NR-341 Complex Adult Health

Complex Adult Health CMS Review

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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

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- 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

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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”

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- • N/V

- • Pale, clammy skin

- • Tachycardia, Tachypnea, heart palpitations, SOB

- • Diaphoresis, 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

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• 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

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- 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, 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

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