Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PN2 RN > Test 1 SG > Flashcards

Test 1 SG Flashcards

1
Q

Water does not move into or out of body’s cells

• Risk for fluid overload, especially older adults

A

Isotonic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types is isotonic fluid

A

NS, LR, D5W -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Corrects fluid, electrolyte, and acid–base imbalances by moving water out of body’s cells, into bloodstream

A

Hypertonic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of hypertonic fluid

A

3% saline & parenteral nutrition, d5NS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Moves water into cells & expands them

A

Hypotonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hypotonic fluid

A

Ex: ½ NS & less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

solutions are used to correct altered FLUID AND ELECTROLYTE BALANCE and acid-base imbalances. These fluids are infused, water moves out of the cells in an attempt to dilute the infusate, shrinking the cells.

A

Hypertonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

solutions are commonly used to give fluids intravenously to hospitalized patients in order to treat or avoid cellular dehydration.

A

Hypotonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

solutions- hemorrhage, vomiting, diarrhea, hypovolemia, hemorrhage, drainage from GI suction, metabolic acidosis, or shock.

A

Isotonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

135-145, Wherever this goes, water follows, Responsible for excitable cell membrane depolarization, S/S of Na+ alterations are d/t effects on excitable cellular activity

A

Sodium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  • 1.3-2.1- Critical for skeletal muscle contraction
  • Carbohydrate metabolism
  • ATP formation-fuel for cells
  • Vitamin activation
  • Cell growth
A

Magnesium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

9-10.5
Absorption requires active form of vitamin D, stored in bones, Parathyroid hormone-increases serum Ca+, Thyrocalcitonin-decreases serum Ca+, Ca+ stabilizes action potentials in cells

A

Calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  • Normal level: 3.5 to 5.0 mEq/L
  • Almost all foods contain potassium
  • Sodium-potassium pump
  • Moves extra Na+ from the ICF & moves extra K+ from the ECF back into the cell.
  • Serum K+ remains low & cellular K+ remains high
A

Potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Normal & abnormals & signs & symptoms of

Elevated: Hypernatremia;

A

dehydration; kidney disease; hypercortisolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Low: Hyponatremia; s/s

A

fluid overload; liver disease; adrenal insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Elevated: Hyperkalemia;

A

dehydration; kidney disease; acidosis; adrenal insufficiency; crush injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Low: Hypokalemia;

A

fluid overload; diuretic therapy; alkalosis; insulin administration; hyperaldosteronism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Elevated: Hypercalcemia;

A

hyperthyroidism; hyperparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Low: Hypocalcemia;

A

vitamin D deficiency; hypothyroidism; hypoparathyroidism; kidney disease; excessive intake of phosphorus-containing foods and drinks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Elevated: Hypermagnesemia;

A

kidney disease; hypothyroidism; adrenal insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Low: Hypomagnesemia;

A

malnutrition; alcoholism; ketoacidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Assessment findings & techniques

Hyponatremia-
Caused by:

S/s

A 
•	 Na+ less than 135
•	Often occurs with a fluid imbalance
•	Prolonged use of diuretics
•	Excessive sweating
•	SIADH
•	Psychogenic water intoxication
•	Excess water in plasma leads to dilution of Na+
•	Hypovolemia
s/s
•	Altered mental status/confusion
•	Muscle weakness
•	Seizures
•	Decreased deep tendon reflexes
•	Increased GI motility
•	Changes in cardiac output
•	Coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hypernatremia-
Caused by:

S/s

A

Dehydration
-Diabetes Insipidus
Usually due to a LOSS OF WATER (vomiting, excessive diarrhea-leads to dehydration)
s/s:
-Decreased urine output
NEURO: short attention span, agitation, confusion, coma
-Thirst, dry mucous membranes, flushed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hyperkalemia

Caused by

A

RARE unless chronic or acute kidney failure
-Potassium sparing diuretics
ACEI’s (usually in the setting of renal failure)
-salt substitutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Hypokalemia

Caused by?

A 
Diarrhea/laxatives
Diuretics
Vomiting 
S/s:
-muscle weakness
EKG changes 
Decreased peristalsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Hypermagnesemia

Caused by?

A

RARE
Renal failure

-excessive intake of Mg+ containing antacids
S/s :

  • decreased respiratory rate
  • muscle weakness/decreased deep tendon reflexes
  • peripheral vasodilation/hypotension
  • bradycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Hypomagnesemia

Caused by?

A 
loop & thiazide diuretics
chronic alcoholism
-malabsorption
S/S
muscular excitability/tetany
Stridor/laryngospasm
-hyperactive deep tendon reflexes

-tremors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Hypercalcemia

Caused by?

A 
prolonged immobility
overactive parathyroid gland
-cancer
-severe dehydration
s/s?
-dysrhythmias
-muscle weakness/decreased reflexes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Hypocalcemia

Caused by?

A 
hypoparathyroidism
-low vitamin D
s/s? 
muscle spasms/tetany
-stridor/laryngospasm
-paresthesia’s
-dysrythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Hyponatremia tx:

A
  • NS infusions/3% saline/Na+ tabs
  • Increase dietary Na+
  • Fluid restriction (if cause is hypervolemia) if cause is hypervolemia)
31
Q

Hypernatremia tx:

A
  • Depends on CAUSE:
  • IV hydration
  • Na+ restriction
  • increase PO fluid intake
32
Q

Hyperkalemia

Tx

A

K+ excreting diuretics

  • Insulin
  • kayexalate
  • albuterol sulfate
  • restricting potassium
  • dialysis when severe
33
Q

Hypokalemia

Tx

A

Potassium supplements

-Potassium sparing diuretics (decreases overall fluid without losing potassium)

34
Q

Hypermagnesemia

Tx

A

IV fluids

  • loop diuretics
  • Ca+ to reverse cardiac affects
35
Q

Hypomagnesemia

Tx

A
  • D/C diuretics

- PO or IV replacement

36
Q

Hypercalcemia Tx

A

NS infusion

  • Loop diuretics
  • phosphorus/calcitonin
37
Q

Hypocalcemia

Tx

A

PO or IV replacements

-Vit. D with Ca+

38
Q

Fluid compartments in body

*more info

A

Interstitial fluid
Extracellular fluid-sodium
Intracellular fluid-potassium, magnesium

Transcellular fluid

39
Q

 Fluid overload
 Signs & symptoms
 Patient might complain of:

A 
Clothing fits tighter
Orthopnea
Weight gain
Increased UOP
Decreased activity tolerance
Increased cough
Shortness of breath
Bounding pulse
Hypotension
Tachycardia
40
Q

 Assessment findings
For fluid overload
—————————

A

Fluid intake or retention is greater than body’s needs
• Risk factors
• Surgery
• Chronic illness
• Glucocorticoids
• Can lead to heart failure & pulmonary edema
• Adaptive responses-increased UOP & edema-WHY?

41
Q

 Treatment of fluid overload

A

Skin care: pressure-reducing mattresses, frequent repositioning; edema
 Drug therapy: diuretics if kidney function is normal
 Daily weights-2 lbs overnight or 3 lbs in 1 wk
 Intake & outputs
 Diet restrictions-fluid & sodium restrictions

42
Q

 Dehydration
 Signs & symptoms

A

*Mental status changes common in adults

?????? what else??

43
Q

 Assessment findings for dehydration

A

Fluid intake/retention does not meet body’s fluid needs; results in fluid volume deficit
 Older adults & infants are at high risk
 Body uses compensatory mechanisms to maintain perfusion, often not enough
 Monitor vital signs, especially blood pressure and pulse rate and quality,
 fluid intake and output, and weight. Changes in weight are the best indicator of fluid volume changes in the body.
 Assess skin and mucous membranes for dryness and decreased skin turgor.
 Monitor and interpret laboratory tests to determine fluid or electrolyte imbalance. Examples of common tests are measurements of serum electrolyte concentration, blood urea nitrogen (BUN), and serum osmolality.

44
Q

 Treatment of dehydration

Education :

A
  • Mild to moderate dehydration:

oral fluid replacement

	Severe dehydration: IV fluid replacement
	Monitor VS
	Weight monitoring
	Monitor I & O’s, urine appearance
	Provide for safety

Teach patients to drink adequate fluids to remain hydrated. Eight glasses or more of water a day are often recommended unless medically contraindicated. Older adults may not feel thirsty or want to limit their fluid intake to prevent urinary incontinence. Teach them the importance of drinking adequate fluids to prevent dehydration and potential urinary tract infection. Remind all adults about the need to eat a well-balanced diet that promotes electrolyte balance. Certain foods contain high concentrations of essential vitamins, minerals, and electrolytes. For instance, milk and other dairy products are a good source of calcium. Bananas and potatoes are good sources of potassium.

45
Q

 Acid-base imbalance

 Know how to interpret ABG’s!!

A

Yes

46
Q

 Significance of the acid-base imbalances, causes, & consequences of
 Respiratory alkalosis

A

 Main cause is anything that causes hyperventilation!! Anxiety, panic attack, severe pain, fever, early ASA OD- (stimulates respiratory center of the brain, causing hyperventilation)

 All of these disorders cause us to hyperventilate. When we hyperventilate, we blow off CO2, leading to alkalosis!

47
Q

 Respiratory acidosis

A

 COPD, pulmonary edema/heart failure, obstructive sleep apnea, pneumonia, narcotic/opioid/sedative overdose, severe asthma exacerbation (late stage), neuromuscular disorders that impair ventilation (ALS, MS, guillain barre’)

 All of these disorders affect the lungs ability to exchange oxygen for carbon dioxide (CO2) by either directly affecting the exchange of gases at the alveolar level, OR by depressing the respiratory drive/depressing ventilation.

48
Q

 Metabolic alkalosis

A

Vomiting, GI suctioning, excessive intake of ANTACIDS, diuretics
All of these disorders cause the body to lose too much acid or gain too much base.

49
Q

 Metabolic acidosis

A

 DKA, lactic acidosis, dehydration, kidney failure, diarrhea, high output ileostomy, late stage ASA overdose

 All of these disorders either lead to the PRODUCTION of bicarb, or the LOSS of bicarb, causing an imbalance.

50
Q

 IV infusion therapy
 Saline locks

Purpose?

A

is an intravenous (IV) catheter that is threaded into a peripheral vein, flushed with saline, and then capped off for later use.
Purpose?
To prevent the backflow of blood into the line which may cause clotting, it is important to flush the line with normal saline, and allow the saline to remain in the tubing to ensure that the tube stays patent

For patients who need IV access but are at risk for fluid overload or do not need extra IV fluids, the peripheral vascular access device (VAD) can be converted into an intermittent IV lock, also called a saline lock.
This device allows administration of specific drugs given IV push (e.g., furosemide [Lasix, Furoside]) or on an intermittent basis using a medication administration set. IV antibiotics are frequently given this way. In some cases the saline lock is placed in case there is a need for emergency drug administration via IV push. The intermittent device is flushed with saline before and after drug administration to ensure patency and prevent occlusion with a blood clot.

51
Q

 PICC lines???

A

It is important because it provides an efficient means for those who require chemotherapy, intravenous medication or fluids for a long period. It is also used when one requires frequent blood sampling.

Sterile technique is used for insertion to reduce the risk for CRBSI. Before the catheter can be used for infusion, a chest x-ray indicating that the tip resides in the lower SVC is required when the catheter is not placed under fluoroscopy or with the use of the electrocardiogram tip-locator technique.

 Length of 18 to 29 inches (45 to 72 cm); 5-6 French
 Sterile technique, RN’s with training can place
 Chest x-ray determines placement or waveform
 Power ICCs used for contrast injection; can also attach to transducers for CVP monitoring

The INS recommendation for flushing PICC lines not actively used is 5 mL of heparin (10 units/mL) in a 10-mL syringe at least daily when using a nonvalved catheter and at least weekly with a valved catheter. Use 10 mL of sterile saline to flush before and after medication administration; 20 mL of sterile saline is flushed after drawing blood. Always use 10-mL barrel syringes to flush any central line because the pressure exerted by a smaller barrel poses a risk for rupturing the catheter.

52
Q

 Central Lines????

A

Central venous catheters may be used for the following reason: To give medicines for treatment of pain, infection, or other medical issues (e.g., cancer or heart problems) To provide fluids for nutrition. To help conduct certain medical tests.

  • Vascular access device (VAD) placed in central circulation, specifically within superior vena cava (SVC) near junction with right atrium
  • Chest x-ray to confirm placement

The most common complications from PICCs include phlebitis, thrombophlebitis, deep vein thrombosis (DVT), and CRBSIs. When infections occur from a central line, they are also referred to as central line-associated bloodstream infection, or CLABSI. Thrombophlebitis and DVT can be very serious, threaten the integrity of the vein, and decrease perfusion. The smallest possible French size should be used to decrease the rate of upper-extremity DVT, a potentially life-threatening event.

53
Q

 Bowel obstruction
 Types
Mechanical obstruction:

A

occur because the bowel is physically blocked, and its contents cannot get past the obstruction.
May be caused from adhesions from surgery (most common), tumors, diverticulitis, and fecal impactions.

54
Q

Bowel obstruction

Non mechanical

A

Bowel obstruction
 Types
Non-mechanical:

May be caused from neurogenic disorder, vascular disorder, electrolyte imbalance, and inflammation.
Called paralytic ileus, occurs because the wavelike muscular contractions of the intestine (peristalsis) that ordinarily move food through the digestive tract stop.

55
Q

Tx options for bowel obstructions

A

Treatment options
NPO, place NG tube, administer IV fluids and electrolytes
Surgery: colon resection, colostomy, and lysis (break down cell wall) of adhesions

s/s of both: abd distension, obstipation (a severe form of constipation, where a person cannot pass stool or gas), abd pain, high pitched bowel sounds above obstruction, hypoactive bowel sounds below obstruction.
s/s of small bowel obstruction: Projectile vomiting with fecal odor, severe F&E imbalances, metabolic alkalosis.
s/s of Large bowel obstruction: Diarrhea or ribbon-like stools around impaction.

56
Q

 IBS

 Treatment options

A

Medications: IBS with diarrhea: Alosetron (may cause constipation), IBS w/ constipation: Lubiprostone (may cause diarrhea)
Teach patient: to avoid dairy, eggs, wheat products, alcohol, caffeine, increase fiber to 30-40g per day, increase fluid intake to 2-3 L per day. Keep a diary of food intake and bowel patterns.
IBS- An intestinal disorder causing abdominal pain, gas, diarrhea, and constipation

57
Q

 GERD

 Patho

A

Gastric contents (including enzymes) backflow into esophagus causing pain and mucosal damage (esophagititis, Barette’s epithelium). Decreased esophageal sphincter function. The most common upper GI disorder in the United States, occurs most often in middle-age and older adults.

58
Q

 Exacerbating factors

Of GERD- what makes it worse •

A

Caffeinated beverages, such as coffee, tea, and cola • Chocolate • Citrus fruits • Tomatoes and tomato products • Smoking and use of other tobacco products • Calcium channel blockers, • Nitrates • Peppermint, spearmint • Alcohol • Anticholinergic drugs • High levels of estrogen and progesterone • Nasogastric tube placement, obesity, older age, pregnancy, ascites, hiatal hernia, supine position, diet high in fatty/fried/spicy foods, heavy lifting.

59
Q

 Chronic GERD

S/s

A

can cause dysphagia (difficulty swallowing),

  • a narrowing of the esophagus because of stricture or inflammation, which can interfere with NUTRITION.
  • Assess the patient for degree of dysphagia, whether ingesting solids and/or liquids induces dysphagia, and whether dysphagia occurs intermittently or with each swallowing effort
  • Odynophagia (painful swallowing) can also occur with chronic GERD, but it is rare in patients with uncomplicated reflux disease.
  • Other symptoms include atypical chest pain, symptoms of asthma, and chronic cough that occurs mostly at night or when the patient is lying down.
  • Cough and symptoms of asthma occur when refluxed acid is spilled over into the tracheobronchial tree.
  • Dyspepsia (indigestion)
  • Throat irritation
  • Bitter taste
  • Burning pain in esophagus- pain worsens when laying down, pain improves with sitting upright.
  • Chronic cough
60
Q

 Treatment options
For GERD

A

Meds:
Antacids (take 1-3 hours after, 1 hr before/after meds)
H2 receptor antagonists (ranitidine)
Proton Pump Inhibitors (pantoprazole)
Prokinetics (metoclopramide accelerates gastric emptying, watch for symptoms of EPS)

Surgery: Fundoplication (Fundus of stomach is wrapped around esophagus)

61
Q

Pt education for gerd

A

 Patient education

Avoid fatty/spicy/fried foods
Eat smaller meals
Remain upright after meals
Lose weight
Elevate HOB 6-8 inches with blocks 
Avoid straining or excessive vigorous exercise
62
Q

What is a hernia?

Common types?

A

 Hernias
A hernia is a weakness in the abdominal muscle wall through which a segment of the bowel or other abdominal structure protrudes. Hernias can also penetrate through any other defect in the abdominal wall, through the diaphragm, or through other structures in the abdominal cavity.

The most common types of abdominal hernias (Fig. 56-7) are indirect, direct, femoral, umbilical, and incisional

63
Q

• An indirect inguinal hernia

A

a sac formed from the peritoneum that contains a portion of the intestine or omentum. The hernia pushes downward at an angle into the inguinal canal. In males, indirect inguinal hernias can become large and often descend into the scrotum.

Indirect inguinal hernias, the most common type, occur mostly in men because they follow the tract that develops when the testes descend into the scrotum before birth.

64
Q

• Direct inguinal hernias,

A

in contrast, pass through a weak point in the abdominal wall.

Direct hernias occur more often in older adults.

65
Q

protrude through the femoral ring. A plug of fat in the femoral canal enlarges and eventually pulls the peritoneum and often the urinary bladder into the sac.
Femoral and adult umbilical hernias are most common in pregnant women or those with obesity

A

Femoral hernias

66
Q

• Umbilical hernias

A

are congenital or acquired. Congenital umbilical hernias appear in infancy. Acquired umbilical hernias directly result from increased intra-abdominal pressure.

They are most commonly seen in people who are obese.

67
Q

• Incisional, or ventral, hernias

A

occur at the site of a previous surgical incision. These hernias result from inadequate healing of the incision, which is usually caused by postoperative wound infections, inadequate NUTRITION, and obesity.

. Incisional hernias can occur in people who have undergone abdominal surgery.

68
Q

Hernias may also be classified as reducible, irreducible (incarcerated), or strangulated.

A

A hernia is reducible when the contents of the hernial sac can be placed back into the abdominal cavity by application of gentle pressure.

An irreducible (incarcerated) hernia cannot be reduced or placed back into the abdominal cavity. Any hernia that is not reducible requires immediate surgical evaluation.

A hernia is strangulated when the blood supply to the herniated segment of the bowel is cut off by pressure from the hernial ring (the band of muscle around the hernia). If a hernia is strangulated, there is ischemia and obstruction of the bowel loop. This can lead to necrosis of the bowel, sepsis, and possibly bowel perforation.
Signs of strangulation are abdominal distention, nausea, vomiting, pain, fever, and tachycardia.

69
Q

Absent bowel sounds may indicate what medical emergencies

A

obstruction and strangulation, which are considered medical emergencies.

70
Q

To palpate an inguinal hernia, the health care provider??

A

gently examines the ring and its contents by inserting a finger in the ring and noting any changes when the patient coughs.

The hernia is never forcibly reduced; this maneuver could cause strangulated intestine to rupture. If a male patient suspects a hernia in his groin, the health care provider has him stand for the examination.

Using the right hand for the patient’s right side and the left hand for the patient’s left side, the examiner pushes in the loose scrotal skin with the index finger, following the spermatic cord upward to the external inguinal cord.
At this point, the patient is asked to cough, and any palpable herniation is noted.

71
Q

Inguinal hernia Nonsurgical Management.

If the patient is not a surgical candidate (often an older man with multiple health problems), the health care provider may

A

prescribe a truss for an inguinal hernia, usually for men.

A truss is a pad made with firm material. It is held in place over the hernia with a belt to help keep the abdominal contents from protruding into the hernial sac.

If a truss is used, it is applied only after the physician has reduced the hernia if it is not incarcerated.

The patient usually applies the truss on awakening. Teach him to assess the skin under the truss daily and to protect it with a light layer of powder.

72
Q

Surgical Management.

 Consequences of various types
 Management of

Inguinal hernias

A

Most hernias are inguinal, and surgical repair is the treatment of choice.

Surgery is usually performed on an ambulatory care basis for patients who have no pre-existing health conditions that would complicate the operative course. In same-day surgery centers, anesthesia may be regional or general, and the procedure is typically laparoscopic.

If bowel strangulation and tissue death occur, more extensive surgery, such as a bowel resection or temporary colostomy, may be necessary. Patients undergoing this extensive surgery are hospitalized for a longer period.

Surgical repair of a hernia is called herniorrhaphy.

A minimally invasive inguinal hernia repair (MIIHR) through a laparoscope is the surgery of choice.
A conventional open herniorrhaphy may be performed when laparoscopy is not appropriate.
Patients having minimally invasive surgery (MIS) recover more quickly, have less pain, and develop fewer postoperative complications compared with those having a conventional open surgery.

In addition to patient education about the procedure, the most important preoperative preparation is to teach the patient to remain NPO for the number of hours before surgery that the surgeon specifies. If same-day surgery is planned, remind the patient to arrange for someone to take him or her home and for that adult to be available for the rest of the day at home. For patients having a conventional open approach, provide general preoperative care as described in Chapter 14. During an MIIHR, the surgeon makes several small incisions, identifies the defect, and places the intestinal contents back into the abdomen. During a conventional open herniorrhaphy, the surgeon makes an abdominal incision to perform this procedure. When a hernioplasty is also performed, the surgeon reinforces the weakened outside abdominal muscle wall with a mesh patch. The patient who has had MIIHR is discharged from the surgical center in 3 to 5 hours, depending on recovery from anesthesia.

Teach him or her to avoid strenuous activity for several days before returning to work and a normal routine. A stool softener may be needed to prevent constipation. Caution patients who are taking oral opioids for pain management to not drive or operate heavy machinery.
Teach them to observe incisions for redness, swelling, heat, drainage, and increased pain and promptly report their occurrence to the surgeon. Remind patients that soreness and alterations in COMFORT (rather than severe, acute pain) are common after MIIHR. Be sure to make a follow-up telephone call on the day after surgery to check on the patient’s status.

General postoperative care of patients having a hernia repair is the same as that described in Chapter 16 except that they should avoid coughing. To promote lung expansion, encourage deep breathing and ambulation. With repair of an indirect inguinal hernia, the physician may suggest a scrotal support and ice bags applied to the scrotum to prevent swelling, which often contributes to pain. Elevation of the scrotum with a soft pillow helps prevent and control swelling. In the immediate postoperative period, male patients who have had an inguinal hernia repair may experience difficulty voiding.

Encourage them to stand to allow a more natural position for gravity to facilitate voiding and bladder emptying. Urine output of less than 30 mL per hour should be reported to the surgeon. Techniques to stimulate voiding such as allowing water to run may also be used. A fluid intake of at least 1500 to 2500 mL daily prevents dehydration, maintains urinary function, and minimizes constipation. A “straight” or intermittent (“in and out”) catheterization is required if the patient cannot void. Chart 56-7 summarizes best nursing practices for postoperative care after an MIIHR. Chart 56-7

73
Q

 Colorectal Cancer
 Colorectal—refers to colon & rectum, which together make up large intestine

 Signs and symptoms

A 
Patients with ulcerative colitis with a history longer than 10 years have a high risk for colorectal cancer. This complication accounts for about one third of all deaths related to ulcerative colitis.
•	Age > 50 years
•	Genetic predisposition
•	Personal/family history of cancer
•	Familial adenomatous polyposis

• Physical Assessment

  • Bleeding & change in stool (most common signs)
  • changes in bowel habits, changes in stool consistency, blood in the stool, and abdominal discomfort.

• Gas, narrow stools
• Laboratory Assessment
• Fecal occult blood test (FOBT)
• Carcinoembryonic antigen (CEA)
• Imaging Assessment
• Barium enema
• Sigmoidoscopy-lower colon
Colonoscopy-entire large bowel
S/S:
The priority collaborative problems for patients with UC include:
1. Diarrhea due to inflammation of the bowel mucosa
2. Acute pain or chronic noncancer pain due to inflammation and ulceration of the bowel mucosa and skin irritation
3. Potential for lower GI bleeding and resulting anemia due to UC

74
Q

Peritonitis s/s

A

Inflammation of the membrane lining the abdominal wall and covering the abdominal organs.

s/s:
Increased pulse, increased BP, dehydration, pain, decreased bowel sounds
Nausea/vomiting, anorexia, above 100-degree fever
Rebound tenderness, board-like abdomen, rigidity, increased WBC
Diagnosed by X-ray

Treatment:
Identify the cause
Antibiotics
IV fluids
Decrease abd distension 
Nursing care:
IV and electrolytes
Balance and GI distension
Decrease infection process
Prevent complications: immobility, pulmonary, fluid balance

Risk factors?
Abd surgery
Ectopic pregnancy
Perforation:

PN2 RN (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions