NUR 2058 FINAL EXAM N2 STUDY GUIDE / NUR2058 FINAL EXAM N2 STUDY GUIDE (LATEST 2021) | RASMUSSEN COLLEGE

NUR 2058 FINAL EXAM N2 STUDY GUIDE

Elimination: Ch 49, 50, 53

- BPH
o Definition:
 Enlargement of the prostate gland because of overgrowth in number of
cells. This creates pressure on the neck of the bladder.
o Signs/Sx:
 Difficulty starting the stream of urine
 Voiding small amounts frequently as well as nocturia
 Weak, dribbling stream of urine
o Assessment:
 Common in middle age/elderly white males
 Hyperplasia creates enlargement tissue that is SOFT in consistency
(versus cancer, which is firm and nodular)
 Check PSA lab levels to differentiate between having BPH and cancer.
 Trouble starting urine stream, dribbling
 May feel as if he does not empty his bladder completely
 Nocturia
o Treatment:
 Surgery (removal of the enlarged tissue) [TURP is the procedure]
 Educate your patient on the complications of urinary incontinence,
sexual performance changes and ED
 Prescription Medications
 Cardura (doxazosin) can treat BPH as well as HTN.
 Diverticulitis
o What is it?
 Sac-like out-pouches through muscle layer of the bowel
 Most found in then sigmoid colon
o Signs/Sx:
 LLQ Pain
 Cramps, N/V, changes in bowel habits, fatigue, bloating, IBS, low-grade
fever.
 Changes in LOC: only if perforation has occurred or severe infection
o Causes:
 Low fiber diet, eating lots of processed foods, constipation, decreased
activity levels
o Tests:
 CT Scan
 DO NOT perform Barium or Enemas on these patients!!! Barium may
spill into abdominal cavity if diverticula are perforated.
o Treatment:

,  Avoid taking aspirin/NSAIDs/Warfarin/Coumadin – these can increase
risk of GI bleeding and are very irritating
 IV antibiotics, possible opioids for pain
 Stool softeners
 Draining of abscess
 Surgery
1. Bowel resection (taking portions of colon out)
2. Anastomosis (cut bowel and sew back together/diversion)
3. Colectomy (remove injured intestine and form a colostomy


 Crohn’s
o What is it?
 Chronic inflammatory bowel disease that relapses and remits. Once in
remission, the focus is keeping it in that remission state.
o Signs/Sx:
 PAINFUL!!!
 Pain with eating (eating can provoke it)
 Weight loss/malnutrition/anemia (patient doesn’t want to eat because it
causes abdominal pain)
 Diarrhea, weakness
o Assessment:
 Worse pain than Ulcerative Colitis
 Eating can trigger the pain
 Defecation can temporarily relieve symptoms
 Maybe a palpable mass in the RLQ
o Treatment:
 Surgical Resection of Colon (removal of a section of the bowel)
 Asacol (Anti-Inflammatory) – Take EVERY DAY
o Complications:
 Ulcers, abscesses, fistulas and intestinal obstructions
o Patient Education
 Medication Management
 Stay away from high fiber foods (we don’t want them to have bulky
stools)
 Regular colonoscopies
 Ulcerative Colitis
o What is it?
 Chronic inflammatory disorder that affects the mucosal and submucosal
layer for the colon and rectum.
o Signs/Sx:
 Bloody Diarrhea
 LLQ Pain

,  Weight loss, weakness, hypotension, tachycardia, fatigue (from anemia),
dehydration (from excessive diarrhea)
o Serious Complications:
1. Toxic Megalocolon: Severe episodes of colitis with total dilation of the
colon. The only treatment is to remove the entire colon.
2. Colon Perforation: If Toxic Megalocolon is not reversed, the colon will
become perforated.
o Treatments:
 There is NO CURE
 Symptoms come and go
- Medications:
o Cardura (doxazosin): used to treat BPH and HTN. Allows vasodilation which
decreases peripheral vascular resistence.

Fluid Electrolyte, Acid/Base, and Communication: Ch 12, 13

- Elderly
o Things that attribute to dehydration in the elderly population:
 Alzheimer’s/Dementia, Forgetfulness, ambulation issues, immobility, bed
bound, injury, limited function/mobility, stop drinking early in the day to
avoid having to get up/fear of wetting the bed, decreased sensation of
thirst (happens with age).

- Fluid Excess/Hypervolemia
o Signs/Sx:
 Distended neck veins (while sitting), bulging fontanels, bounding pulse,
crackles in lungs, increased BP, edema, increased urine output, decreased
Hematocrit
o What would you assess?
 Daily Weights (if rise of 2lbs+, call MD for CHF pts)
 Auscultate lungs, Reposition Q2 hours, Incentive Spirometer, Stop/Slow
IV infusions, Check Edema, CXR
- Fluid Deficit/Hypovolemia
o Signs/Sx:
 Skin tenting over clavicle, orthostatic hypotension, lack of tears,
depressed fontanels, thread pulses, dry mouth, thirst, cold/clammy skin,
decrease in urine output & decrease of wet diapers
o What would you assess:
 Skin Turgor, BUN & Creatinine (ratio of greater than 10:1 is
Hypovolemia), hematocrit levels will be increased
o How do you assess skin turgor?
 Tenting the skin on the Clavicle (not on the hand)