1
Q
common complications with a colonoscopy?
A
abdominal cramping, flatus, watery stools
2
Q
inserting an NG tube
how to measure?
neck position?
what do you do if you meet resistance?
when can you remove stylet?
what to do if pt coughs or gags?
what to do if it becomes dislodged?
A
- measure the tube from the tip of the nose to the earlobe to the xiphoid process
- first neck is extended then later it is flexed and pt takes small sips of water
- resistance- allow for rest periods
- remove stylet after XR
- withdraw the tube slightly and allow them to take a few breaths
- contact the HCP get a repeat x-ray before resuming any feedings or meds
3
Q
Nasoenteric tube?
what is the risk?
A
- avoids the esophagus and stomach
- inc risk for aspiration compared to NG tubes bc it can get dislodged into lungs
4
Q
dysphagia diet?
type of food?
position?
do NOT?
A
- puréed or liquids (second)
- sit client at 90° angle
- Do NOT: make the consistency too thin or it the risk of aspiration, use a straw bc it difficulty swallowing and choking
5
Q
Bilroth II
risk for? and sx of this? and how to prevent this?
A
- risk for: dumping syndrome
- sx: hypotension, abdominal pain, n/v, dizziness, sweating, tachycardia
- Lie down after eating, do not consume fluids with meals (wait 30 min)
6
Q
appendicitis
where is the pain?
A
- periumbilical region then moves to RLQ centering at McBurney’s point
7
Q
irrigating a colostomy
where do you place the irrigation container?
how long do we irrigate?
A
- place the irrigation container approximately 18-24 inches above the stoma
- irrigate 5-10 min
8
Q
cholecystitis pain location?
murphy’s sign?
A
- RUQ pain referred to right shoulder and scapula
- murphy’s sign: palpitation over RUQ causes pain and inability to take a deep breath
9
Q
hanging enema
where do you direct the rubing when you insert it?
what to do if abd cramping occurs?
A
- direct tubing tip toward umbilicus during insertion to prevent intestinal perforation
- slow rate
10
Q
barium enema
what is it?
pre op? drink and diet?
post op?
A
- Visualizes the colon to detect polyps, ulcers, tumors, diverticula
- Pre op:
- cathartic (empties stool from colon),
- CL diet the day before
- NPO 8 hours prior,
- Post op:
- laxatives after
- higher fiber diet and high fluids to expel contrast
- poop will be chalky white
11
Q
bariatric surgery
diet post op?
risk for?
best food choice for a FL diet?
A
- small meals of CL, then advance to FL 24-48 hours later then progress to solid foods
- Low in simple carbs (can lead to dumping syndrome) and high in nutrients (fiber, protein)
- The best foods include for a FL diet: cream soups, refined cooked cereals, sugar free drinks and low sugar protein shakes and dairy foods
12
Q
ulcerative colitis?
sx?
meal timing?
diet?
toxic megacolon sx?
A
- UC: Inflammation and ulceration of the LI
- sx: abdominal pain, bloody diarrhea, anorexia, anemia
- Small frequent meals
- high protein, high calories, multivitamins (calcium)
- oral hydration is critical as bc diarrhea is common (drink at least 2 liters of water daily)
- Toxic megacolon: abd distension, bloody diarrhea, fever
13
Q
small bowel follow through (SBFT)
procedure?
what are we looking for?
A
- Examines the anatomy and function of the SI
- Barium is ingested and the x-ray images are taken every 15 to 60 minutes to visualize the barium as it passes through the SI
- identifies inc or dec motility, fistulas or obstructions
14
Q
salem sump tube?
can you use it for continuous suction?
can you check residual volume with this?
can you use it for feedings?
do you want the air vent/blue pigtail open? and where do we want this placed?
A
- basically an NG tube used for decompression of the stomach
- Can be used for continuous suction
- The air vent (blue pigtail) must remain OPEN
- above the level of client’s stomach
15
Q
acute pancreatitis
why do we want them NPO?
why do we want an NG tube?
pain location?
position to dec vs inc pain?
position to dec abd tension?
normal findings?
risk for?
A
- NPO: stimulates secretion of pancreatic enzymes
- NG tube: suction out gastric secretions to dec nausea
- Pain: LUQ or midepigastric that radiates to back
- Pain dec with leaning forward or side lying and head 45 degrees
- pain inc with lying flat and high fat meals
- flex trunk and draw knees up to abdomen (semi fowlers) to dec abdominal tension
- Normal findings: hyperglycemia, severe burning, steatorrhea, inc pancreatic enzymes
- Risk for hypovolemia (third spacing), ARDS, hypocalcemia, peritonitis, pancreatic abscess development (high fever, leukocytosis, abd pain)
16
Q
hernias
which is a medical emergency?
sx?
tx?
A
- Rolling or paraoesophageal hernia is a medical emergency
- Sx: GERD, heartburn, dysphagia, pain with supine positioning, abdominal pressure
- Tx: dec fatty foods, small frequent meals, dec fluid intake during meals, do not eat close to bedtime, avoid lifting, elevate HOB
17
Q
ileostomy and colostomy?
stool type?
diet?
when do you empty the pouch?
what colostomys do we irrigate?
A
- ileostomy: Stool is very liquid
- colostomy: stool is formed
- ilestomy diet:
- Low residue/fiber, no stringy veggies, no seeds, no edible peels (apples, cucumber, dried fruit)
- colostomy diet
- Adequate fluid intake, no foods that cause gas (broccoli and cauliflower),
- empty pouch when it is 1/3 full
- DO NOT irrigate a transverse or ascending colostomy, but irrigate a descending colostomy
18
Q
diverticulitis
etiology?
pain location?
complications?
A
Etiology: chronic constipation, high residue/fiber
- pain: LLQ
- Complications:
- abscess formation
- intestinal perforation
- peritonitis (pain in other quadrants of abdomen, rigidity, guarding, rebound tenderness)
- Client should lie still and take shallow breaths and need to report to HCP immediately
19
Q
celiac disease
what can/cant they eat?
A
- Can’t eat gluten- BROW: barley. Rye, oats, wheat
- Allowed rice, corn, potatoes
20
Q
Guaiac fecal occult blood test
screening for?
what can give false test results?
procedure?
how do we know if test is positive?
A
- Screening for colorectal CA
- false test results: ingestion (last 3 days) of red meat, anticoags, corticosteroids
- procedure:
- Open the sides flap and use the wood an applicator to apply to separate stool samples to the boxes on the slide
- close the slide cover and allow the stool specimen to dry for 3 to 5 minutes
- open the back of the slide and apply two drops of developing solution
- asses within 30-60 sec
- Positive: paper will turn blue, indicating blood in stool
21
Q
peritonitis
complication of what?
sx?
tx?
A
- Serious complication of peritoneal dialysis
- Sx: cloudy peritoneal effluent (early), low grade fever, tachycardia, abd pain, rebound tenderness (late)
- Get a C&S from peritoneal fluid then abx based on results
22
Q
AV fistula
how long does it take to mature?
complications?
report?
do not?
how to check its function?
A
- 2-4 months to mature
- Complications: stenosis, thrombosis, hemorrhage
- Report: numbness/tingling
- do NOT: allow anyone to draw blood or take NP on that extremity, do not carry heavy objects with that arm, no restrictive clothing or jewelry, do not sleep on arm
- check its function several times/day by feeling vibration (thrill)
23
Q
refeeding syndrome?
what electrolyes are affected?
A
- After a malnourished client receives feedings insulin secretion is inc leading to a dec in phosphorus, K+, Mg+
- Hypophosphatemia: muscle weakness, RF
- Hypokalemia/hypomag: cardiac arrhythmias
24
Q
IBS
what can it cause?
foods we want and dont want?
A
- can cause diarrhea and/or constipation
- Restrict gas producing foods (bananas, cabbage, onions), caffeine, alcohol, FODMAPs, dairy, spices
- Tolerate protein, bread, bland good
25
Magnetic resonance cholangiopancreatography (MRCP)?
what does it use?
what do we want to check for prior?
NPO?
* Visualizes biliary, hepatic and pancreatic ducts via **_MRI_**
* uses oral or IV gadolinium (non-iodine contrast)
* Check for
* metal or electrical implants
* allergies to contrast
* pregnancy: ask when they had their period (pregnancy concern)
* NPO for 4 hours prior
26
Endoscopic retrograde cholangiopancreatography (ERCP)?
risk for?
* Endoscope passed through duodenum to assess pancreatic and biliary ducts
Perforation or irritation can cause acute pancreatitis
Sx: epigastric or LUQ pain radiating to back and rapid in pancreatic enzymes
27
liver biopsy
preop?
positioning during and post?
* Prior/after to procedure:
* assess for rising pulse and respirations after
* check PT/INR and PTT values
* ensure the clients blood is typed in cross matched
* position during: supine, right arm overhead and holding my breath,
* Post procedure: lie on the right side for a minimum of 2-4 hours
28
Labs with liver dysfunction
albumin?
ammonia?
INR and PT?
AST/ALT?
* albumin: low
* ammonia: high
* INR and PT: High
* AST/ALT: High
29
transmission
hepatitis A
hepatitis B
hepatitis C
* hepatitis A: fecal/oral
* hepatitis B: sex, body fluids, blood
* hepatitis C: sex, body fluids, blood
30
hepatitis
what do we avoid?
meals?
* avoid: hepatotoxins (alcohol, acetaminophen), meds metabolized by liver should be used cautiously (appetite stim, antipruritic, analgesics, sedatives)
* Low fat, high cal, high carb, small/frequent meals
* eat larger breakfast,
* avoid extreme food temp
31
Cirrhosis
sx?
meals? (cal, carbs, fat, Na, protein)
meds to NOT admin?
* Pruritis: due to buildup of bile salts under skin
* cholestyramine (questran)—give 1 hr after all other meds
* high calories, high carb, low fat, low Na, do NOT restrict protein
* no acetaminophen, -statins, aspirin, NSAIDs
32
Hemorrhoids
pain post hemorrhoidectomy?
post op tx?
* Pain after hemorrhoidectomy: severe due to spasms of anal sphincter
* post op: Sitz bath 1-2 days post op, use stool softeners, drink fluids
33
JP drain normal output?
80-120mL/hr of serosanguineous or sanguineous drainage for the 1st 24 hrs after surgery can be expected
34
DASH diet
Eliminate foods: high in sodium, sugar, cholesterol, trans or saturated fats, less red meat
Focus on eating fruits/veggies, whole grains, fat free or low fat dairy, dec sweets intake
35
Metabolic syndrome
* Presence of \> 3metabolic health factors that risk for stroke, DM, CV disease
* Abdominal obesity
* High serum triglycerides
* Low HDL
* Fasting blood glucose of \>100
36
chronic kidney disease (CKD)
risk for?
avoid?
what do we want to restrict?
* Risk for fluid overload and hyperkalemia
* Avoid salt substitutes bc they can contribute to hyperkalemia
* Sodium and K+ restriction, low protein diet (but if client is on HD, protein intake is recommended), low phosphorus diet
NCLEX
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