EXAM PREPARATION TIPS AND GUIDE FOR NURSING NR 142 NR142 Exam 1 Study Guide, Study Guides, Projects, Research of Nursing

Download EXAM PREPARATION TIPS AND GUIDE FOR NURSING NR 142 NR142 Exam 1 Study Guide and more Study Guides, Projects, Research Nursing in PDF only on Docsity! EXAM PREPARATION TIPS AND GUIDE FOR NURSING NR 142 NR142 Exam 1 Study Guide Instructions: The contents on this guide are intended to help you organize your preparation for the Subject for the NR142 exam 1. This is NOT intended to serve as a direct reflection of the exact questions which will be presented in the exam. As you review the topics listed below, be sure that you can 1. Understand the Pathophysiology 2. Identify the appropriate assessment skills 3. Interpret the appropriate lab or other diagnostic findings 4. Develop a safe and competent plan of care with rationale 5. Associate the nursing implications with the appropriate medications or other treatments 6. Teach the RATIONALE for all the above. 7. Prioritize especially r/t interventions and use of the nursing process keeping in mind scope of practice and responsibilities related to practicing as a R.N. Medication calculations Review: All oral and injectable; IV fluids, IV medications (continuous/intermittent; with meds; not weight based); Reconstitution Gastrointestinal Alterations ❖ Esophagus (Meg) Esophageal Cancer – Occurs 3x more often in men than in women. Seen more frequently in African Americans than in Caucasians. Occurs most often in 5th or 6th decade of life. Is seen more in China and Northern Iran than in other parts of the world. Pathophysiology – Consists of 2 cell types – Adenocarcinoma and Squamous cell carcinoma. Normally not found till disease is advanced and then there is a very poor prognosis 1. Adenocarcinoma is primarily found in the distal esophagus and gastroesophageal junction. • Risk factors – chronic esophageal irritation as with tobacco and alcohol use, people with GERD and Barrett’s esophagus (chronic irritation of the mucous membranes due to reflux) 1 2. Squamous Cell Carcinoma • Risk factors – chronic ingestion of hot liquids or foods, nutritional deficiencies, poor oral hygiene, exposure to nitrosamines in the environment or food, cigarette smoking or chronic alcohol use and some esophageal medical conditions such as caustic injury Tumor cells of both types may spread beneath the esophageal mucosa or directly into, through and beyond the muscle layer into the lymph nodes. In later stages patients can have obstruction of the esophagus and possible perforation into the mediastinum and erosion into the vessels. Assessment – Diagnosis confirmed by biopsy S/S – lesions in the throat, dysphasia, with solid foods first and then liquids, sensation of a mass in the throat, painful swallowing, substernal pain or fullness, regurgitation of undigested foods with bad breathe and hiccups. Rationale – Pain and trouble swallowing can indicate a blockage or mass in the throat. A mass in the throat can cause gastroesophageal reflux, and damage or irritation to the nerves. Both of these things can cause consistent hiccupping. Reflux or respiratory issues denying oxygen into the blood, to the heart and other muscles, can cause substernal pain Treatment: • Surgery to remove tumor or surgical resection of the esophagus • Esophagectomy – partial or full removal of the esophagus • Radiation • Chemo • Combination • Palliative treatments – dilation of the esophagus, laser therapy, placement of a stint • Radical neck dissection is how they perform surgery on the esophagus Tumors in the cervical or upper thoracic area of the esophagus may be maintained by a free jejunal graft in which the tumor is removed and the area is replaced with a portion of the jejunum. (Esojejunostomy) Complications: • Surgery or surgical resection – high mortality rate due to infection, pulmonary complications, leakage through the anastomosis 2 Diagnosed by x-ray, barium swallow, chest CT, endoscopy and esophageal manometry Assessment – S/S – difficulty swallowing both solids and liquids, sensation of food sticking to lower part of esophagus, vomiting either spontaneous or intentional, chest pain (heartburn), pulmonary complications from aspiration, low or absent peristalsis @distal end of esophagus, lower esophageal sphincter does not relax – watch airway, for bleeding and v/ s Rationale – all assessment items are directly related to food residue in the esophagus, either from the feeling or from the related complication Treatments: pts instructed to eat slowly and drink fluids with meals • Calcium channel blockers and nitrates administered to decrease esophageal pressure and improve swallowing • Injection of Botox into the esophagus via endoscopy is used to inhibit the contraction of smooth muscle • Pneumatic dilation stretches the narrowed area of the esophagus (high success rate) • Esophagomyotomy –esophageal muscle fibers are separated to relieve the lower esophageal stricture Complications of treatments: • Pneumatic dilation – painful (patient must be sedated), perforation is possible so watch for abdominal tenderness and fever ❖ Upper GI alterations ➢ Types ▪ GERD ▪ Hiatal Hernia ▪ Barrett’s Esophagus ▪ PUD ▪ Gastritis ▪ Gastric cancer ▪ Morbid Obesity ➢ Pathophysiology ➢ Assessment with rationale ➢ Diagnostics ➢ Treatment with rationale with consideration to long-term use of GI suction and complications from long-term use of NG tubes ➢ Consider the role of intrinsic factor on Vitamin B12 deficiency 5 ➢ Complications ❖ Inflammatory ➢ Types ▪ Crohn’s Disease ▪ Ulcerative Colitis ▪ Diverticullitis ➢ Pathophysiology ➢ Assessment with rationale ➢ Diagnostics ➢ Treatment with rationale including use of TPN and special diets Appendicitis (Matt) Appendicitis is a condition in which your appendix becomes inflamed and fills with pus. Your appendix is a finger-shaped pouch that projects out from your colon on the lower right side of your abdomen. Appendicitis is a medical emergency that requires prompt surgery to remove the appendix. Left untreated, an inflamed appendix will eventually burst, or perforate, spilling infectious materials into the abdominal cavity. This can lead to peritonitis, a serious inflammation of the abdominal cavity's lining (the peritoneum) that can be fatal unless it is treated quickly with strong antibiotics. S/S • Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right abdomen. This is usually the first sign. • Loss of appetite • Nausea and/or vomiting soon after abdominal pain begins • Abdominal swelling • Fever of 99-102 degrees Fahrenheit • Inability to pass gas Diagnosis • Abdominal exam to detect inflammation • Urine test to rule out a urinary tract infection • Rectal exam • Blood test to see if your body is fighting infection 6 • CT scans and/or ultrasound Treatment Surgery to remove the appendix, which is called an appendectomy Peritonitis Peritonitis is an inflammation of the peritoneum, the tissue that lines the inner wall of the abdomen and covers and supports most of your abdominal organs. Peritonitis is usually caused by infection from bacteria or fungi. Left untreated, peritonitis can rapidly spread into the blood (sepsis) and to other organs, resulting in multiple organ failure and death. (Appendix bursting can cause peritonitis) The two main types of peritonitis are primary spontaneous peritonitis, an infection that develops in the peritoneum; and secondary peritonitis, which usually develops when an injury or infection in the abdominal cavity allows infectious organisms into the peritoneum. The most common risk factors for primary spontaneous peritonitis include: Liver disease with cirrhosis. Such disease often causes a buildup of abdominal fluid (ascites) that can become infected. Kidney failure getting peritoneal dialysis. This technique, which involves the implantation of a catheter into the peritoneum, is used to remove waste products in the blood of people with kidney failure. It's linked to a higher risk of peritonitis due to accidental contamination of the peritoneum by way of the catheter. S/S • poor appetite and nausea • a dull abdominal ache that quickly turns into persistent, severe abdominal pain, which is worsened by any movement • Abdominal tenderness or distention • Chills • Fever • Fluid in the abdomen • Extreme thirst • Not passing any urine, or passing significantly less urine than usual • Difficulty passing gas or having a bowel movement • Vomiting 7 A femoral hernia occurs when the intestine enters the canal carrying the femoral artery into the upper thigh. Femoral hernias are most common in women, especially those who are pregnant or obese. In an umbilical hernia, part of the small intestine passes through the abdominal wall near the navel. Common in newborns, it also commonly afflicts obese women or those who have had many children. A hiatal hernia happens when the upper stomach squeezes through the hiatus, an opening in the diaphragm through which the esophagus passes. S/S Many hernias are picked up by routine physicals Hernias can cause discomfort or pain during your daily activities, especially when you exert yourself. Hernias can cause discomfort or pain during urination or bowel movements. Hernias can cause a feeling of weakness or pressure in the groin area. Hernia pain may be sharp and sudden or dull and achy. It can also be a combination of both. Signs and symptoms of strangulated hernia include: Nausea, vomiting or both Fever Rapid heart rate Sudden pain that quickly intensifies A hernia bulge that turns red, purple or dark Diagnosis Most often physical examination Treatment Hernia treatment consists of surgery unless you have medical conditions that preclude surgery. In some cases, belts or trusses can be used to temporarily hold the hernia in place Colorectal Cancer • Colorectal cancer is a malignant tumor arising from the inner wall of the large intestine. 10 • Colorectal cancer is the third leading cause of cancer in males and fourth in females in the U.S. • Risk factors for colorectal cancer include heredity, colon polyps, and long-standing ulcerative colitis. • Most colorectal cancers develop from polyps. Removal of colon polyps can prevent colorectal cancer. • Colon polyps and early cancer can have no symptoms. Therefore regular screening is important. • Genetics and/or a high fat diet are believed to increase risk of getting this type of cancer S/S • fatigue, weakness, shortness of breath, change in bowel habits, narrow stools, diarrhea or constipation, red or dark blood in stool, weight loss, abdominal pain, cramps, or bloating. • Other diseases can mimic these symptoms and it is possible for you to have colon cancer for several years without a symptom. SCREENING IS IMPORTANT!!! Diagnosis • Colon cancer is suspected, either a lower GI series (barium enema X-ray) or colonoscopy is performed to confirm the diagnosis and locate the tumor. A barium enema involves taking X-rays of the colon and the rectum after the patient is given an enema with a white, chalky liquid containing barium. The barium outlines the large intestines on the X-rays. Tumors and other abnormalities appear as dark shadows on the X-rays • Colonoscopy is the best procedure to use when cancer of the colon is suspected. While the majority of the polyps removed through colonoscopes are benign, many are precancerous. Removal of precancerous polyps prevents the future development of colon cancer from these polyps. Treatment • Surgery- the tumor, a small margin of the surrounding healthy intestine, and adjacent lymph nodes are removed. The surgeon then reconnects the healthy sections of the 11 bowel. In patients with rectal cancer, the rectum sometimes is permanently removed. The surgeon then creates an opening (colostomy) on the abdominal wall through which solid waste from the colon is excreted. • Chemotherapy is used for advanced stages of colon cancer- (5-fluorouracil, or 5-FU) is a pill form drug for chemotherapy often used. ❖ Ostomies ▪ Types o Ascending o Descending o Transverse o Double barrel (Loop) o Ileostomy o Sigmoid colostomy ➢ Pathophysiology ➢ Assessment with rationale ➢ Diagnostics ➢ Treatment with rationale Hepatic, Biliary, and Pancreatic Alterations (Maira) ❖ Cirrhosis (pgs. 1116,1125f, 1146-1158) • Ac chronic liver disease characterized by fibrotic changes and the formation of dense connective tissue within the liver, subsequent degenerative changes and loss of functioning cells • Extensive scarring of the liver; r/t chronic reaction to hepatic inflammation and necrosis. • Compensated cirrhosis There are three types of cirrhosis or scarring of the liver: 12 ▪ Dyspnea – elevate the hob at least 30 degrees or as high as pt. wishes/can tolerate, encourage pt. to sit in a chair and weigh pt. in standing position ▪ ➢ Diagnostics • Liver biopsy confirms diagnosis ▪ Labs: LFT’s, Serum alkaline phosphatase, AST, ALT & GGT, Serum cholinesterase, Bilirubin and Prothrombin time (See Table 39-1 pg. 1121) ▪ Ultrasound is used to measure the density of parenchymal cells & scar tissue ▪ CT, MRI & radioisotope liver scans used to get liver size & hepatic blood flow & obstruction. ▪ ABG analysis may reveal a ventilation-perfusion imbalance & hypoxia ▪ ➢ Treatment with rationale Treatments & management is based on presenting symptoms • Antacids or histamine-2 (H2) antagonists are used to decrease gastric distress & minimize GI bleeding • Vitamin & nutritional supplements promote healing of damaged liver cells • Nutritional therapy – low sodium diet, limited fluid intake, vitamin supplements, protein • Drug therapy – diuretic, electrolyte replacement, Lactulose, Neomycin sulfate, Metronidazole • Paracentesis • Observe for impending shock ➢ Complications ▪ Bleeding & Hemorrhage – at risk because of decreased production of prothrombin & decreased ability of deceased liver to synthesize the necessary substances for blood coagulation 15 ▪ Portal-systemic Hepatic Encephalopathy & Coma – manifest as deteriorating mental status & dementia &/or physical signs like abnormal voluntary/involuntary movements. ▪ Fluid Volume Excess – develop cardiovascular abnormalities due to an ↑cardiac output, ↓peripheral vascular resistance ▪ Portal hypertension –increased pressure throughout the portal venous system d/t obstructed blood flow through the liver. Results in ascites & esophageal varices ▪ Ascites – Fluid in peritoneal cavity due to portal hypertension, vasodilation of splanchnic circulation, changes in ability to metabolize aldosterone, decreased synthesis of albumin and movement of albumin into the peritoneal cavity ▪ Bleeding esophageal varices ▪ Coagulation defects ▪ Jaundice – due to increased serum bilirubin levels. Four kinds: 1. Hepatocellular – lack of appetite, nausea, weight loss, malaise, fatigue, weakness, HA, chills & fever if infectious in origin 2. Obstructive – pruritus, dark orange-brown urine, light clay-colored stools, dyspepsia, fat intolerance fat/impaired digestion 3. Hemolytic 4. Hereditary hyperbilirubinemia ▪ Hepatorenal syndrome ▪ Spontaneous bacterial peritonitis ❖ Hepatitis all types ➢ Pathophysiology ➢ Assessment with rationale ➢ Diagnostics ➢ Treatment with rationale ❖ Cancer (liver & pancreatic) ➢ Pathophysiology ➢ Assessment with rationale ➢ Diagnostics ➢ Treatment with rationale ❖ Pancreatitis ➢ Pathophysiology ➢ Assessment with rationale 16 > Diagnostics > Treatment with rationale % % 17