GI
Your patient has just returned from the diagnostic imaging department and the doctor has told the patient that they have a Mallory-Weiss tear. The patient asks you what a Mallory-Weiss tear is. How should you respond to this patient?
A. "A Mallory-Weiss tear is a kind of diverticulitis."
B. "A Mallory-Weiss tear is an esophageal tear"
C. "A Mallory-Weiss tear is a lacrimal gland disorder."
D. "A Mallory-Weiss tear is a tear that results from a peptic ulcer."
BONUS: when does this usually occur most?
Answer: B
Mallory-Weiss syndrome or gastro-esophageal laceration syndrome refers to bleeding from a laceration in the mucosa at the junction of the stomach and esophagus.
BONUS answer: after severe vomiting!
A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/uL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct?
a. "The patient meets the criteria for a diagnosis of an acute HIV infection."
b. "The patient will be diagnosed with asymptomatic chronic HIV infection."
c. "The patient has developed acquired immunodeficiency syndrome (AIDS)."
d. "The patient will develop symptomatic chronic HIV infection in less than a year."
Answer: C
What is the nurses primary responsibility during the perioperative phase?
Answer: Perioperative checklist
The client is admitted with a diagnosis of ulcerative colitis. Which laboratory values should the nurse be sure to check? (Select all that apply.)
A. Hematocrit and hemoglobin
B. Albumin
C. T3 and T4 count
D. White blood cell count (WBC)
E. Blood urea nitrogen (BUN)
F. Erythrocyte sedimentation rate (ESR)
Bonus: What is the defining characteristic of Ulcerative colitis?
Answer: A, B, D and F
Decreased hematocrit and hemoglobin may reveal the client has anemia as a result of the bloody diarrhea characteristic of this inflammatory bowel disease A low protein albumin level would indicate that the client is experiencing a nutritional deficit due to malabsorption. Increased numbers of white blood cells and an elevated erythrocyte sedimentation rate (ESR) indicate active inflammation. Blood urea nitrogen is related to kidney function and T3 and T4 are related to thyroid function; these lab values do not provide information related to the diagnosis.
Bonus: 10-12 bloody stools per day
Post amputation complications due to non-adherence.
- deformity of stump due to not wrapping
- Infection
- Msuscle atrophy and contractures.
The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which indicated this occurrence?
A. Sweating and pallor
B. Dry skin and stomach pain
C. Bradycardia and indigestion
D. Double vision and chest pain
A. Sweating and pallor
TX of muscular dystrophy
How is it diagnosed?
- corticosteroids help muscle strength and reduce progression of certain types of MD.
Gold stadard for diagnosis is a muscle biopsy. CKMB can be drawn to indicate muscle degeneration.
A 72-year old client reports having discomfort immediately after a below-the-knee amputation. Which initial action by the nurse is most appropriate?
A. Wrap the stump snugly in an elastic bandage
B. Ensure that the stump is elevated
C. Administer opioid narcotics as ordered
D. Conduct guided imagery or distraction
Answer: Ensure that the stump is elevated
Elevating the stump is the priority intervention for the first 24 hours after surgery. This will help prevent pressure due to postoperative swelling, which will minimize pain or discomfort. Without this action, a firm elastic bandage, opioid narcotics, or guided imagery will have little effect. Analgesics appropriate to the level of pain should be administered as needed in the postoperative period to promote client comfort. After the first day, the residual limb should be flat on the bed.
Complications of chronic pancreatitis
- Pancreatic diabetes
- Decreased production of pancreatic enzymes(often requiring supplementation)
Mr. Hasakusa is in end-stage liver failure. Which interventions should the nurse implement when addressing hepatic encephalopathy? (Select all that apply.)
A. Assessing the client's neurologic status every 2 hours
B. Monitoring the client's hemoglobin and hematocrit levels
C. Evaluating the client's serum ammonia level
D. Monitoring the client's handwriting daily
E. Preparing to insert an esophageal tamponade tube
F. Making sure the client's fingernails are short
Answer: A, C, D
Hepatic encephalopathy results from an increased ammonia level due to the liver's inability to covert ammonia to urea, which leads to neurologic dysfunction and possible brain damage. The nurse should monitor the client's neurologic status, serum ammonia level, and handwriting. Monitoring the client's hemoglobin and hematocrit levels and insertion of an esophageal tamponade tube address esophageal bleeding. Keeping fingernails short address puritis associated with jaundice.
A patient is post-op from a gastric resection for treatment of peptic ulcer disease. One hour after eating meals, the patient exhibits diaphoresis, tachycardia, and hypotension. In addition, the patient reports feeling abdominal cramps, weakness, and nausea. Which options below can be incorporated in the patient’s plan of care to help alleviate the patient’s signs and symptoms? Select all that apply:
A. Wait 30 minutes after meals to consume liquids.
B. Sit up for 30 minutes after eating.
C. Consume high amounts of dairy products daily.
D. Eat 5-6 small meals a day rather than 3 large meals.
E. When symptoms present, eat cold or hot food to help decrease symptoms.
Answer: A and D
A. Wait 30 minutes after meals to consume liquids. TRUE! It is best to limit the amount of content being dumped into the small intestine. Therefore, the patient should avoid drinking fluids with meals but rather consume liquids 30 minutes AFTER meals.
B. Sit up for 30 minutes after eating. FALSE! The goal of decreasing the signs and symptoms of dumping syndrome is to help decrease gastric motility. The patient should LIE DOWN for 30 minutes to help decrease the rapid dumping of the contents into the small intestine.
C. Consume high amounts of dairy products daily. FALSE! Dairy products are known to cause GI distress and should be consumed in very same amounts until tolerated. The patient should instead consume high amount of proteins and complex carbs. These foods will help stabilize blood glucose levels and are broken down over longer periods of time.
D. Eat 5-6 small meals a day rather than 3 large meals. TRUE! Remember the goal is to decrease the amount of food that is rapidly entering the stomach/small intestine. It is best for the patient to consume small amounts of food throughout the day rather than 3 large meals.
E. When symptoms present, eat cold or hot food to help decrease symptoms. FALSE! Foods that are very cold or hot increase gastric motility and should be avoided. The patient should consume foods that are room temperature or warm.
. A 6 year-old is admitted with sickle cell crisis. The patient has a FACE scale rating of 10 and the following vital signs: HR 115, BP 120/82, RR 18, oxygen saturation 91%, temperature 101.4’F. Select all the appropriate nursing interventions for this patient at this time?
A. Administer IV Morphine per MD order
B. Administer oxygen per MD order
C. Keep NPO
D. Apply cold compresses
E. Start intravenous fluids per MD order
F. Administer iron supplement per MD order
G. Keep patient on bed rest
H. Remove restrictive clothing or objects from the patient
Answers:A, B, E, G, and H.
When a patient is in sickle cell crisis, the abnormal RBCs are sickling and sticking together, which blocks blood flow. To help alleviate the RBCs from clumping together and sickling, oxygen and hydration are priority. This will help dilute the blood (hence decrease the sticking of RBCs) and help supply oxygen to the RBCs (remember abnormal RBCs with hemoglobin S are very sensitive to low oxygen levels and will sickle when there is low oxygen). In addition, pain needs to be addressed. Opioid medication is the best on a scheduled basis rather than PRN (as needed). Avoid keeping patient NPO unless needed (remember patient needs hydration). Avoid cold compresses (can lead to more sickling) but instead use warm compresses. The patient will need FOLIC ACID supplements to help with RBC creation rather than iron (iron can actually build up in the body and collect in the organs in patients with sickle cell disease). Patients definitely need to be on bedrest, and restrictive clothing or objects (blood pressure cuff etc.) should be removed to help blood flow.
Intrinsic pathway VS extrinsic pathway (clotting)
Intrinsic pathway: inside the blood, triggers cascade by a stimulus such as damage. prothrombin---thrombin---fibrinogen----fibrin----clot
Extrinsic pathway: stimulated by external damage; activates in response to tissue factor protein.
A nurse is caring for a patient with hepatic encephalopathy. The nurse’s assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Ans: C
Feedback:
Patients in the third stage of hepatic encephalopathy exhibit the following symptoms: stuporous, difficult to arouse, sleeps most of the time, exhibits marked confusion, incoherent in speech, asterixis, increased deep tendon reflexes, rigidity of extremities, marked EEG abnormalities. Patients in stages 1 and 2 exhibit clinical symptoms that are not as advanced as found in stage 3, and patients in stage 4 are comatose. In stage 4, there is an absence of asterixis, absence of deep tendon reflexes, flaccidity of extremities, and EEG abnormalities.
A patient came into the emergency room following a car accident. The patient told paramedics he hit his nose on the dashboard on impact. What is the nurses immediate priority? What would the nurse be monitoring his nose for? What type of fractures may be present up X-ray?
Answer: Airway! CSF leakage! Le fort fractures!
Le Fort fractures are fractures of the midface, which collectively involve separation of all or a portion of the midface from the skull base.
You’re educating a group of outpatients about signs and symptoms of ulcerative colitis. Which of the following are NOT typical signs and symptoms of ulcerative colitis? SELECT-ALL-THAT-APPLY:
A. Rectal Bleeding
B. Abdominal mass
C. Bloody diarrhea
D. Fistulae
E. Extreme Hungry
F. Anemia
Answer: B, D and E
In a patient with leukocytosis with a shift to the left, what does the nurse recognize as causing this finding?
a. the complement system has been activated to enhance phagocytosis
b. monocytes are released into the blood in larger-than-normal amounts
c. the response to cellular injury is not adequate to remove damaged tissue and promote healing
d. the demand for neutrophils causes the release of immature neutrophils from the bone marrow
Answer: D
What is metabolic syndrome. Provide examples.
List post -op nursing interventions/assessments.A cluster of conditions that increase the risk of heart disease, stroke, and diabetes.
Metabolic syndrome includes high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. The syndrome increases a person's risk for heart attack and stroke.
Aside from a large waist circumference, most of the disorders associated with metabolic syndrome have no symptoms.
Vital signs, using appropriately sized equipment•Oxygen saturation•Electrolytes•Daily weight and intake and output•Skin •Skinfolds•Incisions and drains•Pain
The nurse is providing discharge education to a patient after a roux-en-Y gastric bypass procedure. Which nutritional supplements must this patient take for the rest of his life? (Select all that apply.)
A. Iron
B. Calcium
C. Folic acid
D. Vitamin C
E. Vitamin D
F. Vitamin B12
A. Iron
B. Calcium
C. Folic acid
F. Vitamin B12
The nurse is doing a preoperative assessment on a male patient who has type 2 diabetes mellitus, weighs 146 kg, and is 5 feet 8 inches tall. Which patient assessment is a priority related to anesthesia?
A. Has hemoglobin A1C of 8.5%
B. Has several seasonal allergies
C. Has body mass index of 48.8 kg/m2
D. Has history of postoperative vomiting
C. Has body mass index of 48.8 kg/m2
The patient's body mass index is the priority because it indicates the patient is severely obese. The patient's size may impair the anesthesiologist's ability to ventilate and medicate the patient properly, as well as the surgery room staff's ability to position the patient safely. The other factors are not the priority.
Which term related to what disorder and what is it?
- Varus
- valgus
-dowagers
- Fector hepaticus
- Melena
- asterixis
- Pagets: Varus is bow legged, Valgus is knock knock knees.
- Osteoperosis: Kyphosis/ hunchback
- Liver failure: musty breath and shakey hand tremors/ jerky movements
- PUD/ Duodenal ulcer: digested blood from bleed.
What are the most common causes of delayed wound healing?
What interventions can improve wound healing?
age, body type, chronic disease, immunosuppression, nutritional status, radiation therapy, and vascular insufficiencies
- Increase protein and vitamin C. (also zinc, copper, iron and keeping wounds dressed if indicated.)
- Maintinece/control of heal conditions which can impead the healing process.
List Bariatric post surgical complications
- impaired mobility
- gastric reflux
- increased risk of clot formation
- dehydration
- skin infections
- increased risk for atelectasis/pneumonia.
__________________. This condition can cause cause a loss of height, hunched posture, and a hump in the upper back (dowager's hump).
Bonus: Management
What is Osteoperosis.
Bonus: prevention and early screening. Calcium and vitamin D supplementation.
What are reticulocytes?
Why is the lab important/what does it indicate?
-help evaluate conditions that affect red blood cells (RBCs), such as anemia or bone marrow disorders. Reticulocytes are newly produced, relatively immature red blood cells. (used to check status of anemias)
EX: If the absolute reticulocyte count is 100,000 mm3 or higher, the anemia is hyperproliferative type (i.e. hemolytic anemia or anemia of acute blood loss as the bone marrow kicks into overdrive to compensate for RBC loss). If it is less than 100,000 mm3 the anemia is hypoproliferative (iron, B12, or folic deficiency, anemia of chronic disorder etc.).