Summary NUR 2392, MDC II – Examination Blue Print – Exam 3 2023

NUR 2392, MDC II – Examination Blue Print – Exam 3 2023. Hiatal Hernia  Sliding vs Rolling- rolling clearly visible, sliding observed with position changes Sliding- development esophageal reflux, heartburn and chest pain, regurgitation, dysphagia and belching Rolling- No reflux, feelings after eating: breathlessness, chest pain, worse when recumbent, fullness  Assessment  Interventions-avoid late night eating, restricted diet, exercise, elevated head of bed, remain upright after eating, no tight clothes  Surgical care- soft diet, antireflux meds, report signs of infection o Oral Cavity Disorders (Assessment, S/S, Interventions)  Stomatitis-inflammation in oral cavity Assess for lesions/cracking lesions on pharynx may indicate extension down into esophagus, may need swallow studies Rinse with sodium bicarb solution every 2-3 hours, cool liquids, high protein & vitamin C  Oral Tumors (Leukoplakia vs Erythroplakia) Leukoplakia- (smoker’s patch) thickened white patches, slightly raised and rounded, can’t be removed by scraping  Erythroplakia- red lesions, precancerous  Oral Cancer- Mucosal  erythroplasia earliest sign  Red, raised, eroded areas  Lesion not healed within 2 weeks o Basal cell carcinoma  Asymptomatic  Resembles a scab  Primarily on lips  Karposi’s sarcoma  Malignant lesion in blood vessels  Raised, purple nodule/plaque  Usually painless  On hard palate  Salivary Gland Disorders Sialadenitis- inflammation of gland, bacterial or viral, decrease saliva production Interventions: hydration, warm compress, massage gland, saliva substitute Tumors- facial weakness or paralysis, assess facial nerve (CN VII) by wrinkling nose and brows, pucker lips, puff out cheeks, smile o Stomach Disorders  Gastritis (Risks, Assessment, S/S, Intervention)  Treatment: Medications & Education  Peptic Ulcer Disease (Etiology & Complications)  Medication Management  Interventions  Upper GI Bleed (Risks, Assessment, S/S, Intervention)  Gastric Cancer (Assessment, S/S, Intervention)  Dumping Syndrome (Assessment, S/S, Intervention, Education) Non-Inflammatory Disorders o Etiology, Assessment S/S, Interventions, & Management  Obstruction & Fecal Impaction  S/S- Nausea & Vomiting, Cramping, Abdomen distention, Pain, Obstipation, Long history of constipation, Fever, Tachycardia  Complications: High obstruction- Metabolic alkalosis, Low obstructionMetabolic acidosis, Peritonitis, Strangulated obstruction  Interventions: Monitor Vital Signs  Assess abdomen (BS, distention, flatus)  Monitor fluid and electrolyte status  Pain management  Manage nasogastric tube  Drainage  Patency  Placement  Irrigate  Mouth and nares care  Semi-Fowlers position  Preventing:  Eat high-fiber foods; raw fruits & veggies, whole-grain  Drink adequate amounts of fluids, esp water  No routine laxatives  Encourage regular exercise – walking daily  Natural foods to stimulate peristalsis – warm beverages, prune juice  Bulk-forming foods: Metamucil  Check stool for amount & frequency  Sit on toilet or commode rather than bed pan for elimination  Polyps- Small mucosal growths attached to surface of intestines  Most benign, Usually asymptomatic, Removed through scope procedure, Rectal bleeding, Intestinal obstruction, Intussusception  Colorectal Cancer-  S/S Rectal bleeding, Anemia, Change in stool consistency/shape, Transverse/descending colon may have obstruction, gas pains, cramping, incomplete evacuation, Rectosigmoid colon may have hematochezia, straining, narrowing of stools, dull pain, May have obstruction symptoms depending on location  Assessment, Management, & Education of Stomas  Stoma- Color and integrity: Reddish pink, Moist, Protrude about ¾ inch, Function in 2-3 days  Psychosocial needs  Education  Protect skin  Nutrition  Stool consistency  Irritable Bowel Syndrome  Chronic diarrhea, constipation, pain, bloating  Unknown etiology  Diet, stress, anxiety exacerbate  Food intolerance: Dairy products, Raw fruits, Grains  Diet  30-40 g/day fiber  Regular meals  8-10 glasses water  Chew food slowly  Medications  Bulk-forming  Antidiarrheal  Tricyclic antidepressants  Depends on symptoms  Complimentary therapy  Stress management  Daily probiotic  Peppermint oil capsules Inflammatory Disorders o Etiology, Assessment S/S, Interventions, & Management  Appendicitis-  Inflammation occur when it is blocked  Most common cause of RLQ pain  Located below the ileocecal valve  Most common complication is peritonitis  Treatment is surgery  Peritonitis “Hot Belly”  Life-threatening, acute inflammation & infection Primary:  infected via bloodstream Secondary:  injury or infection of abdominal cavity  Bacteria enter by perforation, leads to septicemia  S/S: Increased pulse and BP, dehydrated, pain, decreased bowel sounds, abdomen distention and rigidity, increased WBCs  Nursing Interventions: IV & Electrolytes, prevent complications, Monitor VS & Mental Status, Aseptic technique, Hypertonic fluids, NPO/NG for decompression, Broad-spectrum antibiotics, Surgical procedure  Gastroenteritis-  Norovirus- leading foodborne disease  Most cases, self-limiting, last about 3 days  Complications  Immunosuppressed  Older adults  Dehydration  Hypovolemia Assessment & Interventions:  Travel or foods in last 24-36 hours, N/V with cramping & diarrhea, Dehydration, Fever , Orthostatic BP, Oliguria  Replace fluids, Gatorade, Pedialyte, Powerade, No drugs to suppress motility, Antibiotics if bacterial, Skin care