NR-341 Complex Adult Health

Complex Final Exam Q & A

What is the purpose of dialysis?

- used to correct fluid and electrolyte imbalances and to remove waste products in

kidney failure. It can also be used to treat drug overdoses.

S/S of an upper GI bleed

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- Sudden onset, insidious occult bleeding, black tarry stools, coffee ground

appearance

- Elevated BUN, decreased concentrated urine output

- Tense, rigid board like abdomen, hyperactive vowel sounds

- Rapid shallow respirations, decreased LOC

What is the greatest risk of a GI bleed?

- Shock or bleeding out

Perforation or peritonitis

Priority treatment for a GI bleed

- Assess blood loss

- Protect airway

- Hemodynamic stabilization

- Endoscopy (angiography if endoscopy fails)

- Gastric lavage

- Control gastric acid secretions

- Packed RBCs

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What can often present as the first signs of GI bleeding?

- Vomiting and feces

- bright red vomit, coffee ground vomit

- bright red stool, black tarry stools

- occult bleeding not visible 

Causes, S/S, and treatment for Esophageal varices

Causes

- Portal hypertension

S/S

- Bleeding

Treatment

- Endoscopy ligation or banding

- Balloon tamponade tubes

- Vasopressin, or beta blockers, or octreotide acetate

Causes, S/S and treatment for Mallory-Weis tears

Causes

- Long-term NSAID use, alcohol abuse, forceful retching, binging & purging, bulimia

S/S

- Mild- severe GI bleeding

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Treatment

- Surgical intervention with vasoconstrictors to control hemorrhage

Treatment for esophagitis

- Suppressing gastric acidity, improving gastric emptying, and decreasing pressure

on esophageal sphincter

Treatment for bowel disorders (Ulcerative colitis & Chrons)

- Reduced by pharm interventions & diet changes

Surgery may be needed

Peritonitis

- Occurs when erosion of layers of GI wall

Causes: abd. Surgery, ectopic pregnancy, trauma, ulcer, perforated appendix or

diverticulum

- Sudden severe abdominal pain, tenderness and distention

- Painful, board like abdomen, fever, dehydration, rebound tenderness

Treatment: Antibiotics, IV fluids, decrease abd. Distention, surgery to close

perforation, position with knees flexed

Upon assessment the patient with a GI bleed may have what type of bowel sounds?

- Hyperactive bowel sounds

Futile care

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- care that is useless and prolongs the time until death rather than restoring life

Large bone or multiple bone fractures place clients at risk for what complication

- Fat embolism

Central Venous Pressure (CVP)

- Catheter in superior or inferior vena cave

> triple lumen

> direct measurement of pressure in right atrium

Complications:

> infection

> pneumothorax or hemothorax

> Carotid puncture, heart perforation

> Dysrhythmias (Dr. will pull back a min & decide to proceed or not)

If you have an atrial pacemaker where is the spike?

- Before the P wave

If you have a ventricular pacemaker where is the spike?

- Before the QRS

Once a patient is extubated you want to monitor for...

- Strider - high pitch squeal

- Hoarseness

- Change in VS

- Low O2 stats

- NPPV 

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