ulcerative colitis?
Blood loss<\/p>\n\n\n\n
Anemia<\/p>\n\n\n\n
Fatigue<\/p>\n\n\n\n
Weight loss<\/p>\n\n\n\n
Generalized weakness<\/p>\n\n\n\n
Tachycardia<\/p>\n\n\n\n
Hypotension<\/p>\n\n\n\n
Pallor<\/p>\n\n\n\n
What is chron’s disease?
Inflammatory disorder affecting any portion of the GI tract<\/p>\n\n\n\n
What is the pathophysiology of chron’s disease?
transmural (whole thickness) inflammation causing thickening of the bowel wall, strictures and deep ulcerations<\/p>\n\n\n\n
What are the complications of chron’s disease?
Malabsorption & malnutrition may develop, obstruction, fistulas<\/p>\n\n\n\n
What is the treatment for chron’s disease?
Surgical resection<\/p>\n\n\n\n
How long does acute diarrhea last?
what is it usually caused by?
Less than 1 week<\/p>\n\n\n\n
Usually due to infectious agent<\/p>\n\n\n\n
How long does chronic diarrhea last?
what is it usually caused by?
greater than 3-4 weeks<\/p>\n\n\n\n
Lactose may do this if not broken down
Malabsorption
Endocrine disorders (hyperthyroidism)<\/p>\n\n\n\n
What are the nursing interventions for diarrhea management?
Evaluate each patient’s elimination pattern to their own “normal”<\/p>\n\n\n\n
Monitor stools to quantify diarrhea<\/p>\n\n\n\n
Assess and monitor for fluid and electrolyte imbalance<\/p>\n\n\n\n
monitor for fluid and electrolyte imbalance<\/p>\n\n\n\n
Monitor for alterations in perineal skin integrity<\/p>\n\n\n\n
proper dietary teaching
-BRAT diet is common (Bananas, rice,
applesauce, toast)
-increase fiber intake<\/p>\n\n\n\n
Antidiarrheal medications<\/p>\n\n\n\n
What is may be the cause of constipation?
Typically secondary to another disease\/condition<\/p>\n\n\n\n
May be due to tumor or obstruction<\/p>\n\n\n\n
Activity – Sedentary<\/p>\n\n\n\n
Dietary – Low fiber, inadequate fluids<\/p>\n\n\n\n
Drugs – Antacids with aluminum, narcotics,
anticholinergics, diuretics, antidepressants<\/p>\n\n\n\n
Psychogenic – Voluntary suppression of defecation<\/p>\n\n\n\n
Systemic – age, pregnancy, cerebral vascular accident, Parkinsonism<\/p>\n\n\n\n
What are the s\/s of constipation?
Abdominal distention & discomfort<\/p>\n\n\n\n
anorexia, fecal impaction (watery, foul-smelling liquid stool)<\/p>\n\n\n\n
diminished bowel sounds<\/p>\n\n\n\n
What is the treatment for constipation?
Hydration – increase water throughout the day, juice<\/p>\n\n\n\n
Stool softeners\/laxative<\/p>\n\n\n\n
Enema<\/p>\n\n\n\n
Increase mobility<\/p>\n\n\n\n
Increase fiber throughout the day<\/p>\n\n\n\n
Provide privacy<\/p>\n\n\n\n
Position to facilitate defecation<\/p>\n\n\n\n
What is the treatment for fecal impaction?
enemas<\/p>\n\n\n\n
manual\/digital removal (disimpacting)<\/p>\n\n\n\n
What are two sources of evidence for EBP?
Agency for Healthcare Research and Quality (AHRQ)<\/p>\n\n\n\n
The Cochrane Library<\/p>\n\n\n\n
What is EBP?
the integration of the best current evidence and practices to make decisions about patient care with the goal of achieving maximum health benefits for the patient<\/p>\n\n\n\n
What are organizations that are receiving funding from medicare or medicare obligated to be following?
Organizations receiving Medicare and\/or Medicaid funding are obligated to follow EBP<\/p>\n\n\n\n
What is the process of quality improvement?
Monitor outcomes, identify errors and develop solutions to change and improve care<\/p>\n\n\n\n
What is the DMAIC model and what is it for?
it is for quality improvement<\/p>\n\n\n\n
Define the issue or problem<\/p>\n\n\n\n
Measure the key aspects of the current process for the issue (collect data)<\/p>\n\n\n\n
Analyze the collected data<\/p>\n\n\n\n
Improve or optimize the current process by implementing an evidence-based intervention\/solution<\/p>\n\n\n\n
Control the future state of the intervention to ensure continuity of process<\/p>\n\n\n\n
What are morals?
Morals consider what is good or bad; right or wrong<\/p>\n\n\n\n
What are ethics?
Ethics is a formal process of making logical and consistent decisions and how we conduct ourselves based upon morals<\/p>\n\n\n\n
What is a dilemma?
When a choice must be made and there are conflicting principles<\/p>\n\n\n\n
When choices have no clear right or wrong option<\/p>\n\n\n\n
What are influences on morals and ethics?
Personal life events<\/p>\n\n\n\n
Family<\/p>\n\n\n\n
What is happening in the world<\/p>\n\n\n\n
Culture, Custom, Tradition<\/p>\n\n\n\n
Religion<\/p>\n\n\n\n
Education<\/p>\n\n\n\n
Values: a basis for behavior based on what we perceive to be the worth of something<\/p>\n\n\n\n
Attitude: feelings toward a person, object or idea<\/p>\n\n\n\n
Beliefs: an idea that one accepts as true<\/p>\n\n\n\n
What are bioethics?
When we apply general ethical principles to healthcare, such as, direct patient care, allocation of resources, utilization of staff, and research<\/p>\n\n\n\n
What are nursing ethics?
Ethical issues specific to nursing practice<\/p>\n\n\n\n
The extent and manner in which you provide patient care<\/p>\n\n\n\n
What is moral distress?
Knows what is right or wrong, but for some reason is unable to carry out the decision<\/p>\n\n\n\n
When the nurse knows the right thing to do but either personal or institutional factors make it difficult to do the right thing.<\/p>\n\n\n\n
What does intermediary mean?
Caught between what the patient and\/or family wants and the physician’s plan or the organization’s policies<\/p>\n\n\n\n
What are external constraints of moral distress?
Afraid of what a physician, the organization, other nurses, patients and\/or families might think or say<\/p>\n\n\n\n
Fear of lawsuits<\/p>\n\n\n\n
What are internal constraints of moral distress?
Lack of courage<\/p>\n\n\n\n
Lack of knowledge<\/p>\n\n\n\n
Concern for reputation<\/p>\n\n\n\n
Socialized to follow orders and not to question<\/p>\n\n\n\n
What is moral outrage?
Belief that others are acting immorally but feel powerless to prevent it<\/p>\n\n\n\n
What is fidelity?
The obligation to be loyal and keep promises or obligations<\/p>\n\n\n\n
What is the MORAL model and what is it used for?
used to problem solve<\/p>\n\n\n\n
Massage the Dilemma
-Identify and define the issues and
information gaps<\/p>\n\n\n\n
Outline the options<\/p>\n\n\n\n
Resolve the Dilemma
-Apply basic moral principles<\/p>\n\n\n\n
Act by applying the chosen option<\/p>\n\n\n\n
Look back and evaluate<\/p>\n\n\n\n
What is autonomy?
Why is it important?
An individual’s right to choose and the ability to act on that choice (self-determination)<\/p>\n\n\n\n
Patient will be more willing to follow through with recommendations if he\/she has input into his\/her care<\/p>\n\n\n\n
What is veracity?
The duty to tell the truth<\/p>\n\n\n\n
What is social justice?
All patients should be treated equally and fairly<\/p>\n\n\n\n
Regardless of age, gender, ethnicity, education, religion, sexual orientation, race<\/p>\n\n\n\n
What is the American Nurses Association (ANA) Code of Ethics?
formal statements of expectations and standards for professional behavior<\/p>\n\n\n\n
What is non-maleficence?
Duty to prevent harm by identifying causes or possible sources of harm
-Example: checking the 5 rights before
giving medications<\/p>\n\n\n\n
Discontinuing treatments that may be invasive that could cause harm or injury
-advocating for catheter removal when
unneeded<\/p>\n\n\n\n
What is beneficence?
Duty to do good; positive action to help others<\/p>\n\n\n\n
Explaining benefits versus negative effects of an intervention for the patient’s well-being<\/p>\n\n\n\n
What are the patient’s bill of rights?
Describes what patients can expect in terms of the responsibilities of the health care provider and who to contact in the event of a breach<\/p>\n\n\n\n
What are the 8\/10 ammendments on the bill of rights, that play a critical role in health care?
Right to privacy<\/p>\n\n\n\n
Right against self incrimination<\/p>\n\n\n\n
Protection from cruel and unusual punishment
(restraints)<\/p>\n\n\n\n
Freedom of speech<\/p>\n\n\n\n
Freedom of religion<\/p>\n\n\n\n
Freedom of the press<\/p>\n\n\n\n
Protection of property rights<\/p>\n\n\n\n
Equal protection under the law<\/p>\n\n\n\n
Can the provider delegate the process of obtaining informed consent to RN?
The provider cannot delegate the duty to the RN<\/p>\n\n\n\n
Is the need of informed consent waived in an emergency situation?
In an emergency situation in which life or limb is at risk, the process of informed consent is waived<\/p>\n\n\n\n
Can consent forms have multiple procedures per form?
Consent forms can only have one procedure per form<\/p>\n\n\n\n
Can a family member of a pt give informed consent?
If yes, who needs to witness it?
A family member can sign informed consent for a patient who does not have the ability, but two nurses need to witness<\/p>\n\n\n\n
When can advanced directives be changed?
anytime<\/p>\n\n\n\n
What is an advanced directive?
A directive that lists a variety of treatments depending on the patient’s condition at the time, and lets the patient decide how much or little care he\/she wants<\/p>\n\n\n\n
If a person wishes to change their advanced directives do they have to write it down or can they verbalize it to the physician?
Changes can be written<\/p>\n\n\n\n
Oral changes given to the physician generally have priority over any statement made in an advance directive so long as the patient is able to decide for him\/herself and communicate his\/her wishes<\/p>\n\n\n\n
What is the living will?
Directives from competent individuals to medical personnel and family members regarding the treatment he\/she wishes to receive when he\/she can no longer make decisions for him\/herself<\/p>\n\n\n\n
What is the five wishes directive?
What does it include?
“Five Wishes” directive is a legal document that presents what an individual wants if he\/she is unable to verbalize wishes<\/p>\n\n\n\n
Who can make decisions, kind of medical treatment, information to be shared with loved ones<\/p>\n\n\n\n
What are the 4 purposes of law in nursing?
Establish licensing requirements<\/p>\n\n\n\n
Protect clients\/society<\/p>\n\n\n\n
Define scope of nursing practice<\/p>\n\n\n\n
Identify minimum level of care to be provided<\/p>\n\n\n\n
What is a durable power of attorney for health care?
Allows patients to appoint a surrogate or proxy to make healthcare decisions in the event the patient is incompetent to do so. This does not include making changes to Advance Directives and\/or Living Wills<\/p>\n\n\n\n
What is Physician Orders for Life-Sustaining Treatment (POLST)?
Contains information on patient’s end-of-life directives<\/p>\n\n\n\n
What is the patient self-determination act?
Mandates that patients must be queried about the existence of advance directives and that such advance directives be made available to them if they wish<\/p>\n\n\n\n
What is the Emergency Medical Treatment and Active Labor Act (EMTALA)?
Ensures public access to emergency services regardless of the patient’s ability to provide proper identification, provide verification of insurance, or ability to pay<\/p>\n\n\n\n
What are nurse practice acts responsible for?
Determines credentialing<\/p>\n\n\n\n
Establishes licensing requirements<\/p>\n\n\n\n
Defines the Discipline & Scope of Practice<\/p>\n\n\n\n
Protects the public<\/p>\n\n\n\n
Defines nursing practice, boundaries and standards for nursing<\/p>\n\n\n\n
Protects the domain of nursing<\/p>\n\n\n\n
What are the items under mandatory reporting laws?
Communicable disease
-HIV\/AIDS is reported to the CDC
-STDs reported to county health departments<\/p>\n\n\n\n
Abuse
-Reported to the institution board and
applicable authorities<\/p>\n\n\n\n
What is the good samaritan law?
Enacted to allow health care personnel to deliver medical assistance without fear of incurring criminal and civil liability<\/p>\n\n\n\n
CANNOT BE SUED UNLESS THE CARE THEY GIVE IS OUT OF THEIR SCOPE OF PRACTICE
-ex. OB nurse stabilizing a fracture that
resulted in a fat emolus can be help
accountable because their expertise and
scope of practice is with mom and baby
health maintenance<\/p>\n\n\n\n
Where are the standards of practice derived from?
State Boards of Nursing Nurse Practice Acts<\/p>\n\n\n\n
What is criminal law?<\/p>\n\n\n\n
What may it lead to?
Federal or state government prosecutes<\/p>\n\n\n\n
Addresses conduct that is harmful or offensive to society<\/p>\n\n\n\n
Can lead to a fine, imprisonment, or death<\/p>\n\n\n\n
What is civil law?
Allows for resolution of dispute between private parties<\/p>\n\n\n\n
Enforced through courts as damages<\/p>\n\n\n\n
May result in monetary compensation<\/p>\n\n\n\n
What is contract law?
Dealing with agreements between individuals<\/p>\n\n\n\n
Explicit or implicit<\/p>\n\n\n\n
What is defamation?
False communication to a third person that results in harm (ridicule, hatred, contempt, being shunned)<\/p>\n\n\n\n
What is tort law?
Dealing with duties and rights among individuals that are not covered by contractual agreements<\/p>\n\n\n\n
A Tort is a civil wrong, usually with claims for damages
-Malpractice
-Negligence<\/p>\n\n\n\n
What is slander?
Oral defamatory statements<\/p>\n\n\n\n
What is lible?
Written defamatory statements<\/p>\n\n\n\n
How do nurse protect themselves from the claim of assault and battery?
by explaining the procedure before we do it<\/p>\n\n\n\n
What is negligence?
Failure to perform as a reasonable, prudent person would<\/p>\n\n\n\n
Failure to follow standards of practice<\/p>\n\n\n\n
No intent to harm is present<\/p>\n\n\n\n
What is malpractice?
Professional form of negligence<\/p>\n\n\n\n
Public has a right to expect higher standard of care from professionals<\/p>\n\n\n\n
What is an elective surgery?
Convenient for the patient and physician<\/p>\n\n\n\n
satisfies patient need<\/p>\n\n\n\n
What 4 elements must be proved in court to prove that malpractice has occurred?
Existence of a duty: The nurse\/patient relationship creates a duty by the nurse to the patient<\/p>\n\n\n\n
Breach of the duty: Nursing actions failed to meet the standards of care – based on job description, policies & procedures, standards of care,
textbooks<\/p>\n\n\n\n
Causation: Nurses action actually caused the patient’s harm\/injury; type of injury was foreseeable, or a logical consequences of the breach of the nursing standard<\/p>\n\n\n\n
Damages: Plaintiff must prove there has been an actual injury or damage<\/p>\n\n\n\n
What are some common causes of nursing law suits?
Medication and treatment errors<\/p>\n\n\n\n
Failure to use equipment in a responsible manner<\/p>\n\n\n\n
Failure to act as a patient advocate<\/p>\n\n\n\n
Infection caused by poor nursing care<\/p>\n\n\n\n
Failure to follow “chain of command”<\/p>\n\n\n\n
Failure to use sound clinical judgement<\/p>\n\n\n\n
Failure to assess, analyze and diagnose<\/p>\n\n\n\n
Failure to plan<\/p>\n\n\n\n
Failure to implement a plan \u000bof care<\/p>\n\n\n\n
Failure to evaluate<\/p>\n\n\n\n
What is an urgent surgery?
Necessary to maintain health in non-life-threatening situations<\/p>\n\n\n\n
usually within 24-48 hours to preserve life or function<\/p>\n\n\n\n
What is an emergency surgery?
Requires immediate intervention to sustain life and\/or preserve the function of body parts<\/p>\n\n\n\n
Performed immediately<\/p>\n\n\n\n
What is corrective surgery?
Excision or removal of diseased body part<\/p>\n\n\n\n
What is palliative surgery?
To relieve symptoms<\/p>\n\n\n\n
Example: masses that cause pain and\/or obstruction<\/p>\n\n\n\n
What is transplant surgery?
Removal of organs and\/or tissues from a person pronounced brain dead for transplantation into another person<\/p>\n\n\n\n
What is diagnositc surgery?
the removal of all or part of a suspected lesion for examination and testing to confirm or rule out a cancer diagnosis<\/p>\n\n\n\n
What happens in preoperative nursing?
Begins with the patient’s decision to have surgery, ends with entry into the operating room<\/p>\n\n\n\n
What happens in intraoperative nursing?
Begins with entry into the operating room and ends with admission to the recovery room (PACU)<\/p>\n\n\n\n
What happens in postoperative nursing?
Begins with admission to recovery room, and ends with discharge from care<\/p>\n\n\n\n
In the preoperative nursing phase what is gathered in the nursing history?
Key elements that pertain to the risks and needs<\/p>\n\n\n\n
Obtaining legal documents (advance directives, living will, durable power of attorney)<\/p>\n\n\n\n
What information is gathered in the medical history portion of preoperative nursing?
Past illnesses
Primary reason for seeking medical care<\/p>\n\n\n\n
What information is gathered in the family support portion of preoperative nursing?
Extent of support from family and\/or friends<\/p>\n\n\n\n
Why are pts put on NPO status for surgery?
Decreases risk for aspiration<\/p>\n\n\n\n
If you need to remove hair on a patient before they have surgery, do you shave the hair or clip it?
Remove hair by clipping (not shaving)<\/p>\n\n\n\n
Who is part of the surgical team?
Surgeon (leader of the surgical team)<\/p>\n\n\n\n
Anesthesiologist or Certified Registered Nurse Anesthetist (CRNA)<\/p>\n\n\n\n
Scrub nurse<\/p>\n\n\n\n
Circulating nurse<\/p>\n\n\n\n
OR Tech\/Surgical technologist may be used in addition to nursing staff<\/p>\n\n\n\n
What is the job of the scrub nurse?
Works in the sterile field passing instruments, sponges and other items needed for surgery<\/p>\n\n\n\n
What is the job of the circulating nurse?
Control of the environment<\/p>\n\n\n\n
Provision of resources<\/p>\n\n\n\n
Performs a time out<\/p>\n\n\n\n
All activity stops<\/p>\n\n\n\n
Name, birthday, procedure, site, equipment<\/p>\n\n\n\n
What is the job OR tech\/surgical tech
Works in the sterile field with the surgeon<\/p>\n\n\n\n
Ensures the surgery procedure is conducted under optimal conditions<\/p>\n\n\n\n
Holds utensils during the procedure<\/p>\n\n\n\n
What is general anesthesia?
method used when the surgery requires that the patient be unconscious and\/or paralyzed.<\/p>\n\n\n\n
A general anesthetic acts by blocking awareness centers in the brain so that amnesia (loss of memory), analgesia (insensibility to pain), hypnosis (artificial sleep), and relaxation (rendering a part of the body less tense) occur.<\/p>\n\n\n\n
What is the Surgical Scrub, Gowning, and Gloving process?
A. The surgical scrub
Don surgical mask
Scrub under the nails
Remove all jewelry<\/p>\n\n\n\n
B. Rinsing
After scrubbing and rinsing, the scrub nurse dries his hands and arms with a sterile towel inside the operating room and then is assisted into a sterile gown<\/p>\n\n\n\n
C. The scrub nurse prepares sterile gloves.<\/p>\n\n\n\n
D. The scrub nurse puts on his first sterile glove while the sterile gown is being tied in the back.<\/p>\n\n\n\n
E. The scrub nurse puts on his second sterile glove<\/p>\n\n\n\n
What are the risks of anesthesia?
Adverse reaction to anesthetic<\/p>\n\n\n\n
Overdose<\/p>\n\n\n\n
Unrecognized hypoventilation<\/p>\n\n\n\n
N\/V<\/p>\n\n\n\n
Sore throat<\/p>\n\n\n\n
Seizure or heart attack<\/p>\n\n\n\n
Malignant hyperthermia (MH)<\/p>\n\n\n\n
Numbness or loss of function<\/p>\n\n\n\n
What is malignant hyperthermia?
Acute, life-threatening complication<\/p>\n\n\n\n
Genetic – inherited<\/p>\n\n\n\n
Begins with skeletal muscle exposed to a specific anesthetic agent<\/p>\n\n\n\n
Causes increased calcium levels in muscle cells<\/p>\n\n\n\n
Leads to acidosis, high temperatures, dysrhythmias<\/p>\n\n\n\n
What are the s\/s of malignant hyperthermia?
Muscle rigidity of the jaw and upper chest<\/p>\n\n\n\n
Elevated body temperature<\/p>\n\n\n\n
Tachycardia, hypotension, dysrythmias, tachypnea<\/p>\n\n\n\n
Rise in CO2 (respiratory acidosis) and DECREASED O2 sat<\/p>\n\n\n\n
Skin mottling<\/p>\n\n\n\n
Cyanosis<\/p>\n\n\n\n
Hypercalcemia leading to myoglobinuria<\/p>\n\n\n\n
What are the complications for local\/regional anesthesia?
Anaphylaxis<\/p>\n\n\n\n
Incorrect delivery technique<\/p>\n\n\n\n
Systemic absorption<\/p>\n\n\n\n
Overdose<\/p>\n\n\n\n
Local complications<\/p>\n\n\n\n
How is malignant hyperthermia treated?
Stop the anesthetic agent<\/p>\n\n\n\n
Intubate and Hyperventilate giving 100% oxygen<\/p>\n\n\n\n
Administer a muscle relaxant
-Dantrolene is a common muscle relaxant<\/p>\n\n\n\n
Administer cooling interventions
-Cooling blanket, iced IV solutions<\/p>\n\n\n\n
Monitor for dysrhythmias<\/p>\n\n\n\n
Possible cessation of surgery if symptoms are not controlled<\/p>\n\n\n\n
How are the complications of local\/regional anesthesia treated?
Establish open airway<\/p>\n\n\n\n
Give oxygen<\/p>\n\n\n\n
Fast-acting barbiturate (ex: phenobarbital) is usual treatment<\/p>\n\n\n\n
Epinephrine for unexplained bradycardia<\/p>\n\n\n\n
In a post op assessment, what is involved in cardiovascular monitoring?
Vital signs
Heart sounds, rhythm, pattern
Cardiac monitoring
Peripheral vascular assessment
Monitor for venous thromboembolism<\/p>\n\n\n\n
What is surgical positioning?
Assess need for proper alignment and intervene to decrease risk of skin injury<\/p>\n\n\n\n
Patient’s body must remain in physiologic alignment<\/p>\n\n\n\n
What is surgical positioning dependent on?
The surgical procedure<\/p>\n\n\n\n
Exposure at the surgical field<\/p>\n\n\n\n
Surgeon’s preference<\/p>\n\n\n\n
Patient’s condition<\/p>\n\n\n\n
In a post op assessment, what is involved in the GI assessment?
Postoperative nausea\/vomiting common<\/p>\n\n\n\n
30% of patients experience nausea or vomiting after general anesthesia<\/p>\n\n\n\n
Peristalsis may be delayed up to 24 hours<\/p>\n\n\n\n
Monitor for bowel sounds<\/p>\n\n\n\n
In a post op assessment, what is involved in the neuro assessment?
Cerebral functioning
-Level of consciousness should have returned
to pre-surgery level before being transferred
to the unit
-Assess and monitor ability to follow
commands<\/p>\n\n\n\n
Assess and monitor pupillary response
Motor and sensory assessment after epidural or spinal anesthesia<\/p>\n\n\n\n
When are montgomery straps used and why?
Montgomery straps may be used when frequent dressing changes are anticipated.<\/p>\n\n\n\n
They help prevent skin irritation from frequent tape removal.<\/p>\n\n\n\n
What potential complication should the nurse be assessing for that is most common on the 2nd postoperative day?
hypoxemia<\/p>\n\n\n\n
atelectasis<\/p>\n\n\n\n
What do drains do and help prevent?
provide exit route for air, blood, and bile<\/p>\n\n\n\n
help prevent deep infections, abscess formation during healing<\/p>\n\n\n\n
What are some DVT prevention interventions?
Ambulation<\/p>\n\n\n\n
Active or Passive Range of Motion<\/p>\n\n\n\n
Prophylactic Antiplatelet<\/p>\n\n\n\n
Promotion of venous return<\/p>\n\n\n\n
Sequential compression devices (SCD)
-push blood through the blood vessels in —
an upward motion<\/p>\n\n\n\n
Thromboembolic stockings (TED hose)
-Compress superficial vessels in the legs
and force blood to flow through deep
vessels<\/p>\n\n\n\n
What is conscious sedation?
this type of sedation does not require respiratory support and the patient is able to respond to verbal commands<\/p>\n\n\n\n