Latest NR-341 Complex Adult Health CMC Review 2023

Latest NR-341 Complex Adult Health CMC Review 2023 Resources - ATI: RN Adult Medical Surgical Nursing Edition 11 Expected findings of peptic ulcer disease - • Dyspepsia: heart burn, bloating, N/V (may feel like uncomfortable fullness or hunger) - • Dull gnawing pain or burning sensation at mid epigastric or back - • pain after eating - • Pain or epigastric tenderness or abdominal distension - • Blood emesis or stools - • Weight loss Nursing care for peptic ulcer disease - • Esophagogastroduodenoscopy - • If NG is placed monitor fluid amount & color - • Avoid foods that cause distress (coffee, tea, carbonated beverages) - • Orthostatic changes in VS = bleeding of perforation - • Encourage rest periods - • Saline lavage via NG tube When would a client be considered for surgery from PUD? - If ulcers do not heal following 12-16 weeks of medical treatment What signs/ symptoms are seen when a peptic ulcer perforates? - • Severe epigastric pain spreading across abdomen - • Pain can radiate into shoulders (especially right) - • Tender abdomen that is rigid (board like) - • Rebound tenderness - • Hyperactive to diminished bowel sounds - • manifestations of shock, hypotension, & tachycardia Dumping syndrome - Shift of fluid after ingestion of food (high carbs) - Manifestations: full sensation, weakness, diaphoresis, palpitations, dizziness, diarrhea vasomotor manifestations: 10-90 min after meal - pallor, perspiration, palpitations, feeling of warmth, headache, dizziness, drowsiness • NO LIQUIDS WITH MEALS or 1 hr prior to or after • AVOID MILKS AND SUGARS • can occur after gastrectomy Emergency care of a GI bleed - • NPO - • monitor for shock - • If responsive- ABCs - • If unresponsive- CAB Bright red blood: fresh bleed Dark red (coffee ground): old blood What test confirms GI bleeding? And what can A positive finding be indicative of? - • three repeats of a positive guaiac Fecal Occult Blood Test confirms GI bleeding - • Positive results are indicative of Ulcer, Colitis, Cancer What drugs are given during angina and MI - MONA - Beta blocker Nitroglycerin teaching - • can take up to 3 - • sit or lie down to take - • call EMS if needs to take a 2nd pill - • medicine is light sensitive - • once open, only good for 3 months - • headache is common - • change positions slowly What is seen on ECG with angina? - ST depression, and/or T-wave inversion indicates presence of ischemia Expected findings of angina - • Anxiety, feeling of impending doom - • Chest pain (may radiate down shoulder or arm or jaw) - • “crushing” or “aching” - • N/V - • Pale, clammy skin - • Tachycardia, Tachypnea, heart palpitations, SOB - • Diaphoresis, ⬛J⬛ LOC - • FEMALE: pain between shoulders, ache in jaw, sensation of choking with exertion Cardiac catheterization Invasive diagnostic procedure used to evaluate presence & degree of coronary artery blockage - • catheter inserted into femoral artery (maybe brachial) and threaded into vessel - • identified by injection of contrast media under fluoroscopy - • assess renal function prior - • may need to withhold metformin up to 48 to prevent hypoglycemia - • pressure held on site after - • bed rest in supine position ** NPO 8hrs prior ** assess for iodine/ shellfish allergy • fluid to flush out kidneys If a blockage is found during a cardiac catheterization what will be used? - Percutaneous transluminal catheter angioplasty • balloon displaces plaque against vessel wall • stent deployed to keep vessel open • pt sent home with aspirin and Clopidogrel to make sure stent doesn’t clot off What medications are discontinued for a CABG? - Diuretics 2-3 days before surgery Aspirin and other coagulants 1 week prior Coronary artery bypass graft (CABG) - Bypass an obstruction in one or more of coronary arteries • splint incision when coughing • provide padding to bony prominences • report crackles • Dangle clients legs from side to side within 2 hr following extubation • Assist client in chair within 24 hr • Hypotension = graft collapse • Hypertension = bleeding from grafts and sutures • measure chest tube drainage every hour ** incisional pain = localized, sharp, aching, burning and often worsens with deep breathing Complications after a CABG - Hypothermia: monitor temp, provide warm blankets, heat lamps (shivering is common after surgery) - Bleeding: if low central venous pressures, pt needs more fluid - Neurologic deficits: asses pupils, LOC, sensory and motor function memory loss and neuro deficits can be temporary - Bradycardia: treated with transvenous pacemaker Beta blockers - Propranolol, Metoprolol, Carvedilol decrease heart rate and lower blood pressure by blocking beta receptors • monitor for fatigue, weakness, depression, and sexual dysfunction, ⬛J LOC can reduce hypoglycemia, tachycardia • 1st line treatment for glaucoma May cause bradycardia & hypotension • Do not give to asthma clients Anticoagulants - heparin, enoxaparin, warfarin - Contraindications: active bleeding, PUD, hx of stroke, recent trauma • monitor platelet levels & bleeding - Adverse effects: thrombocytopenia, anemia, hemorrhage Antiplatelet agents - Aspirin, Clopidogrel Dipyridamole, Clopidogrel - • caution with GI ulcers - • Tinnitus can be manifestation of aspirin toxicity • risk for bleeding • avoid herbal supplements If and ECG shows a prolonged PR inter