Cat 1
1) What assessment must be done first or highest priority following an upper GI scope (EGD).
2) What other assessment finding could suggest a post operative concern?
1) What is assessing a gag reflex
* don't forget about assessing vital signs for fever, hypotension, tachycardia, hypoxia*
2) Crepitus (shoulders, neck) free air (perforation in the GI system)
1) What can lead to increase abdominal pressure that would be contraindicated in Hiatal Hernia clients?
2) Hiatal Hernia clients may c/o chest pain, what intervention must be completed urgently?
3) What client teaching is required for a client with a Hiatal Hernia
1) What is coughing, sneezing, bending, bearing down (vasovagal).
2) EKG
3) bland small meals, PPI's or H2 antagonist, elevated HOB (minimum 6iches), no ETOH or tobacco
1) Metabolic Alkalosis can happen with what GI intervention that nurses can insert, manage, and remove?
2) Should a client with a NG experience nausea? -
3) How do you troubleshoot an NG Tube?
4) electrolyte abnormalities seen with gastric losses
1) What is an NG tube
2) NO
3)Check for patency, connections, suction, and location/insertion marking.
4) hyponatremia and hypokalemia
What is a concern when administering antibiotic therapy?
What is Clostridium Difficile
Colon Cancer..... UC or Crohns?
what is UC
1) Passing flatus post operative day 1-3 is a common positive/progressive sign for what post operative surgery?
2) What color stool color would need to be reported to the provider?
3) Post operative assessments should include what?
4) What color indicates a healthy stoma?
1) What is an ostomy (colostomy)
2) Red or Black
3) Temp daily, urine output daily, heart rate daily, stoma, and Weight over the last 3 days
4) reddish-pink (beefy red)
Your Peptic Ulcer Disease client complains of sudden onset of severe abdominal pain, what are you concerned about?
What is perforation?
What body system must be assessed when a client has severe abdominal distention?
What is respiratory assessment including breath sounds and SPO2
1) What major side effects/complications with Liver dysfunction/diseases?
2) what are some important nursing interventions for liver patients and esophageal varices to be aware of?
1)what is/are bleeding tendencies, esophageal varices, ascites, hypoalbuminemia, epistaxis
2) prevent bleeding, no enemas, non irritating foods, bland diet, smaller needles when drawing blood (or IV insertion). prevention of constipation, monitor for epistaxis
1) Following a barium enema to assess Crohn's disease, what complication must be assessed for closely?
2) What class of drugs maybe ordered to help prevent this and help evacuate the barium?
3) what can the barium enema be sued to diagnose?
1)What is constipation?
2) Laxatives
3) strictures, obstructions in the small and larger intestines
1) Clients with an ileostomy would have what stool characteristics?
2) What should clients with ileostomy should NOT consume in the dietary
1) liquid, brown stool?
2) Nuts, Seeds (can block opening)
Nuts/seeds
1) What is T tube used for ?
2) How do you know the T tube is ready to removed?
1) what is to drain bile outside the body while allowing the common bile duct to recover/repair, or decrease inflammation.
2) clients stool is normal colored(brown)
Scrotal edema and Urinary retention are common complications following what surgery?
what is herniorrhaphy
1) Liver biopsy is used for diagnosis, what are the common complications RN must be assessing for
2) what assessments findings would indicate this
3) what is the best position post procedure, especially if bleeding the site is bleeding
1) bleeding at the site or internally, pneumothorax
2) assess breath sounds, bruising that increases in size, unilateral chest rise, blood pressure
3) right side
1) Pancreatitis is most commonly associated with what modifiable risk factor?
2) what is the common abdominal location of pain?
3) what labs associated with pancreatitis
1) what is alcohol abuse
2) ULQ, pain is severe and often hard to treat and can radiate to the back
3) HCT, Ca, Glucose, ABG (Pa02/PaCO2), Amylase, Lipase
High fiber diet, increase PO fluid intake, and ambulation are all part of what post-operative lower GI surgical teaching?
What is hemorrhoidectomy
1) Clients with GI hemorrhage (upper GI) may be treated with what interventions?
2) teaching plan for esophageal varices
3) what labs are you reviewing most costly?
1) What are Ice or Cold lavage or Sengkten-Blakemore Tube (Minnesota or esophageal tamponade balloon)
2) no NSAIDS, avoid constipation, soft diet (chew well), avoid any strenuous activity that increases the thoracic pressure
3) PT/INR (elevated)
What are key post operative teaching following a laparoscopic cholecystectomy?
s/s of infection (fever or purulent drainage) hypotension, tachycardia, tachypnea
bile drainage from the incision
N/V/D (intolerant to fatty foods).
your client is being prepped for a paracentesis due to hypoalbunemia and cirrhosis, what must you ensure your client does before the procedure?
Ensure the client voids prior to the procedure
1) what are the dietary recommendations for a client with pancreatitis?
2) when can the client begin to try oral nutrition?
3) what is Turner's Sign and what is your nursing interventions
1) what is strict NPO, and/or TPN
2) once pain is controlled and lipase/amylase levels drop
3) bruising on the flank, coupled with hypotension, tachycardia. Nurse would notify MD and ensuring IV is working and start IVF
What lab would be of most value when assessing you cirrhosis patient with large scale edema?
albumin (hypoalumnemia)
Your client has biliary stents placed to aid in the gall bladder and panaceas function, how do you know the stents are working?
1) stool color is normal, patient is free from jaundice
What are the main assessments associated with TPN administration?
Check daily weights, monitor glucose levels (both finger sticks and serum), check temperature for possible infection. Monitor Central Line site
1) What is a common complications/side effects of pancreatitis?
2) what are some signs that could also indicate these complications?
1) What is hypocalcemia and pleural effusion
2) muscle twitching and jerking and shortness of breath, hypoxia, muffled lung sounds
1) what is the main Hepatic Encephalopathy assessment?
1) what are the lab value associated with this
2) What medication(s) are used treat this
1)What is LOC or AMS
2) ammonia (NH3)
3) lactulose and/or neomycin