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Med Surg 2 > Midterm > Flashcards

Midterm Flashcards

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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
What antiinflammatory medications are used for IBD? Why?
corticosteroids (inflammation) 5-ASA (mesalamine and sulfasalazine - (STOPS the body attacking itself)
26
What immunosuppressant medications are used for IBD? Why?
cyclosporine methotrexate (DMARD) - drink water bc nephrotoxic azathioprine (DMARD) suppress the immune system
27
What immunomodulator medications are used for IBD? What should be monitored?
infliximab adalimumab natalizumab monitor hypotension - decrease 20 BP sys monitor fever bc immune system is suppressed = infection easy
28
What antidiarrheal medications are used for IBD? What does it treat? What should be monitored?
diphenoxylate/atropine loperamide "LOW bowel movements" treats diarrhea monitor for cathartic colon
29
What antimicrobial medication is used for IBD? Why? What type of mouthwash should be used while on this medication? Why?
metronidazole first choice in treating C.diff alcohol free mouthwash - alc causes reaction - pt can get N/v, dizzy, irritability
30
What therapeutic procedures are done for IBD?
bowel resection Crohn's: - strictureplasty: stent to open stricture - surgical repair of fistulas: cut out and connect (anastomosis)
31
What are the nursing interventions for IBD?
- promote rest - monitor I&O - monitor hypokalemia - high protein, high calories, low-residue, low fiber diet - small frequent meals - food journal - TPN (short term)
32
What should a patient with IBD not eat?
oatmeal with cream
33
What can you give a patient with Crohn's disease to eat?
toast with jelly
34
Before giving medications to a patient who has Crohn's disease, what should be assessed?
fever
35
What is concerning for a patient with ulcerative colitis who is taking sulfasalazine?
decreased urine output
36
What should a nurse review for a patient with ulcerative colitis?
review electrolyte values
37
What should be assessed first for a patient who has ulcerative colitis and has severe diarrhea? Why?
heart rate and rhythm bc losing potassium
38
What should a nurse tell a patient who feels that ulcerative colitis controls their life?
"let's discuss potential factors that increase your s/s"
39
What is diverticular disease?
diverticulosis diverticulitis
40
What are the clinical manifestations of diverticulosis?
diverticulosis - little pouches of stress bubbles (diverticula) - asymptomatic - bloating - flatulence - changes in bowel habits
41
What are the clinical manifestations of diverticulitis?
diverticulitis - inflammation of diverticula - left lower quadrant pain - abd distention - fever, chill (infection) - tachycardia - N/V
42
What are the risk factors of diverticular disease?
low fiber, high fat, red meat diet aging constipation
43
What is a complication of diverticulitis?
peritonitis (rigid abdomen)
44
What are the diagnostic studies for diverticulitis?
decreased H&H increased WBC and ESR stool for occult blood + CT w/contrast of abd colonoscopy sx if positive bowel perforation
45
What are the plan of care for the acute phase of diverticulitis?
bowel obstruction will lead to NPO NGT (if N/V or abd distention ) IV fluids (PRIORITY) , morphine, antibiotics Rest
46
If a patient has diverticulitis with a large bowel obstruction, what should be monitored?
abdominal distention
47
What are the nursing interventions for diverticulitis?
- clear liquid until symptoms go - low-fiber then high-fiber when inflammation goes down - low-fat - hydration - NO enemas, laxatives, or colonoscopy
48
What food can you give to someone with diverticulitis?
grilled chicken with white rice
49
If a patient has diverticulosis, what can they eat to prevent diverticulitis?
navy bean soup and veggie salad
50
What is the first intervention for peritonitis caused by a ruptured diverticulum?
administer metronidazole IV
51
Describe intestinal obstruction
partial or complete blockage of intestine mechanical: physical impaction neurogenic: bowel stops responding to stimuli
52
What are examples of neurogenic obstructions?
hypokalemia opioids paralytic ileus cathartic colon
53
What are the clinical manifestations of an obstruction?
*abdominal distention* hyperactive bowel sounds above obstruction hypoactive bowel sounds below obstruction
54
What are the clinical manifestations of a small bowel obstruction?
higher in GI colicky (sporadic) pain frequent N/V
55
What are the clinical manifestations of a large bowel obstruction?
In abdominal area constant pain abdominal distention Fecal fluid around impaction
56
What are the complications of a small bowel obstruction?
electrolyte imbalance metabolic alkalosis fever
57
What are the complications of a large bowel obstruction?
metabolic acidosis dehydration
58
What are the diagnostic studies of bowel obstruction?
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
What are the nursing interventions for bowel obstruction?
NPO NGT IV fluids Semi-fowler's Pain control (avoid morphine, hydrocodone, hydromorphone) Antibiotic Ambulation
60
For a mechanical bowel obstruction, the patient complains that the intermittent bowel pain turned into constant pain. What should the nurse do?
check bowel sound (always assess first)
61
What is an ileostomy? What can you see?
opening in the ileum (small intestine) in the RLQ yellow, green, watery bile
62
What is a colostomy? What can you see?
opening in the colon formed feces, brown
63
What are complications of ostomies?
stomal ischemia - leads to necrosis intestinal obstruction (assess stoma/monitor)
64
What should a healthy stoma look like?
red "beefy" - after sx pink - long term moist and shiny
65
What does a bad stoma look like?
stomal ischemia/necrosis - discolored (pale, grey, purple)
66
When caring for a patient with an ostomy, what should the nurse do? Can an assistive personnel so this?
drain and measure the output AP can do this
67
What food can a person with a colostomy have?
pasta
68
For a patient with a new colostomy, is bleeding okay?
small amount of bleeding is okay
69
What is an expected outcome for a person with a new colostomy?
report of empowerment
70
What medications can a patient not take while having an ileostomy?
enteric coated medications
71
If a patient if anxious before a colonoscopy, how should the nurse respond?
"before the exam, the provider will give a sedative to make you sleepy"
72
What type of prevention is a colonoscopy or a family hx of colon cancer?
secondary
73
What are assessment findings of stroke, MS, and Parkinson's?
stroke - orientation status - speech MS - orientation status - speech Parkinson's - orientation status - speech - muscle movement - facial rigidity - ambulation pattern
74
If there is an air leak in a chest tube, what should the nurse do and monitor? BOWTIE
actions - palpate for subcutaneous emphysema - check the tubing on unit monitor - respiratory status - lung expansion exercise
75
What medications are given for Parkinson's disease?
levodopa/carbidopa
76
What clinical manifestations of multiple sclerosis should be monitored?
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
What is indicate a positive result for the Tensilon test? What is the antidote?
muscle contraction becomes stronger antidote: atropine
78
What is an expected finding for someone who has pleural effusion?
dullness upon percussion over chest
79
What action should be taken for someone with a water seal chest tube?
keep it below the level of the chest
80
What task can be delegated for a patient with a paralytic ileus?
apply petroleum jelly
81
What should a nurse teach a patient who has an MI about having blood drawn?
it will help determine the degree of damage to the heart tissue
82
What are the nursing interventions for a heart attack?
- morphine, oxygen, nitro, aspirin (MONA) - semi or full-fowler - monitor VS and EKG - IV access
83
What are the clinical manifestations of a MI?
Diaphoresis N/V Tachycardia
84
A patient with MG is taking pyridostigmine, when should the medication be taken? WHy?
take 45 min before a meal bc it creates secretions
85
What are the risk factors of MS?
young adults women genetics
86
What should the nurse tell a patient with PD who is taking bromocriptine?
rise slowly when standing
87
What is the fastest route for nitroglycerin?
sublingual
88
For endocarditis, what should a nurse do and monitor? BOWTIE
action - obtain sputum culture - give antibiotics monitor - temperature - neurostatus

Med Surg 2 (7 decks)

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