Week 8: Appendicitis, Alcohol Withdrawal

Question 1

What are the 2 main causes of appendicitis?

Answer 1

occlusion of the appendiceal lumen by a fecalith (accumulated feces) or intramural thickening caused by hypergrowth of lymphoid tissue

Question 2

What are the clinical manifestations of appendicitis?
How is it diagnosed?

Answer 2

-Periumbilical pain (RLQ/ McBurney point), anorexia, N&V
Localized tenderness, rebound tenderness and muscle guarding
Low grade fever
-CT scan or ultrasound

Question 3

What is the Rovsing sign?

Answer 3

Palpation of the LLQ causing pain to be felt in the RLQ

Question 4

What is the blumberg sign?

Answer 4

Pain upon removal of pressure rather than application of pressure to the abdomen (rebound tenderness)

Question 5

What are possible complications of appendicitis?

Answer 5

Perforation, perionitis, abscess

Question 6

What is the treatment of appendicitis?

Answer 6

Appendectomy
-if the appendix has ruptured, and there is evidence of peritonitis or an abscess, antibiotics and parenteral fluids may be used to prevent sepsis and dehydration for 6-8 hours before an appendectomy

Question 7

When do S&S of alcohol withdrawal appear and for how long do they last?

Answer 7

S&S of withdrawal generally begin 6-12 hours after the last drink, and may last for 3-5 days

Question 8

What are S&S of alcohol withdrawal?

Answer 8

tremors, N&V, anxiety, sweating, hyper reflexia, agitation, insomnia, increased HR and BP

Question 9

What are possible complications of alcohol withdrawal?

Answer 9

Alcohol-withdrawal delirium
Death may be caused by hyperthermia, peripheral vascular collapse or cardiac failure

Question 10

What is Wernick’s Encephalopathy?

Answer 10

inflammatory, hemorrhagic, degenerative condition of the brain caused by a thiamine deficiency resulting from poor diet and alcohol-induced suppression of thiamine absorption.
If untreated, can lead to irreversible amnesia

Question 11

What benzodiazepine antagonist can be used in the case of overdose?
What other interventions can be initiated?

Answer 11

-Flumazenil
-gastric lavage, activated charcoal

Question 12

What are the S&S of benzodiazepine overdose?

Answer 12

Agitation, confusion, lethargy, stupor, slurred speech, nystagmus, slow or rapid shallow respirations, hypotension

Question 13

What are the S&S of opioid withdrawal?

Answer 13

craving, abdominal cramps, diarrhea, N&V, flu-like symptoms
peaks 2 to 3 days after last use, resolves by days 5 to 7

Question 14

What are the S&S of opioid overdose?

Answer 14

pinpoint pupils, clammy skin, depressed respirations, and decreased LOC that may lead to coma and death

Question 15

What drugs can be used in management of opioid withdrawal?

Answer 15

Methadone or Buprenorphine

Question 16

What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal?
A. Risk for injury R/T central nervous system stimulation
B. Disturbed thought processes R/T tactile hallucinations
C. Ineffective coping R/T powerlessness over alcohol use
D. Ineffective denial R/T continued alcohol use despite negative consequences

Answer 16

ANS: A
The priority nursing diagnosis for a client experiencing alcohol withdrawal should be risk for injury R/T central nervous system stimulation. Alcohol withdrawal may include the following symptoms: course tremors of hands, tongue, or eyelids; seizures; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia.

Question 17

A nurse evaluates a client’s patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance dependence?
A. Narcotic pain medication is contraindicated for all clients with active substance-abuse problems.
B. Clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control.
C. There is no need to assess the client for substance dependence. There is an obvious PCA malfunction.
D. The client is experiencing symptoms of withdrawal and needs to be accurately assessed for lorazepam (Ativan) dosage.

Answer 17

ANS: B
The nurse should assess the client for substance dependence because clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics, and require increased doses to achieve effective pain control. Cross-tolerance occurs when one drug lessened the client’s response to another drug.

Question 18

On the first day of a client’s alcohol detoxification, which nursing intervention should take priority?
A. Strongly encourage the client to attend 90 Alcoholics Anonymous meetings in 90 days.
B. Educate the client about the biopsychosocial consequences of alcohol abuse.
C. Administer ordered lorazepam in a dosage according to protocol.
D. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

Answer 18

ANS: C

Question 19

A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 24 hours. Which client symptom should the nurse immediate report to the ED physician?
A. Tactile hallucinations
B. Blood pressure of 180/100 mm Hg
C. Mood rating of 2/10 on numeric scale
D. Dehydration

Answer 19

ANS: B
The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal and should promptly report this finding to the physician. Complications associated with alcohol withdrawal may progress to alcohol withdrawal delirium and possible seizure activity on about the second or third day following cessation of prolonged alcohol consumption.

Question 20

Upon admission for symptoms of alcohol withdrawal a client states, “I haven’t eaten in 3 days.” Assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97F (36C) with dry skin, dry mucous membranes, and poor skin turgor. What should be the priority nursing diagnosis?
A. Knowledge deficit
B. Fluid volume excess
C. Imbalanced nutrition: less than body requirements
D. Ineffective individual coping

Answer 20

ANS: C
The nurse should assess that the priority nursing diagnosis is imbalanced nutrition: less than body requirements. The client is exhibiting signs and symptoms of malnutrition as well as alcohol withdrawal. The nurse should consult a dietitian, restrict sodium intake to minimize fluid retention, and provide small, frequent feedings of nonirritating foods.

Question 21

A client telephones the health clinic with complaints of generalized abdominal pain which is aggravated by moving or walking. The client has not been able to eat for a day and is nauseated. Which advice should the nurse provide to this​ client?
A. “Take a warm shower and apply a heating pad to the​ abdomen.”
B. “Rest in bed and drink warm​ fluids.”
C. “Seek immediate medical​ attention.”
D. “Take an​ over-the-counter laxative.”

Answer 21

ANS: C

Question 22

Which clinical manifestation does the nurse expect with acute​ appendicitis?
A. High fever
B. Nausea and vomiting
C. Rebound tenderness
D. Pain relieved with ambulation

Answer 22

ANS: C

Question 23

Which condition may occur if the client does not seek medication attention for acute appendicitis within 24-36 ​hours? (Select all that​ apply.)
A. Seizure
B. Constipation
C. Nausea
D. Peritonitis
E. Perforation

Answer 23

Answer: D, E
​Rationale: If treatment is not​ initiated, tissue necrosis and gangrene result within 24-36 ​hours, leading to perforation​ (rupture). Perforation allows the contents of the gastrointestinal​ (GI) tract to flow into the peritoneal space of the​ abdomen, resulting in peritonitis. Appendicitis does not cause​ seizures, nausea, or constipation.

Question 24

A teenage boy presents with suspected appendicitis. The caregiver​ asks, “Why did my son get​ this?” Which response by the nurse is the most​ appropriate?
A. “Your son has been eating too much​ fiber.”
B. “Your son is eating too many fruits and​ vegetables.”
C. “Your son has not been getting enough​ exercise.”
D. “Your adolescent son is in an at risk​ group.”

Answer 24

Answer: D
​Rationale: Adolescent boys are at greatest risk for appendicitis. Appendicitis cannot be​ prevented, but certain dietary habits may reduce the risk of developing this condition. Eating foods that contain high fiber​ content, such as fresh fruits and​ vegetables, decreases the incidence of appendicitis.

Question 25

Appendicitis almost always results from an obstruction in the appendiceal lumen. Which problem should the nurse identify as the cause of this​ obstruction?
A. Monolith
B. Fecalith
C. Tonsillolith
D. Ptyalith

Answer 25

Answer: B
​Rationale: The obstruction is often caused by a hard mass of feces​ (fecalith). Ptyalith is a calculus in the salivary gland. Tonsillolith is a calculus in the tonsil. A monolith is a large stone used in sculpture.

Question 26

A teenage girl is being assessed for the possibility of appendicitis. Which other condition should the nurse​ consider? (Select all that​ apply.)
A. Pelvic inflammatory disease
B. Ovulation
C. Menstruation
D. Urinary tract infection
E. Ruptured ectopic pregnancy

Answer 26

Answer: A, B, E
​Rationale: In adolescent and young​ women, symptoms must be differentiated from those associated with​ ovulation, ruptured ectopic pregnancy and pelvic inflammatory disease. Although a urinary tract infection may cause abdominal​ pain, it typically does not present in the same way as appendicitis. Menstruation does not have the same symptoms as appendicitis.

Question 27

For which collaborative therapy for peritonitis following a ruptured appendix should the nurse prepare the​ client? (Select all that​ apply.)
A. Antibiotics
B. A​ low-fat, high-calorie diet
C. Passive range of motion
D. Fluid resuscitation
E. Surgery

Answer 27

Answer: A, D, E
Rationale: Clinical therapies for the treatment of peritonitis include removal of the ruptured​ appendix, antibiotics, and fluid resuscitation. A​ low-fat, high-calorie diet and passive range of motion are not therapies used to treat peritonitis after a ruptured appendix.

Question 28

The nurse is caring for a client admitted for a ruptured appendix. Which information should the nurse expect to provide to this​ client? (Select all that​ apply.)
A. A laparotomy will be performed.
B. Intravenous fluids will be provided.
C. Antibiotic medication will be provided before and after the surgery.
D. Pain medication will be provided after the surgery.
E. A laparoscopic appendectomy will be performed.

Answer 28

Answer: A, B, C, D
​Rationale: For a ruptured​ appendix, a laparotomy will be performed. The client will receive antibiotics before and after the surgery to prevent the development of infection from fecal​ contents, which have spilled into the abdominal cavity. Intravenous fluids will be provided to maintain fluid and electrolyte balance. Pain medication will be provided after the surgery. A laparoscopic appendectomy is performed for clients whose appendix has not ruptured.

Question 29

A client with acute appendicitis asks the​ nurse, “Why​ don’t you give me a heating​ pad? I think that will help me with my​ pain.” The​ nurse’s response should be based on which​ reason?
A. It increases the need for fluids.
B. It increases the spread of infection.
C. It reduces white blood cell count.
D. It encourages perforation.

Answer 29

ANS: D

Question 30

The nurse is evaluating a client recovering at home after an emergency appendectomy. Which observation indicates that​ self-care has been​ effective? (Select all that​ apply.)
A. The client snacks on pretzels and club soda during the visit.
B. The client plans to recover at home until cleared by the surgeon.
C. The client uses a pillow to splint the incision before coughing.
D. The client performs abdominal wound care appropriately.
E. The client requests a prescription for more pain medication.

Answer 30

Answer: B, C, D
​Rationale: Observations that indicate that the client is appropriately providing​ self-care after an appendectomy include using a pillow to splint the incision before​ coughing, performing wound care​ appropriately, and planning to recover at home until cleared by the surgeon. Observations that indicate that​ self-care could improve include the need for more pain medication and ingesting a​ less-than-nutritious snack.

Question 31

The nurse is preparing to conduct a physical examination on a client diagnosed with appendicitis. Which intervention should the nurse include in this​ assessment? (Select all that​ apply.)
A. Characteristics of bowel sounds
B. Presence of abdominal pain on palpation
C. Presence of blood in the stool
D. Contour of the abdomen
E. Current body temperature

Answer 31

Answers: A, B, D, E
​Rationale: When conducting the physical assessment on a client with​ appendicitis, the nurse should include abdominal​ contour, current body​ temperature, characteristics of bowel​ sounds, and whether the client is experiencing tenderness to light palpation. Blood in the stool is not an area to assess in the client with appendicitis.

Question 32

Where is the appendix?

Answer 32

RLQ, below the cecum

Question 33

What are the S&S that an appendix has ruptured?

Answer 33

Pain is more diffuse, and distention develops as result of paralytic ileus

Question 34

Define Appendicitis

Answer 34

Inflammation of appendix, commonly caused by occlusion of the appendiceal

Question 35

What are S&S of periostitis?

Answer 35

abdominal tenderness, rigidity; fever, vomiting & tachycardia

Question 36

What interventions are initiated post-appendectomy?
What teaching should the nurse provide

Answer 36

Position in high Fowler’s to reduce tension on incision
Manage pain- opiates
Fluids, food as tolerated when bowel sounds return on day of surgery
Teaching
Follow-up appointment 5- 7 days for suture removal
Incision care guidelines reviewed
No heavy lifting but can resume usually activities within 2- 4 weeks