- Immunize against Hep A + B - No uprotected sex with known drug users to redue risk of Hep C - Less alchol
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Health prevention for Gallblader
- Avoid rapid weight loss - low fat, low cholestol - high fiber and calcium
More pregnancies increases risk for gallbalder disease
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When is increasing fluids contraindiated?
- Cardiac disease - Renal disease
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Gas can case right sided shoulder pain true or false?
true
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Interventions for gas pain
- Trendelenburg position - Ambulation - Abd massage
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How to make laxatives more appealing?
Pour over ice or chill in fridge
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What allergies should you check for before a test with contrast dye?
Shellfish, iodine
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Normal BS
5-30 per minute
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Absent BS
No BS in all 4 quadrents for 5 minutes
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HyPOactive BS
None for 30 seconds or less
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What could absent or hypoactive BS in one quadrent and hyperactive in annother mean?
Intestinal obstruction
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What does a dull vs high pitched sound mean when purcussing?
Dull = mass such as organ Higher pitch = resonant = air/fluid
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Patients recieving TPN (total parenteral nutrition) should be aware of what?
Can cause hyperglycemia due to high glucose content - CBG testing q4h - Must be given through central line
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Why is low suction used on most tubes?
To avoid damage to mucosa
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How high should the HOB be during NG feedings?
30 degrees during and for one hour after
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Types of tubes used for feeding
NG,PEG
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Decompression tubes
- Salem sump (into stomach) has pigtails - NG tube (into stomach) - Miller Abbott (into small intestine) - Cantor (into small intestine) - Harris (into small intestine) - Levin (into stomach)
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What should you do if salem sump pigtail is leaking/fluid inside?
Instill a few milli of air into tube to clear
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What does it mean to asess the patency of the tube?
Is it blocked or open
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NG tube hanging
Keep tubing leading into suction machine above the height of entry into drainage container
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Aspirating gastric juices
PH should be around 5 (proton pump inhibits can make higher) - looks like bile - Hold feeding if excessie residual is aspirated
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Pts draining large amounts of fluid from an NG tube are most at risk for what?
Metabolic alkalosis
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Consequnse of diarrhea?
Lowered nutitonal abosorption
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Foods for diarrhea
- Banannas - white toast - applesause - rice
NO Coffee and tea
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Ngs management for dysphagia
- thicken liquids - sit upright with head forward and chin tucked - keep suction equipment nearby always
Both restrictive and malabsorptive - gastric bypass RYGB
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Gallbladder side effect of bariatric surgery
Gallstones due to liver secreting extra cholestol into bile
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Obestiy VS morbid obestity
Obestiy = BMI greater than 30 Morbid Obesity = BMI greater than 40
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NG tube time frame/info
Less than 6 wks - x ray to check placement - test PH - Auctltating not relaibe
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PEG/PEJ tube time frame/info
- long term - not used if needed shorter than 4 wks
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Feeding tube spoiling guidelines
-Opened feeding formula = disgaurd after 24 hrs -Feeding bags filled by nurses with commercial foruma digaurd after 4-8 hrs - Open systems change q24h - Closed systems changed q24-48 hrs (bags pre filled at factory with formula)
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Bolus feeding
Via gravity over 15 minutes, only for patients with intact gag reflex
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Intermittend feeding
Thorugh pump
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How many ML of water should be used to flush a tube after each med?
15 mL
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Keeping patency of feeding tube
Flush with 30mL of water q4h during continuous feedings - 30 mL of water after each residual check - 15 mL before and after each med
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Should you clamp the feeding and suction before giving meds via tube?
Yes, stop feeding and clamp suction for 30 minutes before restarting after meds
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What does the gallbladder do?
Stores bile produced in the liver and delivers it to the small intestine.
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What is ascites?
Fluid in the abdominal cavity
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What will bilirubin in the urine look like?
dark
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What does undigested fat look like in the stool?
Stool will float in the bowl, if there is bile stool may be white
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If damage to the liver is stopped before all tissue is affected, it can regenerate (true or false)
True
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What is dumping syndrome?
After bariatric surgery when large amounts of food and liquid pass into jejunum. Occurs 15-30 min after eating s/s: - weakness - dizziness - tachycardia - abd cramping **** may help to lie down for 30 minutes after eating****
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Bowel training
Patient should be in private environment 20-40 min after a meal, digital stimulation is performed.
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Barrett's esophagus
GERD is primary cause - precancerous lesions
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Hiatal Hernia
Lower esophagus/stomach slides up into diaphragm and thorax - result of a defect in diaphragm wall - more common in women - cannot be seen
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Treatment of hiatal hernia
- No tight fitting clothes - elevating HOB 6-8 inches - not eating within 3 hours of bedtime - avoid fatty foods - reduce weight - no lifting heavy weight - Sit upright 2 hours after eating
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True or false: 90% of patients with GERD have a hiatal hernia
True
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What are patients on long term proton pump inhibitors at risk for?
Nutrient malabsorption of magnesium, calcium and b12
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Gastroenteritis
inflammation of stomach and small intestine - caused by intake of food/water contaminated with a virus (norovirus for example)
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Gastritis
Inflammation of MM on stomach lining (atrophic involves all layers) - usually caused by H-pyloi bacteria
H-pylori causes erosion of the gI mucosa, making it easily damaged by gastric juices. - massive hemorrhage can occur from ulcer
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Peptic ulcer (duodenal and gastric ulcers)
- H-pylori, smoking, NSAIDS are major causes - H-pylori causes erosion of the gI mucosa, making it easily damaged by gastric juices.
- Hot spicy foods and caffeine NOT PROVEN as a cause, but make s/s worse
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Acute stress ulcer
- more likely to hemorrhage - most likely caused by unrelieved stimulation of the vagus nerve - r/t being severely ill, burn patients, trauma patients, ect.
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S/S of peptic ulcer
Pain relieved with meals and in morning (when secretion is low), and high before meals and at bedtime
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Gastric cancer
- Usually discovered late because patients lack s/s - H-pylori, nitrites and nitrates in foods = risk factors
- anemia like symptoms due to blood loss in GI tract, may see blood in stool
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IBS
Altered motility of the small and large intestine - no known cause
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S/S of IBS
- Change in bowel elimination (constipation, diarrhea or both) - Abd pain and bloating relieved by defecation - Absence of detectable disease - Mucus in stool
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Where is diverticulitis pain located
Lower left abd - high fiber diet encouraged
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mechanical vs non-mechanical intestinal obstruction
Mechanical = tumors, twisting of bowel, strangulated hernias, adhesions Non-mechanical = absence of peristalsis
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Nursing care for intestinal obstruction
Fowler position to lower pressure - measure abd girth q 2-4 h
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Reducible hernia vs incarcerated hernia
Reducible = organ can be pushed back into place by pressing Incarcerated = organ is tightly wedged outside cavity, cannot be re-set
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Complications of incarcerated abd and inguinal hernias
Strangulation leading to necrosis
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Inguinal hernia
hernia in the groin area
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Non-incarcerated hernia nursing management
- may disappear when lying down - avoid lifting - brace site when coughing, sneezing
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Treatment of hernias
Mesh places, or a truss to re-enforce the weakened cavity wall
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Inflammatory bowel disease covers which disorders?
Ulcerative colitis (UC) and crohn's disease - more common in Jewish population - attacks of diarrhea
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UC VS Crohn's
UC: inflammation of rectum/colon Crohn's: masses of inflamed tissue in small intestine with "cobblestone" appearance
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Is bloody stool more common with UC or crohn's?
UC
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Diet for IBD (UC and CD)
Low fiber! - high protein - low fat
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true or false: patients with UC are more likely to develop colon cancer?
true
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Where is appendicitis pain located?
Halfway between the umbilicus and the crest of the ilium at McBurney point (LRQ) - pain when extending leg, walking
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Hot or cold for appendicitis pain?
COLD. Never hot. Hot can cause rupture of the appendix. - Also laxatives can cause rupture
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Peritonitis
- Inflammation of the peritoneum... usually occurs when one of the enclosed organs ruptures and contents spill out (ie appendix bursting) - peristalsis slows/stops CAN BE FATAL
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S/S of peritonitis
- board like abd rigidity - rebound tenderness - fever, chills, ect. Keep pt semi fowler, turn and move gently
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Colon cancer
- people most at risk = those with GI disorders such as UC - polyp like growths that cancer grows from - colonoscopy can help find polyps early and remove them b4 cancerous. Routinely starting at 45
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S/S of colon cancer
- change in bowel habits - weight loss - bowel obstruction
Dark red/pink - purple or black could mean necrosis
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Indications for ileostomy
- when disease causes the need to bypass the entire colon
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True or false: chewing gum can help reduce instances of postoperative ileus
true
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Cirrohosis
Chronic scarring of liver from disease such as - alcholism - Hep B and C - Blood vessels also begin to fail and leak into the abd
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True or false: if not too much tissue on the liver is damaged, it will regenerate?
True
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S/S of cirrosis of liver
- Rash - Leg and food edema - Bleeding and bruising due to vit k defficiency - Palpable nobby liver under right rib cage - Abd distention/acities - Spider angiomas - Dark and foamy urine - Clay colored stool - Jaundice
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Esophageal varicies
Complication of liver cirrosis - caused because normal blood flow to the liver is diverted to veins of stomach/esophagus - vein walls rupture, massive bleeding occurs - Tx by vasopressin
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Encephalopothy
Complication of liver cirrosis - Build up of toxins/ammonia due to liver failure - S/S: confusion, coma, flapping tremors of hands
-Lactulose given to lower intestinal absorption of ammonia
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Fector hepaticus
Occurs as liver failure progresses - breath with a sweet, fecal odor
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Acute pancreatitis
Inflammation of the pancreas (acute) - frequently accompanies gallstones blocking pancreatic duct - most common cause = alcoholism - pseydocysts may occur (sac like structure around the pancreas, danger of hemorrhage if rupture occurs)
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S/S of pancreatitis
- Left upper quad pain, eating makes pain worse - Lowered BS - gaurding and tenderness of abd
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Chronic pancreatitis
- Most common in men who have been drinking for years
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S/S of chronic panreatitis
- Abd pain - weight loss - mild jaundice - DM develops - dark urine