GERD is NOT Great
These things can be the cause of GERD.
What are an incompetent Lower Esophageal Sphincter (LES), Obesity, Pregnancy, Smoking, and Medications (nitrates, Beta-adrenergic blockers, and calcium channel blockers)?
Your patient complains of mid-abdominal burning/gaseous pain 1-2 hours after eating. You suspect they suffer from this type of Peptic Ulcer Disease.
What is Gastric?
Your client makes the statement, "I feel better after I vomit- it relieves the pain in my belly, but the pain then comes back every 4-5 min." You suspect your client has this condition:
What is a small bowel obstruction?
These two medications can be used to treat BPH. Name each as well as describe how they help BPH.
What are:
Finasteride - helps shrink the prostate gland
Tamsulosin- helps to relax the smooth muscle in the urethra
Your client with PCOS states she doesn't understand why she is on a diuretic like her grandma. You explain it to her.
What is:
It blocks androgen receptors and women with PCOS have hyperandrogenism.
These three 'fancy' terms are clinical manifestations of GERD.
What are Pyrosis (heartburn), Dyspepsia (mid-epi pain), and Regurgitation (sour taste in mouth from bile)?
A nursing student is shadowing you and asks why the Provider ordered these two blood tests (related to 2 other organs) when they are sure the patient has a gastric ulcer.
What is because the GI, hepatic, and pancreatic systems can have very similar signs and symptoms when something is wrong, we would assess liver function to rule out impaired liver function, and amylase to rule out pancreatic issues?
Your client has recovered from bowel obstruction surgery that required a Colostomy and is going home tomorrow. You start educating her on ostomy care and add precautions and signs to call her surgeon immediately.
Name 1 topic on ostomy care.
Name 1 post-surgical caution related to ostomies.
Name 1 sign that would necessitate a call to her surgeon.
What are:
•Empty when 1/3 full
•Change pouch q4-7 days
•Fluids 2-3 L/day
•No heavy lifting, resume activity 6-8 weeks post-op
•Avoid odor, gas, and diarrhea-producing foods
•Psychosocial support
Assess stoma color - pale, purple, black are signs of poor blood flow to the stoma.
Fever >100.4 (accepted as well).
Your client presents with clinical manifestations of chronic kidney disease. Name at least 3:
What are:
Hyperglycemia
Hyperkalemia
Hyperphosphatemia
Hypernatremia
Low Vit D causing PTH to release Ca from the bones resulting in Osteomalacia.
Anemia
Metabolic Acidosis
Your client with Breast cancer needs a nasogastric enteral feeding due to due to poor nutrition intake due to chemotherapy. You monitor for these things when it comes to feeding tubes. Name at least 3.
What are:
Aspiration risk - Keep HOB elevated 30 degrees during and after feedings.
Assess for skin breakdown in the nares.
Flush before and after medications.
Crush medications (that are allowed to be crushed).
Assess bowel sounds before feedings.
Assess daily weights.
You educate your client on some interventions that can assist with GERD (name at least two).
•Elevate HOB 30 degrees or higher
•Pillows
•4-6 inch blocks
•2-3 hours after ingestion
•Lifestyle modifications
•Decrease alcohol intake
These are two major complications of PUD.
What are bleeding and perforation?
Your patient does a teach-back about Diverticulitis and you verify that he understands his diagnosis correctly when he tells you that Diverticulitis is this (name at least two characteristics or definitions).
•Diverticula pouches of the colon
•Diverticulitis infection of diverticula
•Caused by diet and/or lifestyle
•More common in western civilizations
Lifestyle causes include
•Obesity,
•Inactivity
•Smoking,
•Alcohol use
•Overusing NSAIDs
Western diets tend to be higher in saturated fats and red meats
Name 3 complications of each:
Hemodialysis and Peritoneal Dialysis.
What are:
Hemodialysis - "Hs"
Hypotension
Hepatitis
Hypovolemia
Hurting Muscles (ms cramps)
Peritoneal - "Ps"
Peritonitis - the fluid out is cloudy
Protein and blood loss
Potential Infection - at the site of insertion
Possible hernias
Possible pain in back
Pulmonary complications -fluid shift in the lungs
Your client is scheduled for a total left breast mastectomy/ lymphotomy and needs education on post-surgical precautions. Name three things:
What are:
Keep the affected arm up on pillows at the heart level.
Watch for extreme swelling and tightness in the affected arm.
May need to wear a compression sleeve.
No BP, IVs, or blood draws on left arm.
Name three separate class of medications that can aid in management of GERD.
•Proton pump inhibitor (PPI)
•Omeprazole, pantoprazole
•H2 receptor blockers
•Ranitidine
•Antacids
•Calcium carbonate, oxide aluminum, & magnesium hydroxide
Your patient is diagnosed with PUD, and you anticipate the orders will include what nursing interventions (be specific to PUD and name at least three).
•NPO with NG suction
•IV fluids
•Rest
Pain management
Medications -
•PPI, h2-inhibitor, and/or antacids
•Antibiotics- amoxicillin or clarithromycin
You measure the NG output : 750ml bile colored fluid. You think back to your nursing school days and remember that your patient would be in potential Metabolic Acidosis with this ABG:
Come up with an ABG that reflects Metabolic Acidosis. Include all 3 values.
Correct answer subject to Professor approval.
pH needs to be <7.45 (Acidosis)
PCO2 Normal 35-45
HCO3 <22
You are a new Dialysis nurse, and you know that a patient can have dialysis 4 different ways.
Name and explain the 4 ways.
Hemodialysis catheter - like a central line- for emergency dialysis only. Do NOT use except for dialysis.
Atrioventricular Fistula - suturing a vein and artery together to withstand the high pressure from dialysis. Takes 6 weeks to heal. Has a bruit/thrill.
Atrioventricular Graft -synthetic material is used to make a loop between the vein and the artery. More likely to become clotted and suffer from STEAL syndrome (distal ischemia - paresthesia, poor cap refill).
Peritoneal dialysis - catheter is placed in the abdomen. Can be done by the patient, at home.
Your client needs TPN due to her extreme anorexia from the chemotherapy treatment. You educate her about receiving TPN- name at least three things you will include in your teaching.
What is:
It bypasses the GI tract.
Will need a central line.
It has a high concentration of dextrose.
Will need glucose checks q4-6 hours.
When a TPN bag is empty and another is not available yet, need to hang 10% Dextrose to prevent hypoglycemia.
You are educating your client on foods to avoid that cause their GERD. You name at least 3.
•The typical GI irritants
•Chocolate
•Caffeine
•Acidic or spicy foods
•Peppermint
•Dairy products increase gastric secretion.
•Overall, encourage clients to avoid foods known to cause their GERD.
Your patient is diagnosed with Duodenal Ulcer and you match these symptoms with this diagnosis.
•Pain 2-5 hours after eating
•Burning/cramp-like
Food alleviates pain
Your patient has Irritable Bowel Disease, name at one of the diseases that are found under this heading of Irritable Bowel Disease and name 2 clinical manifestations of the disease:
Crohn's & Colitis.
What are:
GI bleeds
Bloody stools
Malnutrition
Infection
Your patient with ESRD asks about being allowed to eat and drink. You reply that there are restrictions.
Name at least 3 possible restrictions the Nephrologist might order in regards to food and fluids:
What are:
Limiting:
Potassium - what are some foods?
Phosphate - limit what? and what CAN they have?
Sodium
Fluids
Your patient has expressed fear about the diagnosis of cancer and how overwhelming it feels to go through surgery and chemotherapy. You respond to her and say: (Please answer in the manner you would actually respond to a client).
What is: (Professor's discretion if it is an acceptable response.)