Pharmacology
Antacids
Calcium carbonate (Tums), neutralizes acid, used in GERD, common side effect: constipation.
You are the nurse caring for a patient with a new diagnosis of a hiatal hernia. What education would you provide about the disorder?
Weakness in diaphragm causing stomach to herniate up. Symptoms include pyrosis, N/V, GERD symptoms. Diagnosed with a barium swallow, X-ray or EGD. Should eat small frequent meals, elevate HOB or sit upright after eating. Can be repaired with surgery.
Define "bowel rest."
NPO, NGT to LIS, hold PO meds or switch to IV. Purpose is to allow the bowel to rest and heal from inflammatory processes. Concern is always hydration, nutrition, electrolytes.
What foods would you tell your client diagnosed with GERD to avoid?
Fatty, fried foods; chocolate; caffeine; alcohol; carbonation; spicy foods; "red sauce", and trigger foods.
Define the pre- and post-op care of a client with appendicitis.
Pre-op: Fowler's position, monitor for signs of perforation (temporary relief of pain, then pain similar to peritonitis, fever, elevated WBC), no enemas or laxatives
Post-op: pain management, maybe abx, monitor incision, restart PO slowly, monitor for return of bowel function
H2 Receptor antagonists
famotidine (Pepcid); decreases gastric acid production, use care in clients with kidney injury (can prolong QT interval)
You are a nurse caring for a patient with diverticulosis. Describe the clinical manifestations for diverticulitis that you would instruct the client to monitor for.
Chronic constipation prior to exacerbation, then intervals of diarrhea, LLQ pain, bloating, nausea, fever, palpable abdominal mass.
What signs would lead you to believe your client with Crohn's disease is experiencing complications from their disease?
What diagnosis requires a high fiber diet? What diagnosis requires a low fiber diet?
High fiber - constipation, diverticulosis
Low fiber (low residue) - IBD
You are caring for a client admitted with influenza A with a history of esophageal varices. What is your priority for this client?
Minimize strain on the varices - minimize coughing or straining. Rupture of the varices would cause an upper GI hemorrhage - manage the airway!
Proton pump inhibitors
Lansoprazole, Pantoprazole. Decreases gastric acid production. Used in GERD or PUD. Side effects: infection due to loss of acidity. Swallow capsules whole before meals.
What education would you provide to your client to prevent constipation?
High fiber diet, increase fluids, exercise, don't ignore the urge to defecate, don't overuse laxatives, talk to your doctor about medications that may cause constipation (opioids).
Describe your nursing interventions for the client with ascites.
Daily weight, abdominal girth, I/O, High Fowler's position, low Na diet, diuretics, prep for paracentesis.
Define the process of protein breakdown in the body and how it contributes to complications of liver disease.
Protein is broken down in the liver to synthesize glucose when the body needs it. A by-product of this is ammonia. Normally the liver turns ammonia into urea and it's excreted in the kidneys. When ammonia is elevated, it leads to hepatic encephalopathy (confusion, mental status changes).
Two common medications are used to treat bleeding esophageal varices - name them and identify the contraindication for one.
Octreotide. Vasopressin (contraindicated in cardiac disease)
Which medication for constipation may be prescribed to clients with cardiac disease and why?
Docusate (Colace) - softens the stool to prevent straining to prevent the Valsalva maneuver.
What is the most common drug that causes acute liver failure?
Antidote is acetylcysteine!
Describe the expected findings for a client experiencing acute cholelithiasis.
RUQ pain radiating to back or shoulder. N/V, jaundice, pruritus, dark urine, clay-colored stools.
What are signs of malnutrition?
Steatorrhea, vitamin deficiencies, weight loss, abnormal electrolytes, dehydration.
When caring for a client as the RN, what can you NOT delegate to a UAP (unlicensed assistive personnel)?
Corticosteroids
Identify the two most common complications following a liver biopsy and nursing care for them.
Infection - monitor WBC, biopsy site, temp
Bleeding - lay on right side, monitor site, frequent VS to assess for hypovolemia.
You are caring for a client in the PACU as they recover from abdominal surgery. Describe the care you would provide.
Monitor for LOC, airway, VS (bleeding, hypovolemia), return of bowel function, start PO slowly, treat pain, get OOB when awake to help with gas pain.
Describe foods to avoid for clients with celiac disease.
Gluten - wheat, rye, barley, oats
Define the management of an active GI bleed caused from a perforated peptic ulcer.
Always airway first! Monitor for hypovolemic shock, NGT to suction, prepare for emergency endoscopy.