Gastrointestinal Problems (Exam Mode) By Rnpedia.Com

First, antacids and over-the-counter histamine – 2 blockers are used. In step two, prescription histamine – 2 blockers are prescribed. Finally, proton-pump inhibitors are used. Focus: Prioritization

Showing the student how to insert the suppository meets that immediate client need and the student’s learning need. The instructor can address the student’s fears and long-term learning needs once he/she is aware of the incident. It is preferable that students express fears and learning needs. The other options will discourage the student’s future disclosure of clinical limitations and need for additional training. Focus: Supervision/assignment

The nursing assistant should use infection control precautions for the protection of self, employees, and other clients. Planning and monitoring are RN responsibilities. While the nursing assistants can report valuable information, they should not be responsible for signs and symptoms that can be subtle or hard to detect, such as skin changes. Focus: Delegation

Reminding the client to follow through on advice given by the nurse is an appropriate task for the nursing assistant. The RN should take responsibility for teaching rationale and discussing strategies for the treatment plan and assessing client concerns. Focus: Delegation

Stay calm and stay with the client. If the client does anything to increase intra-abdominal pressure, the evisceration will worsen. Have a colleague gather supplies and notify the physician. Putting the client in a semi-Fowler’s position with knees flexed will decrease the strain on the wound site. Covering the site provides protection of tissue. Monitor vital signs particularly for decrease in blood pressure or increase in pulse. Anticipate and prepare the client for emergency surgery. Focus: Prioritization

The goal of bowel training is to establish a pattern that mimics normal defecation, and many people have the urge to defecate after a meal. If this is not successful, a suppository can be used to stimulate the urge. Incontinence briefs are embarrassing for the client and must be changed frequently to prevent skin breakdown. Routine use of rectal tubes is not recommended because of damage to the mucosa and sphincter tone. Focus: Prioritization

Immediate decontamination is appropriate because time can affect viral load. Occupational health will direct the employee in filing the correct forms, getting the appropriate laboratory tests, getting appropriate prophylaxis, and following up on results. Focus: Prioritization

First, you need to check the solution for cloudiness or turbidity (c). Then, select the correct tubing and filter (e). Next, thread the IN tubing through an infusion pump (b). After that, use aseptic technique when handling the injection cap (a). Connect the tubing to the central line (d). Finally, set the infusion pump at the prescribed rate (f).

The nursing assistant can reinforce dietary and fluid restrictions after the RN has explained the information to the client. It is also possible that the nursing assistant can administer the enema; however, special training is required and policies may vary between institutions. Medication administration should be performed by licensed personnel. Focus: Delegation

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Distention and rigidity can signal hemorrhage or peritonitis. Physician may also decide that symptoms require a medication to stimulate peristalsis. Absent bowel sounds are expected within the first 24 – 28 hours. Nausea and vomiting are not uncommon and are usually self-limiting, and a PRN order for an antiemetic is usually part of the routine post-operative orders. Assess the client’s reason for pulling tube, and secure as necessary. Focus: Prioritization

The experienced medical-surgical nurse will know the types of questions that clients generally ask during the pre-operative or discharge teaching. The new graduate may have enthusiasm and knowledge, but will lack practical application. SICU nurses are less involved in pre-operative or discharge teaching. LPN/LVNs can do teaching, but their educational scope does not provide for development of teaching materials and strategies. Focus: Assignment

Both clients will need frequent pain assessments and medications. Clients with copious diarrhea or vomiting will frequently need enteric isolation. Cancer clients receiving chemotherapy are at risk for immunosuppression and are likely to need reverse isolation. Focus: Assignment

The LPN/LVN can assist in the planning of interventions, but the RN should take ultimate responsibility for planning or designing. Obtaining equipment should be delegated to the nursing assistant. Contact physical therapy to set up specialized equipment. Focus: Delegation

A board-like abdomen with shoulder pain is a symptom of a perforation, which is most lethal complication of peptic ulcer disease. A burning sensation is a typical complaint, which can be controlled with medications. Projectile vomiting can signal an obstruction. Coffee-ground emesis is typical of slower bleeding and will require diagnostic testing. Focus: Prioritization

Body dysmorphic disorder is a preoccupation with an imagined physical defect. Corrective surgery can exacerbate this disorder when the client continues to feel dissatisfied with the results. The other criteria are indicators of candidacy for this treatment. Focus: Prioritization

RUQ is a sign of hemorrhage or bile leak. Ability to void should return within 6 hours post-operatively. Right shoulder pain is related to unabsorbed CO2 and will resolve by placing the client in the Sims’ position. Output that does not equal input after surgery for the first several hours is expected. Focus: Prioritization

When a client has esophageal varices, the vessels become very fragile and massive hemorrhage can occur. The mortality rate is 30% - 50% after an episode of bleeding. Ascites and edema occur when liver production of albumin fails. Asterixis is a sign of hepatic encephalopathy. Focus:Prioritization

Assisting with procedures in stable clients with predictable outcomes is within the educational scope of the LPN/LVN. Teaching the client about self-care or pathophysiology and evaluating the outcome of interventions are responsibilities of the RN. Focus: Delegation

A client with fractured femur is at risk for fat embolism, so fat emulsion should be used with caution. Vomiting may be a problem if the emulsion is infused too rapidly. TPN is commonly used for gastrointestinal obstruction, severe anorexia nervosa, and chronic diarrhea or vomiting. Focus: Prioritization

Disconnecting the tube from suction is an appropriate task to delegate. Suction should be reconnected by the nurse, so that correct pressure is checked. If the nursing assistant is permitted to reconnect the tube, the RN is still responsible for checking that the pressure setting is correct. During removal of the tube, there is a potential for aspiration, so the nurse should perform this task. If the tube is dislodged, the nurse should recheck placement before it is secured. Focus: Delegation

Nausea and vomiting are common after chemotherapy. Administration of antiemetics and fluid monitoring can be done by an LPN/LVN. The RN should do the pre-operative teaching for the glossectomy client. Clients returning from surgery need extensive assessment. The client with anorexia is showing signs of hypokalemia and is at risk for cardiac dysrhythmias. Focus: Assignment

Strangulated intestinal obstruction is a surgical emergency. NG tube is for decompression of the intestine. Abdominal x-ray is the most useful diagnostic aid. IV fluids are needed to maintain fluid and electrolyte balance and delivery of medication. Barium enema is not ordered if perforation is suspected. Focus: Prioritization

The immediate problem is controlling the diarrhea. Addressing this problem is a step to correcting the nutritional imbalance and decreasing the diarrheal cramping. Self-care and compliance with the treatment plan are important long-term goals that can be addressed when the client is feeling better physically. Focus: Prioritization

Assessment is the first step. Checking for tube placement prevents accidentally instilling feeding/medication into the lungs. The amount of residual volume determines whether the amount of the scheduled feeding is appropriate or whether the physician should be notified. Flushing the tube before and after feeding helps maintain tube patency. Focus: Prioritization