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Galen College of Nursing NURSING 242Med Surg Exam 3 study guide 100% verified

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Exam #3 Study guide GI GI AssessmentInspect > Auscultate > Palpate If bulging or pulsating mass is present, DO NOT PALPATE as this may be a AAA. Report immediately or any observable peristaltic ac... tion. Ask when last BM? Was it normal for the pt.? To promote eliminationPosition- upright, sitting. Output- adequate hydration. Offer fluids. Privacy. Exercise. Report results. Observe- Size (amount), Consistency, Occult blood, Odor, Peristalsis. Textures of stoolSausage shaped, smooth & soft- optimal stool. Separate hard lumps- lacking fiber & fluids. Increase fluids. Eat more fruits and veggies. Watery, no solid pieces, all liquid- diarrhea. Probably due to some type of infection. Stool needs to be eliminated. Increase fluids to compensate loss. Floating stool- indicative of low iron Soft, sticks to the side of the toilet bowl- Fat(steatorrhea). Indicative of pancreatitis. Occult blood/GuaiacPrior to testing avoid, raw fruits, vegetables & red meat. Vitamin C-rich foods, juices, & tablets must also be avoided. Anticoagulants & NSAIDS m=should be d/c 7 days prior. Occult blood is old blood that is not visible in the stool. Bleeding may occur anywhere in the GI system. Bright red blood comes from the lower intestine. Dark tarry stools are usually from the upper GI tract. Avoid urine and paper in stool samples. Stool CulturesObtain with tongue depressor or spoon. Pt will be in contact Isolation prior to results. List any ABX on specimen container. Avoid contaminating the specimen with paper or urine. Pinch off a sample from each end of the stool. Include any mucous or blood. Lipase- 56-190 Amylase- 0-110 Persistent elevation of amylase & Lipase is indicative of pancreatitis. Antacid- QUICK Ca+ based buffer. Tums. H2- blocks histamine receptor. Take before meals, 30 minutes before antacids. * watch for confusion* PPI- Shuts off acid production. Works well for NPO pt.’s. Take 30 minutes before meals. GERD (reflux)- Backward flow of gastric contents into esophagus causes irritation & inflammation of mucosa. Avoid Caffeinated beverages, chocolate, citrus fruits, tomatoes, smoking, calcium channel blockers, nitrates, peppermint, spearmint, alcohol. Factors contributing to decreased lower esophageal sphincter pressure- anticholinergic drugs, high levels of estrogen & progesterone, NG tube placement. Remain upright for 1-2 hours after meals. Never sleep flat in bed (elevate the head of your bed 6-12 inches) Hiatal hernia- protrusion of stomach through the diaphragm into the chest. s/s typically worse after a meal. Do not lie down for 1 hours after eating. Remain upright for several hours after eating. Avoid straining or excessive exercise. Refrain from wearing tight/constrictive clothing around the abdomen, Eat 6 small meals a day. Elevate bed while sleeping. When assessing, if you hear crackles, they have aspirated. Lie on RIGHT side to facilitate flow!!! Sliding- heartburn, regurgitation, chest pain, dysphagia, belching Rolling (paraesophageal)- fullness after eating, breathlessness after eating, feeling off suffocation, chest pain that mimics angina, worsening of manifestations in a recumbent position. Strangulated- Blood supply is cut off. Emergent situation. Incarcerated- Hernia is trapped outside peritoneal cavity. Reducible- Hernia moves back into the peritoneal cavity. Postoperative care- Clear liquids for 24 hours. Soft diet after the first day. Continue drug therapy as prescribed (PPI’s). no NG tubes x 1 month. Contact MD if these s/s result- chest or abdominal pain, bleeding, dysphagia, SOA, N, V. Elevate HOB 30 degrees. Ambulate ASAP. Shunt incision during cough. PUD (peptic ulcer disease)- a mucosal lesion of the lining of the stomach or duodenum. It results when the mucosal defenses become impaired and no longer protect the epithelium from the effects of acid & pepsin. Risk factors- stress, h. pylori, alcohol, smoking, gastritis. [Show More]

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