Cat 1
What assessment must be done first or highest priority following an upper GI scope (EGD)
What is assessing a gag reflex
What can lead to increase abdominal pressure that would be contraindicated in Hiatal Hernia clients?
What is coughing, sneezing, bending, bearing down (vaso-vagal) when a client bends over or coughs, it increases the abdominal pressure therefore allowing the stomach to push up through the diaphragm opening into the thoracic cavity
1) Hiatal Hernia clients may c/o chest pain, what intervention must be completed? -
2) client teaching for H.Hernia
1) EKG - When a client presents to the ED complaining of Chest Pain its important to rule out a cardiac event.
2) bland small meals, PPI's or H2 antagonist, elevated HOB, no ETOH or tobacco - A client who experiences heartburn with a H.Herina should do the following to help reduce acid refluxing back up the esophagus
Metabolic Alkalosis can happen with what GI intervention that nurses can insert, manage, and remove?
What is an NG tube
1) Should a client with a NG experience nausea? -
2) How do you troubleshoot an NG Tube? 3) electrolyte abnormalities seen with gastric losses
1) NO
2)Check for patency, connections, suction, and location/insertion marking.
3) hyponatremia and hypokalemia
Antibody therapy can lead to what super infection?
What is Clostridium Difficile
Colon Cancer..... UC or Crohns?
what is UC
Passing flatus post operative day 1-3 is a common positive/progressive sign for what post operative surgery?
What is an ostomy (colostomy); After a colostomy the passing of flatus is a sign of bowel peristalsis and motility
1) What color stool color would need to be reported to the provider?
2) Post operative assessments should include what?
1) pale pink, grey, purple, or Black
2) Clients weight, Temp, BP, Pulse, Urine Output, SPO2, and Resp. Rate
PUD client who complains of sudden onset of severe abdominal pain
What is perforation?
1) What's another complication of PUD
Gastrointestinal bleed (upper) dark tarry stools may be having bleeding ulcers and must be reported immediately.
What body system must be assessed when a client has severe abdominal distention?
What is respiratory assessment including breath sounds (diminished breath sounds) and SPO2 (hypoxia)
Liver dysfunction/diseases have what major side effects/complications
what is/are bleeding tendencies, esophageal varices, ascites, hypoalbuminemia, epistaxis
1) what labs would reveal bleeding issues
2) nursing interventions for liver patients and esophageal varices
1) PT, INR, PTT
2) prevent bleeding, no enemas, non irritating foods, bland diet, smaller needles when drawing blood (or IV insertion). prevention of constipation, monitor for epistaxis
Following a barium enema to assess Crohn's disease, what complication must be assessed for closely?
What is constipation and or Obstruction?
1)What class of drugs maybe ordered to help prevent this and help evacuate the barium?
2) electrolyte to closely monitor when client has crohns
1) Laxatives
2) Hypokalemia d/t excessive diarrhea
Clients with an ileostomy would have what stool characteristics?
What is liquid, brown stool
1)What foods can clog or block the ileostomy opening and should be avoided?
Nuts/seeds (as they can clog the ostomy)
What is T tube used for ?
what is to drain bile outside the body while allowing the common bile duct to recover/repair, or decrease inflammation.
1) how do you know the T tube is ready to removed?
1) darkening of the clients stool (return to normal color)
Scrotal edema and Urinary retention are common complications following what surgery?
what is herniorrhaphy
following an inguinal herniorrhaphy repair it's important to assess for any scrotal edema which can lead to decreased perfusion to the testies, and increased swelling can lead to urinary retention as it can compress the urethra.
Liver biopsy is used for diagnosis, what are the common complications RN must be assessing for
what is bleeding at the site or internally, pneumothorax
1) what assessments findings would indicate this
2) positioning post procedure
1) assess breath sounds, bruising that increases in size, unilateral chest rise, BP
2) right side
Pancreatitis is most commonly associated with what modifiable risk factor?
what is alcohol abuse
1) common abdominal location of pain?
2) lab associated with pancreatitis
1) ULQ, pain is severe and often hard to treat and can radiate to the back
2) 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
Hemorrhoids occur typically to straining when the client attempts a bowel movement. After having surgical removal of the hemorrhoids, the client should have a high fiber diet to ensure the bowel is being regulated for ease of bowel movement.
Clients with GI hemorrhage (upper GI such as esophageal varices) may be treated with what interventions?
What are Ice or Cold lavage or Sengkten-Blakemore Tube (Minnesota or esophageal tamponade balloon)
Ice/cold leads to vasoconstriction minimizing or stopping the bleeding. Sengstaken-blakemore tub is place and blown up with air to place pressure on the veins to compress them and stop the bleeding
1) teaching plan for esophageal varices
1) no NSAIDS, avoid constipation, soft diet (chew well), avoid any strenuous activity that increases the thoracic pressure
Post operative teaching following a laparoscopic cholecystectomy
what is s/s of infection (fever or purulent drainage), bile drainage from the incision, N/V/D (especially after eating fatty foods).
Client is being prepped for a paracentesis due to hypoalbuminemia and cirrhosis
What is ensure the client voids prior to the procedure
dietary recommendations for a client with pancreatitis?
what is strict NPO, and/or TPN, monitor Calcium closely for hypocalcemia
1) when can the client begin to try oral nutrition?
2) what is Turner's Sign and what is your nursing interventions
1) once pain is controlled and lipase/amylase levels drop
2) bruising on the flank, coupled with hypotension, tachycardia. Nurse would notify MD and ensuring IV is working and start IVF
What is the Post-Operative assessment revealing complication from an upper endoscopy
What is Presence of Subcutaneous creptius in cervical/neck
Presence of crepitus can indicate a complication post upper endoscopy of perforated intestines.
Biliary stents are placed to aid in the gall bladder and panaceas function, how do you know the stents are working
what is stool color is normal, patient is free from jaundice
If the clients biliary stent fails it can lead to Jaundice as the bile is unable to escape
Assessments associated with TPN administration?
What are check daily weights, monitor glucose levels (both finger sticks and serum), check temperature for possible infection. Monitor Central Line site
What is a common complications/side effects of pancreatitis?
What is hypocalcemia, pleural effusion (hypoxia/hypoxemia), hemorrhage (loss of blood), hyperglycemia (DM), PAIN,
Main Hepatic Encephalopathy assessment?
What is LOC or AMS
1) lab value associated with this
2) What medication(s) are used treat this
1) ammonia (NH3)
2) lactulose and/or neomycin