Nutrition
If a bag of TPN runs out what should be infused until another bag becomes available?
10% dextrose in water
The nurse is assessing a client with complaints of vague upper abdominal pain that is worse at night but is relieved by sitting up and leaning forward. Which assessment question should the nurse ask next?
1. "Have you noticed a yellow haze when you look at things?"
2. "Does the pain get worse when you eat a meal or snack?"
3. "Have you had your amylase and lipase checked recently?"
4. "How much weight have you gained since you saw the HCP?"
1. A yellow haze is a sign of a toxic level of digoxin, with the client seeing through the yellow haze. Seeing a yellow haze is not the same as the client being jaundiced. In jaundice, the skin and sclera are yellow, signs of pancreatic cancer
**2. The abdominal pain is often made worse by eating and lying supine in clients diagnosed with cancer of the pancreas.
3. The client would not know these terms, and the HCP would be the one to check these laboratory values.
4. Clients diagnosed with cancer of the pancreas lose weight, not gain weight.
a nurse is preparing a teaching plan for a client who has just found out she has type 2 diabetes mellitus. What is the nurse's priority in preparing for this plan?
Determine what the client knows about managing her diabetes
A nurse is completing the admission assessment of a client who has acute pancreatitis. Which finding is the first priority?
A. History of cholelithiasis
B. Elevated serum amylase levels
C. Decrease in bowel sounds upon auscultation
D. Hand spasms present when blood pressure is checked
D. Hand spasms present when blood pressure is checked
Rationale: Greatest risk to the client is ECG changes and hypotension from hypocalcemia. Hand spasms are a manifestation of hypocalcemia.
What kind of carbohydrate should the majority of your diet be
Polysaccharides
The nurse caring for a client diagnosed with cancer of the pancreas writes the collaborative problem of "altered nutrition." Which intervention should the nurse include in the plan of care?
1. Continuous feedings via PEG tube.
2. Have the family bring in foods from home.
3. Assess for food preferences.
4. Refer to the dietitian.
1. Tube feedings are collaborative interventions, but the stem did not say the client had a feed- ing tube.
2. This is an independent intervention.
3. Assessment is an independent intervention and the first step in the nursing process. No one should have to tell the nurse to assess the client.
**4. A collaborative intervention would be to refer to the nutrition expert, the dietitian.
The accumulation of ketones in the blood - acids formed from the breakdown of free fatty acids in the absence of insulin. Associated with uncontrolled diabetes and resulting in metabolic acidosis.
ketoacidosis
A nurse is assessing a client who has pancreatitis. Which of the following actions should the nurse take to assess the presence of Cullen's sign.
A. Tap lightly at the costovertebral margin on the client's back
B. Palpate the RLQ
C. Inspect the skin around the umbilicus
D. Auscultate the area below the scapula
C.
Rationale: Cullen's sign is indicated by a bluish-gray discoloration in the periumbillical area.
A nurse is completing nutritional teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply)
A. I plan to eat small, frequent meals.
B. I will eat easy-to-digest foods with limited spice.
C. I will use skim milk when cooking
D. I plan to drink regular cola
E. I will limit alcohol intake to two drinks per day
A, B, and C.
Rationale: The patient should eat small, frequent, easy to digest meals. They should avoid alcohol and caffeinated beverages.
The nurse is planning a program for clients at a health fair regarding the prevention and early detection of cancer of the pancreas. Which self-care activity should the nurse teach that is an example of primary nursing care?
1. Monitor for elevated blood glucose at random intervals.
2. Inspect the skin and sclera of the eyes for a yellow tint.
3. Limit meat in the diet and eat a diet that is low in fats.
4. Instruct the client with hyperglycemia about insulin injections.
1. Monitoring the blood glucose at random inter- vals, as would be done at a health fair, can pick up possible diabetes mellitus or the presence of a pancreatic tumor, but detecting a disease at an early stage is secondary screening, not primary prevention.
2. Inspecting the skin for jaundice would be a secondary nursing intervention.
**3. Limiting the intake of meat and fats in the diet would be an example of primary interventions. Risk factors for the development of cancer of the pancreas are cigarette smoking and eating a high-fat diet that is high in animal protein. By changing these behaviors the client could possibly prevent the development of cancer of the pancreas. Other risk factors include genetic predisposition and exposure to industrial chemicals.
4. Instructing a client with hyperglycemia (diabetes mellitus) is an example of tertiary nursing care.
Any of numerous disturbances or pathologic changes in the peripheral nervous system, most often affecting sensation, and often a long-term complication of diabetes.
neuropathy
A nurse is completing nutritional teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply)
A. I plan to eat small, frequent meals.
B. I will eat easy-to-digest foods with limited spice
C. I will use skim milk when cooking
D. I plan to drink regular cola
E. I will limit alcohol intake to two drinkers per day
A,B C
Rationale: Patients with pancreatitis should eat small, frequent, easy to digest, low-fat meals. Pt should avoid alcohol and caffeinated beverages.
How much of your diet should be protein
10% to 35% a day
The nurse and an unlicensed nursing assistant are caring for clients on an oncology floor. Which intervention should the nurse delegate to the assistant?
1. Assist the client with abdominal pain to turn to the side and flex the knees.
2. Monitor the Jackson Pratt drainage tube to make sure it is draining properly.
3. Check to see if the client is sleeping after pain medication is given.
4. Empty the bedside commode of the client who has been having melena.
**1. The nursing assistant can help a client to turn to the side and assume the fetal position, which would decrease some abdominal pain.
2. This is a high-level nursing intervention that the unlicensed nursing assistant is not qualified to implement
3. Evaluation of the effectiveness of a PRN medication must be done by the nurse.
4. The nurse should empty the bedside commode to determine if the client is continuing to pass melena (blood in the stool).
polyphagia
excessive hunger
The nurse is caring for a 55-yr-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect?
A) Hematochezia
B) Left upper abdominal pain
C) Ascites and peripheral edema
D) Temperature over 102 F
B
Rationale: Abdominal pain (usually in the left upper quadrant) is the predominant manifestation of acute pancreatitis. Other manifestations of acute pancreatitis include nausea and vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice. Abdominal tenderness with muscle guarding is common. Bowel sounds may be decreased or absent. Ileus may occur and causes marked abdominal distention. Areas of cyanosis or greenish to yellow-brown discoloration of the abdominal wall may occur. Other areas of ecchymoses are the flanks (Grey Turner's spots or sign, a bluish flank discoloration) and the periumbilical area (Cullen's sign, a bluish periumbilical discoloration).
What is beriberi?
A thiamine deficiency (vitamin b)
The client diagnosed with cancer of the pancreas is being discharged to start chemo- therapy in the HCP's office. Which statement made by the client indicates the client understands the discharge instructions?
1. "I will have to see the HCP every day for six (6) weeks for my treatments."
2. "I should write down all my questions so I can ask them when I see the HCP."
3. "I am sure that this is not going to be a serious problem for me to deal with."
4. "The nurse will give me an injection in my leg and I will get to go home."
1. This would be the routine for radiation ther- apy, but chemotherapy is given one (1) to three (3) or four (4) days in a row and then a period of three (3) to four (4) weeks will elapse before the next treatment. This is called intermittent pulse therapy.
**2. The most important person in the treatment of the cancer is the client. Research has proved that the more involved a client becomes in his or her care, the better the prognosis. Clients should have a chance to ask all the questions that they have.
3. Cancer of any kind is a serious problem.
4. Most antineoplastic medications are given intravenously. Many of the medications can cause severe complications if given intramuscularly.
A long-term measure of glucose control. Provides an average blood glucose reading for the last 2 to 3 months. Below 7% is recommended for adult, nonpregnant patients who have diabetes.
Hemoglobin A1c
Nursing management of the patient with acute pancreatitis includes: (SATA)
A. Check for signs of hypocalcemia
B. Provide a diet low in carbohydrates
C. Giving insulin based on sliding scale
D. Observing stools for signs of steatorrhea
E. Monitoring for infection, particularly respiratory tract infection
A, E
Rationale: During the acute phase, it is important to monitor vital signs. Hemodynamic stability may be compromised by hypotension, fever, and tachypnea. Injection fluids are ordered, and the response to therapy is monitored. Fluid and electrolyte balances are closely monitored. Frequent vomiting, along with gastric suction, may result in decreased levels of chloride, sodium, and potassium. Because hypocalcemia can occur in acute pancreatitis, the nurse should observe for symptoms of tetany, such as jerking, irritability, and muscular twitching. Numbness or tingling around the lips and in the fingers is an early indicator of hypocalcemia. The patient should be assessed for Chvostek's sign or Trousseau's sign. A patient with acute pancreatitis should be observed for fever and other manifestations of infection. Respiratory infections are common because the retroperitoneal fluid raises the diaphragm, which causes the patient to take shallow, guarded abdominal breaths.