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Med Surg 2 > Midterm > Flashcards

Midterm Flashcards

1
Q

What is the function of the small intestine and the large intestine?

A

small: absorb nutrients
large: absorb water

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2
Q

What is irritable bowel syndrome (IBS)?

A

chronic disorder that affects the large intestine

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3
Q

What are the risks factors of IBS?

A

smoking
caffeine
NSAIDs
stress
family hx
females
high-fat diet
dairy products
alcohol = 1 drink, super bloated
mental/behavioral illness

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4
Q

What are the clinical manifestations of IBS?

A

recurrent diarrhea, constipation, bloating, and/or ABDOMINAL PAIN

belching
mucus in stool
tenesmus = desire to go poop

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5
Q

What is a main indicator of IBS?

A

abdominal pain

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6
Q

What medications are given for IBS?

A

loperamide (standard)
alosetron (last resort)
lubiprostone
linaclotide
bulk agents
probiotics

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7
Q

What can loperamide lead to?

A

cathartic colon (inability to pass stool)

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8
Q

What should be assessed for the medication alosetron?

A

constipation

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9
Q

What are lubiprostone and linaclotide used for?

A

IBS-constipation

lubiprostone: opioid induced constipation, “slip and slide effect”

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10
Q

What should be avoided if a patient who has IBS is taking a bulking agent?

A

psyllium

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11
Q

If a patient is taking antibiotics and then develops watery diarrhea, what should the nurse do?

A

initiate contact precautions

possible C.diff

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12
Q

What are nursing interventions for a patient with IBS?

A
  • have a journal of symptoms, diet, and stress levels
  • increase fiber and fluid intake
  • limit beans, eggs, dairy (yogurt), fruits
  • exercise and stress management
  • ENCOURAGE PT TO ASK Q’S
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13
Q

What is inflammatory bowel disease (IBD)?

A

autoimmune disease
chronic inflammation of intestinal tract

classified as:
Ulcerative colitis
or
Crohn’s disease

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14
Q

Describe ulcerative colitis

A
  • inflammation and ulcers in the rectum
  • from transverse colon to rectum
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15
Q

Describe crohn’s disease

A
  • inflammation granulomas (bumps) that don’t bleed
  • from mouth to anus
  • lesions are transmural (burns a hole where contents can leak out and contaminate)

more serious

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16
Q

What are the clinical manifestations of ulcerative colitis?

A

anal/rectal symptoms

abd pain - severe
diarrhea - common
rectal bleeding - common
tenesmus - common
fever - during acute attacks
can still absorb
weight loss - rare

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17
Q

What are the clinical manifestations of crohn’s disease?

A

Weakness and fatigue

GI symptoms:
abd pain - cramping
diarrhea - steatorrhea (fatty stool)
rectal bleeding - sometimes
tenesmus - rare
fever - based on flare up
impaired absorption
weight loss - common

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18
Q

Why do patients with ulcerative colitis have a new diagnosis of anemia?

A

chronic blood loss (not malabsorption)

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19
Q

If a patient has steatorrhea, what should the nurse ask?

A

have you noticed any recent weight loss?

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20
Q

What are the complications of IBD?

A

Ulcerative- decreased Hct & Hgb (give blood)
Crohn’s- perforation leads to peritonitis (rigid abd., fever, rebound tenderness)

both:
- fluid/electrolyte imbalance
- colorectal cancer
- C.diff infection
- perineal abscess/fistulas
- strictures (scar tissue leads to bowel obstruction)
- toxic megacolon

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21
Q

What is toxic megacolon?

A

inflammation that causes the loss of function of the colon

fluid, toxins, and gas dilate the colon and lead to perforation

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22
Q

Describe the lab studies for IBD

A

increased H&H, WBC, ESR, CRP
decreased K, Mg, Ca
stool for occult blood

crohn’s: decreased albumin
ulcerative: no change in albumin

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23
Q

What are the diagnostic studies for IBD?

A

sigmoidoscopy
colonoscopy (main tool for dx)
CT scan
barium enema (imaging of lower GI tract)

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24
Q

What medications are used for IBD?

A

antiinflammatory
immunosuppressants
immunomodulators
antidiarrheal
antimicrobial

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25
Q

What antiinflammatory medications are used for IBD? Why?

A

corticosteroids (inflammation)
5-ASA (mesalamine and sulfasalazine - (STOPS the body attacking itself)

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26
Q

What immunosuppressant medications are used for IBD? Why?

A

cyclosporine
methotrexate (DMARD) - drink water bc nephrotoxic
azathioprine (DMARD)

suppress the immune system

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27
Q

What immunomodulator medications are used for IBD?

What should be monitored?

A

infliximab
adalimumab
natalizumab

monitor hypotension - decrease 20 BP sys
monitor fever bc immune system is suppressed = infection easy

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28
Q

What antidiarrheal medications are used for IBD?

What does it treat? What should be monitored?

A

diphenoxylate/atropine
loperamide “LOW bowel movements”

treats diarrhea

monitor for cathartic colon

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29
Q

What antimicrobial medication is used for IBD? Why?

What type of mouthwash should be used while on this medication? Why?

A

metronidazole

first choice in treating C.diff

alcohol free mouthwash
- alc causes reaction
- pt can get N/v, dizzy, irritability

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30
Q

What therapeutic procedures are done for IBD?

A

bowel resection

Crohn’s:
- strictureplasty: stent to open stricture
- surgical repair of fistulas: cut out and connect (anastomosis)

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31
Q

What are the nursing interventions for IBD?

A
  • promote rest
  • monitor I&O
  • monitor hypokalemia
  • high protein, high calories, low-residue, low fiber diet
  • small frequent meals
  • food journal
  • TPN (short term)
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32
Q

What should a patient with IBD not eat?

A

oatmeal with cream

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33
Q

What can you give a patient with Crohn’s disease to eat?

A

toast with jelly

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34
Q

Before giving medications to a patient who has Crohn’s disease, what should be assessed?

A

fever

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35
Q

What is concerning for a patient with ulcerative colitis who is taking sulfasalazine?

A

decreased urine output

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36
Q

What should a nurse review for a patient with ulcerative colitis?

A

review electrolyte values

37
Q

What should be assessed first for a patient who has ulcerative colitis and has severe diarrhea? Why?

A

heart rate and rhythm

bc losing potassium

38
Q

What should a nurse tell a patient who feels that ulcerative colitis controls their life?

A

“let’s discuss potential factors that increase your s/s”

39
Q

What is diverticular disease?

A

diverticulosis
diverticulitis

40
Q

What are the clinical manifestations of diverticulosis?

A

diverticulosis
- little pouches of stress bubbles (diverticula)
- asymptomatic
- bloating
- flatulence
- changes in bowel habits

41
Q

What are the clinical manifestations of diverticulitis?

A

diverticulitis
- inflammation of diverticula
- left lower quadrant pain
- abd distention
- fever, chill (infection)
- tachycardia
- N/V

42
Q

What are the risk factors of diverticular disease?

A

low fiber, high fat, red meat diet
aging
constipation

43
Q

What is a complication of diverticulitis?

A

peritonitis (rigid abdomen)

44
Q

What are the diagnostic studies for diverticulitis?

A

decreased H&H
increased WBC and ESR

stool for occult blood +
CT w/contrast of abd
colonoscopy
sx if positive bowel perforation

45
Q

What are the plan of care for the acute phase of diverticulitis?

A

bowel obstruction will lead to

NPO
NGT (if N/V or abd distention )
IV fluids (PRIORITY) , morphine, antibiotics
Rest

46
Q

If a patient has diverticulitis with a large bowel obstruction, what should be monitored?

A

abdominal distention

47
Q

What are the nursing interventions for diverticulitis?

A
  • clear liquid until symptoms go
  • low-fiber then high-fiber when inflammation goes down
  • low-fat
  • hydration
  • NO enemas, laxatives, or colonoscopy
48
Q

What food can you give to someone with diverticulitis?

A

grilled chicken with white rice

49
Q

If a patient has diverticulosis, what can they eat to prevent diverticulitis?

A

navy bean soup and veggie salad

50
Q

What is the first intervention for peritonitis caused by a ruptured diverticulum?

A

administer metronidazole IV

51
Q

Describe intestinal obstruction

A

partial or complete blockage of intestine

mechanical: physical impaction
neurogenic: bowel stops responding to stimuli

52
Q

What are examples of neurogenic obstructions?

A

hypokalemia
opioids
paralytic ileus
cathartic colon

53
Q

What are the clinical manifestations of an obstruction?

A

abdominal distention
hyperactive bowel sounds above obstruction
hypoactive bowel sounds below obstruction

54
Q

What are the clinical manifestations of a small bowel obstruction?

A

higher in GI
colicky (sporadic) pain
frequent N/V

55
Q

What are the clinical manifestations of a large bowel obstruction?

A

In abdominal area

constant pain
abdominal distention
Fecal fluid around impaction

56
Q

What are the complications of a small bowel obstruction?

A

electrolyte imbalance
metabolic alkalosis
fever

57
Q

What are the complications of a large bowel obstruction?

A

metabolic acidosis
dehydration

58
Q

What are the diagnostic studies of bowel obstruction?

A

decreased H&H and BUN
decreased Na, Cl, K
increased creatinine, WBC, amylase

ABG
CT scan
endoscopy (colonoscopy or sigmoidoscopy)
exploratory laparotomy (risk of infection)

59
Q

What are the nursing interventions for bowel obstruction?

A

NPO
NGT
IV fluids
Semi-fowler’s
Pain control (avoid morphine, hydrocodone, hydromorphone)
Antibiotic
Ambulation

60
Q

For a mechanical bowel obstruction, the patient complains that the intermittent bowel pain turned into constant pain. What should the nurse do?

A

check bowel sound (always assess first)

61
Q

What is an ileostomy? What can you see?

A

opening in the ileum (small intestine) in the RLQ

yellow, green, watery bile

62
Q

What is a colostomy? What can you see?

A

opening in the colon

formed feces, brown

63
Q

What are complications of ostomies?

A

stomal ischemia - leads to necrosis
intestinal obstruction (assess stoma/monitor)

64
Q

What should a healthy stoma look like?

A

red “beefy” - after sx
pink - long term
moist and shiny

65
Q

What does a bad stoma look like?

A

stomal ischemia/necrosis - discolored (pale, grey, purple)

66
Q

When caring for a patient with an ostomy, what should the nurse do?
Can an assistive personnel so this?

A

drain and measure the output

AP can do this

67
Q

What food can a person with a colostomy have?

A

pasta

68
Q

For a patient with a new colostomy, is bleeding okay?

A

small amount of bleeding is okay

69
Q

What is an expected outcome for a person with a new colostomy?

A

report of empowerment

70
Q

What medications can a patient not take while having an ileostomy?

A

enteric coated medications

71
Q

If a patient if anxious before a colonoscopy, how should the nurse respond?

A

“before the exam, the provider will give a sedative to make you sleepy”

72
Q

What type of prevention is a colonoscopy or a family hx of colon cancer?

A

secondary

73
Q

What are assessment findings of stroke, MS, and Parkinson’s?

A

stroke
- orientation status
- speech

MS
- orientation status
- speech

Parkinson’s
- orientation status
- speech
- muscle movement
- facial rigidity
- ambulation pattern

74
Q

If there is an air leak in a chest tube, what should the nurse do and monitor?

BOWTIE

A

actions
- palpate for subcutaneous emphysema
- check the tubing on unit

monitor
- respiratory status
- lung expansion exercise

75
Q

What medications are given for Parkinson’s disease?

A

levodopa/carbidopa

76
Q

What clinical manifestations of multiple sclerosis should be monitored?

A

WEAKNESS (pickin up pencil)
diplopia (double vision)
tinnitus
paresthesia
chronic neuropathic pain
nystagmus (shaking of eyes)
dysphagia (difficulty swallowing)
ataxia (poor muscle control)
cognitive difficulties (word finding)
bowel/bladder problems
sexual dysfunction
depression

77
Q

What is indicate a positive result for the Tensilon test? What is the antidote?

A

muscle contraction becomes stronger

antidote: atropine

78
Q

What is an expected finding for someone who has pleural effusion?

A

dullness upon percussion over chest

79
Q

What action should be taken for someone with a water seal chest tube?

A

keep it below the level of the chest

80
Q

What task can be delegated for a patient with a paralytic ileus?

A

apply petroleum jelly

81
Q

What should a nurse teach a patient who has an MI about having blood drawn?

A

it will help determine the degree of damage to the heart tissue

82
Q

What are the nursing interventions for a heart attack?

A
  • morphine, oxygen, nitro, aspirin (MONA)
  • semi or full-fowler
  • monitor VS and EKG
  • IV access
83
Q

What are the clinical manifestations of a MI?

A

Diaphoresis
N/V
Tachycardia

84
Q

A patient with MG is taking pyridostigmine, when should the medication be taken? WHy?

A

take 45 min before a meal

bc it creates secretions

85
Q

What are the risk factors of MS?

A

young adults
women
genetics

86
Q

What should the nurse tell a patient with PD who is taking bromocriptine?

A

rise slowly when standing

87
Q

What is the fastest route for nitroglycerin?

A

sublingual

88
Q

For endocarditis, what should a nurse do and monitor?

BOWTIE

A

action
- obtain sputum culture
- give antibiotics

monitor
- temperature
- neurostatus

Med Surg 2 (7 decks)

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