MDC2 Final Exam Study Guide PDF

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MDC2 Final Exam Study Guide Study Materials https://create.kahoot.it/share/mdc2-final/e294b19e-458d-4121-bafe-342f7b1d01dd? fbclid=IwAR3VQdZODU1_qRlMPbhuYuB3IJwUAdd14Q7bF1-YtUOhpv1fl0EdEhnrD9s

ATI Adaptive Quizzes- Endocrine and GI

https://quizlet.com/_9xuw6a?x=1qqt&i=2z3d5j https://quizlet.com/_9xx5q3?x=1jqt&i=2z3d5j https://quizlet.com/_9xxoz8?x=1jqt&i=2z3d5j https://quizlet.com/_9y0fis?x=1qqt&i=2z3d5j Med Surge Success book (found in library)= ch 7 # 13-24,37-144, ch 8 # all questions *The exam questions are not limited to only what is listed on this guide. Please refer to your chapter readings, recordings, and module materials. ATI has additional practice questions for review in Learning Systems RN 3.0.

Ch. 56 – Care of Patients with Noninflammatory Intestinal Disorders ● Nonmechanical (ileus) vs. mechanical obstruction (intussusception, volvulus, etc.) o Non-mechanical: results from neurological disturbances that affect the muscles. Can be primary or secondary (often based on anesthesia medications). Remember to assess the patient's bowel tones for complications from this! ▪ Paralytic Ileus: the bowel is not impacted by a physical obstruction, but because of a lack of peristalsis as a result of neuromuscular disturbance, causing backup of fecal contents and abdominal distention and potentially leakage of stool contents into the peritoneum space can occur, causing inflammation and infection, decreased electrolyte levels and reduced blood volume. o Mechanical: from a structural disturbance of the bowel. ▪ Adhesions: scar tissue from surgery that builds up and causes obstruction ▪ Benign or malignant tumors ▪ Appendicitis complications: if the appendix bursts, often the contents will cause disruptions in fecal matter flow. ▪ Hernia: protrusion of the bowel through an opening that should not be there, causing pain and blockages. ▪ Fecal impactions: from constipation ▪ Strictures: from crohns or radiation ▪ Intussusception: telescoping of the bowel into itself. ▪ Volvulus: twisting of the bowels, allowing nothing to go through. o Physical Assessment ▪ Obstipation: severe constipation that may last for days without any passage of stools. Diarrhea may be present in partial obstructions ▪ Failure to pass gas ▪ Vomiting that may be foul smelling or coffee ground like.

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▪ Abdominal Distention: abdominal when assess will be firm, swollen, and painful ▪ Peristaltic waves: movement of the intestine, then stopping ▪ Borborygmi: high pitch gurgling bowel sounds Diagnostics: ▪ Barium Swallow ▪ CT with contrast ▪ Ultrasound Nursing Care: ▪ Monitor vitals ▪ Assess abdomen 2 times a day for bowel tones, distention, and passing for gas ▪ Monitor F/E,I/O, lab values for disturbances- may need to give IV fluid replacement due to potential loss of electrolytes such as NS ▪ Manage NG tube- often will be a salem sump tube ▪ Ensure tube patency ▪ Check initial tube placement with XRAY ▪ May need suction and decompression for the obstruction ● Metabolic alkalosis is a concern ▪ Check for tube placement (pH 0-4) ▪ Irrigate tube ▪ NPO status ▪ Perform mouth and nare care ▪ Place patient in a semi fowler's position ▪ Give pain medications ▪ Give alvimopan. Surgery ▪ Exploratory laparotomy: will allow the provider to relieve and locate the obstruction. may be large or small incisions. ▪ The RN should teach the patient about what to expect after such as NG tube insertion and a clear liquid diet that will advance as tolerated. Potential N and V. Patient Teaching ▪ Patients should eat high fiber foods, like raw fruits and veggies. ▪ Drink lots of water ▪ Do not use routine laxatives as they have a potential to become abused. and cause damage to the abdominal muscles. ▪ Daily exercise needed to promote gastric motility ▪ Take bulk forming products and a stool softener. ▪ Sit on the toilet or commode rather than the bedpan. ▪ Must report and abdominal pain, distention, N,V,constipation ▪ Teach about incision care ▪ Drug therapy will often include percocet, stool softener.

● Polyps o Small growths that are attached to the intestinal mucosa that are often benign but can become malignant. o Adenomatous: polyps that have the potential to become malignant ▪ Villious ▪ Tubular o Hyperplastic: little chance to become cancerous polyps

Malignant: those polyps that are cancerous when developed Familial adenomatous polyposis and hereditary nonpolyposis are inherited that will eventually progress to colorectal cancer o Assessment: ▪ Asymptomatic and usually discovered on a routine colonoscopy screening ▪ May cause bleeding, obstruction or intussusception o Diagnostics: biopsy and will often be removed at time of finding. o Patient teaching: follow ups may be needed for complete polyp removals. Teach about bleeding, abdominal distention and pain and blood in the stool after the procedure. ● Colorectal cancer labs (CEA), diagnostics o Fecal occult blood test (FOBT) – positive test indicates bleeding in the GI tract ▪ Patient needs to avoid aspirin, vitamin C, iron and red meat for 48 hours before giving stool specimen ▪ Also, assess whether the patient is taking anti-inflammatory drugs, need to be discontinued ▪ Negative results do not completely rule out the possibility of CRC o Carcinoembryonic antigen (CEA) – an oncofetal antigen is elevated in many people with CRC ▪ Normal value is less than 5 ng/mL ▪ This protein is not specifically associated with the CRC, and it may be elevated in the presence of other benign or malignant diseases and in smokers ▪ It is often used to monitor the effectiveness of treatment and to identify disease recurrence ● Imaging Assessment ○ Sigmoidoscopy – provides visualization of the lower colon using a fiberoptic scope ○ Colonoscopy – provides better visualization of polyps and small lesions than does a barium enema alone o o

● Irritable bowel syndrome health teaching and testing (hydrogen breath test) o

Types ▪ IBS C: constipation ▪ IBS D: diarrhea ▪ IBS M: mixed constipation and diarrhea ▪ IBS A/U: alternating constipation and diarrhea or unknown

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Hydrogen breath test or small-bowel bacterial overgrowth breath test. When small-intestinal bacterial overgrowth or malabsorption of nutrients is present, an excess of hydrogen is produced. Some of this hydrogen is absorbed into the bloodstream and travels to the lungs where it is exhaled. Patients with IBS often exhale an increased amount of hydrogen.

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Teach the patient that he or she will need to be NPO (may have water) for at least 12 hours before the hydrogen breath test. At the beginning of the test, the patient blows into a hydrogen analyzer. Then, small amounts of test sugar are ingested, depending on the purpose of the test, and additional breath samples are taken every 15 minutes for 1 to 5 hours

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Dietary fiber and bulk help produce bulky, soft stools and establish regular elimination habits. ● The patient should consume 30-40 g of fiber each day ● Eating regular meals, drinking 8-10 glasses of water each day, and chewing food slowly help promote normal bowel function. ● Drug therapy depends on main symptoms of IBS ○ Constipation-predominant IBS treated with bulk forming laxatives ○ Diarrhea-predominant treated with antidiarrheals ● Patient with intestinal bacterial overgrowth are recommended to use probiotic supplements Stress management

Ch. 57 – Care of Patients with Inflammatory Intestinal Disorders ● Peritonitis symptoms ○ Peritonitis is a life-threatening, acute inflammation and infection of the visceral/parietal peritoneum and endothelial lining of the abdominal cavity. ○ Peritoneal cavity is contaminated by bacteria from peritoneum perforation from appendicitis, diverticulitis, PUD, penetrating wounds, gangrene gallbladder, bowel obstruction, tumors, surgery. ○ Inflammation spreads resulting in peritonitis ○ Fluid is shifting into the peritoneal cavity causing a significant decrease in circulatory volume and hypovolemic shock. ○ Decreased circulatory volume results in insufficient perfusion to kidneys leading to acute kidney injury and impaired fluid and electrolyte balance. ○ Peristalsis slows or stops ○ Bacteria can enter the bloodstream causing septicemia ○ Respiratory problems can occur as result of increased abdominal pressure ○ Key Features: ■ Rigid, boardlike abdomen is classic sign ■ Abdominal pain (classic) ■ Distended abdomen ■ Nausea, anorexia, vomiting ■ Diminishing bowel sounds ■ inability to pass flatus or feces ■ rebound tenderness in the abdomen ■ high fever ■ tachycardia ■ dehydration from high fever ■ decreased urine output

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■ hiccups ■ possible compromise of respiratory status Psychosocial assessment: ■ Patient may be fearful and anxious about implications of diagnosis ■ Provide calm, non anxious presence and reassure the patient that you will stay with them during this time Lab Assessment: ■ WBC elevated with high neutrophil count ■ Blood culture to determine is septicemia has occurred ■ Serum electrolytes ■ BUN, creatinine, HGB, HCT Imaging: ■ Xrays, ultrasound of abdomen Non-surgical interventions: ■ Assess vitals frequently ● Complication can include: ○ Septic shock: hypotension, decreased pulse pressure, tachycardia, fever, skin changes, tachypnea ■ Monitor mental changes ■ Asepsis when caring for wounds, drains, and dressings ■ Broad spectrum antibiotics as prescribed ■ Supplemental oxygen if needed ■ Restoring fluid balance: ● Hypertonic IV fluids and broad spectrum antibiotics ● Monitor daily weight and I and O ● NG tube decompresses the stomach and intestine ● NGT suctioning and NPO status require patient receive IV fluids ■ Managing Acute pain: ● Drug therapy: analgesics Surgical management: ■ Surgery may be needed to identify cause of peritonitis ■ Focuses on controlling the contamination, removing foreign material from the peritoneal cavity, and draining collected fluid. ■ Exploratory laparotomy or laparoscopy ■ If the surgeon requests peritoneal irrigation through a drain, maintain sterile technique during manual irrigation to prevent further risk for infection. Home care: ■ Length of hospitalization depends on severity ● No complications: DC in several days ● Others may require mechanical vent or hemodialysis and longer stays Self-management: ■ Report problems if: ● Unusual or foul-smelling drainage

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Swelling, redness, or warmth or bleeding from the incision site

● A temperature higher than 101° F (38.3° C) ● Abdominal pain ● Signs of wound dehiscence or ileus ■ Educate on wound care and medications ■ Refrain from lifting for 6 weeks

● Appendicitis ○ Pathophysiology: Appendicitis is an acute inflammation of the vermiform appendix that occurs most often among young adults. It is the most common cause of right lower quadrant (RLQ) pain. ○ All complications of peritonitis are serious. Gangrene and sepsis can occur within 24 to 36 hours, are life threatening, and are some of the most common indications for emergency surgery. Perforation may develop within 24 hours, but the risk rises rapidly after 48 hours. Perforation of the appendix also results in peritonitis with a temperature of greater than 101° F (38.3° C) and a rise in pulse rate. ○ Patients with appendicitis are hospitalized due to severity of illness ○ S and S: include abdominal pain followed by nausea and vomiting. Anorexia, muscle rigidity and guarding (rebound tenderness). Pain is present anywhere in the abdomen and flank area, more commonly in the RLQ “McBurney’s Point”. ● Abdominal pain that increases with cough or movement and is relieved by bending the right hip or the knees suggests perforation and peritonitis ● ●

Lab findings: Do not establish the diagnosis but often there is a WBC elevation Non-surgical management: ○ Patient is NPO to prepare for possibility of surgery ○ Pain management ○ IV fluids as prescribed to maintain fluid and electrolyte imbalances

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Surgical management: ○ Appendectomy: removal of inflamed appendix ○ Laparoscopy: minimally invasive surgery with one or more small incisions near the umbilicus ○ Laparotomy: open surgical approach with a large abdominal incision for complicated or atypical appendicitis.

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Complications: ○ Wound drains are inserted if peritonitis or abscesses are found and ng tube may be placed to decompress the stomach and prevent abdominal distention

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Administer IV antibiotics and opioid analgesics Help patient in and out of bed to prevent respiratory complications Patients may be hospitalized for as long as 3-5 days and may return to normal activity in 4-6 weeks.

● Gastroenteritis ○ Diarrhea and/or vomiting as a result of inflammation of the mucous membranes of the stomach and intestinal tract. It affects mainly the small bowel and can be caused by either viral (more common) or bacterial infection. ○ Epidemic viral gastroenteritis is transmitted by fecal-oral route in food and water. ○ Norovirus is transmitted by fecal-oral and possibly respiratory, affects adults of all ages and older adults can become hypovolemic and experience electrolyte imbalances. Leading foodborne illness and spread from human to human and contaminated food and water. ○ Campylobacter Enteritis, Ecoli diarrhea, and shigella are all bacterial gastroenteritis and are transferred by fecal-oral route ○ All forms last about 3 days ●

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Health promotion and maintenance ○ Handwashing and sanitizing surfaces and other environmental items to help prevent the spread of the illness. ○ Proper food and beverage preparation to prevent contamination Signs and Symptoms: ○ When obtaining patient history ask about recent travel, especially to tropical regions. inquire if the patient has ate at any restaurant within 2436 hours ○ Patient usually looks ill ○ Nausea and vomiting occur first ○ Abdominal cramps ○ Diarrhea ○ Patients that are older and have compromised immune systems ■ weakness and cardiac dysrhythmias due to loss of potassium from diarrhea. ○ Monitor for signs of dehydration Treatments: ○ Encourage fluid replacement ○ Oral rehydration therapy may be needed for some patients to replace fluid and electrolytes (Gatorade, pedialyte, powerade) ○ May need IV fluids in the hospital setting ○ Drugs that suppress intestinal motility are contraindicated due to them preventing infecting organisms from being eliminated from the body. ○ Antibiotics may be needed if gastroenteritis is caused by bacterial infection with fever and severe diarrhea such as Ciprofloxacin, Azithromycin ○ Teach patient to avoid toilet paper and harsh soaps to anal region to avoid irritation. Wash with warm water and gentle drying. ○ Use of protective barrier cream between stools ○ Sitz baths for 10 minutes 2-3x a day to relieve discomfort ○ If leakage is a problem, use panty liner or snug underwear

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Patient and family education regarding the risk of transmission of gastroenteritis: ■ Advise the patient to: ■ Wash hands well for at least 30 seconds with an antibacterial soap, especially after a bowel movement, and maintain good personal hygiene. ■ Restrict the use of glasses, dishes, eating utensils, and tubes of toothpaste for his or her own use. In severe cases, disposable utensils may be wise. ■ Maintain clean bathroom facilities to avoid exposure to stool. ■ Inform the health care provider if symptoms persist beyond 3 days. ■ Do not prepare or handle food that will be consumed by others. If you (the patient) are employed as a food handler, the public health department should be consulted for recommendations about the return to work. ● Ulcerative colitis vs Crohn’s disease Ulcerative Colitis ● ● ● ●

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Widespread inflammation of the rectum and rectosigmoid colon. Cause is unknown Periodic remissions and exacerbations Intestinal mucosa becomes hyperemic (increased blood flow), edematous, and reddened. More severe cases, the lining will bleed and small erosions and ulcers will form. Abscesses can form and edema and mucosal thickening can cause intestinal obstruction Four types based on severity ○ Mild: < 4 stools/day without blood ○ Moderate: > 4 stools/day without blood (minimal symptoms, mild abdominal pain, and mild intermittent nausea ○ Severe: > 6 bloody stools/day with fever tachycardia, anemia, abdominal pain ○ Fulminant: >10 bloody stools/day, increasing symptoms, may require blood transfusion Stool contains blood and mucus Pt reports tenesmus (unpleasant and urgent sensation to defecate Other S/S: ○ malaise ○ anorexia ○ anemia ○ dehydration ○ fever

Crohn’s Disease ● ● ● ● ● ● ●

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Chronic inflammatory disease of the small intestine, the colon, or both. Cause is unknown Peak incidence at age is 15-40 years Can affect the GI tract from the mouth to the anus but most commonly the terminal ileum Slowly progrssive and unpredictable Recurrent with remissions and exacerbations S/S: ○ Thickened bowel wall ○ Strictures and deep ulcerations ○ 5-6 soft, loose stools per day , nonbloody ○ Diarrhea ○ Low grade fever ○ Muscle guarding, abdominal pain ○ steatorrhea ○ weight loss ○ Masses ○ Rigidity, tenderness ○ Malabsorption of vital nutrients ○ Anemia Complications: ○ Hemorrhage due to erosion of the lower GI bowel wall ○ Severe malabsorption by small intestine ○ Rarely cancer ○ Fistulas ■ Fistulas can occur between segments of the intestine or

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○ weight loss ○ Abdominal distention Complications: ○ See Crohn's complication ----->>>> Psychosocial Assessment: ○ inability to control the disease symptoms, particularly diarrhea, can be disruptive and anxiety producing Laboratory Assessment: ○ Chronic blood loss lead to decreased HCT and HGB ○ Increased WBC count C-reactive protein, and ESR are all consistent with an inflammatory disease Other Diagnostics: ○ MRE to visualize the lumen, wall, and surrounding organs ○ Colonoscopy ○ Barium enemas can show differences between UC and Crohn’s Nonsurgical Interventions: ○ Decreasing Diarrhea ■ Record bowel movements and assessments to determine the severity ■ Monitor skin and perianal area for irritation and ulceration ■ Stool cultures ■ Weigh 1-2 times per week ○ Drug therapy ■ Aminosalicylates for antiinflammatory effect ■ Sulfasalazine ■ Glucocorticoids for inflammation and flare ups ■ Antidiarrheals ■ Immunomodulators to alter the immune response ○ Nutrition therapy and Rest: ■ NPO to ensure bowel rest ■ May prescribe TPN for severe cases ■ Avoid alcohol and caffeine , may increase diarrhea and cramping ■ High fiber foods can exacerbate GI symptoms ■ Avoid GI stimulants such as carbonated drinks, peppers, nuts, fruits

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manifest as cutaneous fistulas (opening to the skin) or perirectal abscesses. They can also extend from the bowel to other organs and body cavities, such as the bladder or vagina ○ Intestinal obstruction secondary to inflammation and edema ○ Abscess formation in the bowel lining ○ Toxic megacolon- paralysis of the colon causes dilation and subsequent colonic ileus ○ Osteoporosis Assessment: Noticing ○ Exacerbated by bacterial infection ○ Thorough abdominal assessment ○ Psychosocial assessment for patient and family ○ Lab tests indicate severity of inflammation and complications ○ X-rays, MRE, ultrasound Nonsurgical Interventions: ○ Drug therapy: ■ 5- ASA for mild to moderate CD ■ Azathioprine and Mercaptopurine for moderate to severe CD ■ Biological response modifiers (BRMs) ■ Glucocorticoids ● Use with caution ● monitor for signs of infection ■ Antibiotics : Cipro and metronidazole ○ Nutrition therapy ■ Poor nutrition can lead to inadequate fistula and wound healing. ■ Severe exacerbations require bowel rest and total parenteral nutrition ■ Nutritional supplements such as ensure ■ Teach to avoid GI stimulants and caffeinated beverages and alcohol. ○ Fistula management ■ Includes nutrition, elect...