NUR 2392 Multidimensional Care II

Multidimensional Care II Final Exam Study Guide 2021

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*The exam questions are not limited to only what is listed on this guide. Please refer to

your chapter readings, recordings, and module materials. ATI has additional practice

questions for review in Learning Systems RN 3.0. *

Ch. 56 – Care of Patients with Noninflammatory Intestinal Disorders

● Nonmechanical (ileus) vs. mechanical obstruction (intussusception, volvulus,

etc.)

o Non-mechanical: results from neurological disturbances that affect the

muscles. Can be primary or secondary (often based on anesthesia

medications). Remember to assess the patient's bowel tones for

complications from this!

▪ Paralytic Ileus: the bowel is not impacted by a physical

obstruction, but because of a lack of peristalsis as a result of

neuromuscular disturbance, causing backup of fecal contents and

abdominal distention and potentially leakage of stool contents into

the peritoneum space can occur, causing inflammation and

infection, decreased electrolyte levels and reduced blood volume.

o Mechanical: from a structural disturbance of the bowel.

▪ Adhesions: scar tissue from surgery that builds up and causes

obstruction

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▪ Benign or malignant tumors

▪ Appendicitis complications: if the appendix bursts, often the

contents will cause disruptions in fecal matter flow.

▪ Hernia: protrusion of the bowel through an opening that should

not be there, causing pain and blockages.

▪ Fecal impactions: from constipation

▪ Strictures: from crohns or radiation

▪ Intussusception: telescoping of the bowel into itself.

▪ Volvulus: twisting of the bowels, allowing nothing to go through.

o Physical Assessment

▪ Obstipation: severe constipation that may last for days without

any passage of stools. Diarrhea may be present in partial

obstructions

▪ Failure to pass gas

▪ Vomiting that may be foul smelling or coffee ground like.

▪ Abdominal Distention: abdominal when assess will be firm,

swollen, and painful

▪ Peristaltic waves: movement of the intestine, then stopping

▪ Borborygmi: high pitch gurgling bowel sounds

o Diagnostics:

▪ Barium Swallow

▪ CT with contrast

▪ Ultrasound

o Nursing Care:

▪ Monitor vitals

▪ Assess abdomen 2 times a day for bowel tones, distention, and

passing for gas

▪ Monitor F/E,I/O, lab values for disturbances- may need to give IV

fluid replacement due to potential loss of electrolytes such as NS

▪ Manage NG tube- often will be a salem sump tube

▪ Ensure tube patency

▪ Check initial tube placement with XRAY

▪ May need suction and decompression for the obstruction

● Metabolic alkalosis is a concern

▪ Check for tube placement (pH 0-4)

▪ Irrigate tube

▪ NPO status

▪ Perform mouth and nare care

▪ Place patient in a semi fowler's position

▪ Give pain medications

▪ Give alvimopan.

o Surgery

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▪ Exploratory laparotomy: will allow the provider to relieve and

locate the obstruction. may be large or small incisions.

▪ The RN should teach the patient about what to expect after such

as NG tube insertion and a clear liquid diet that will advance as

tolerated. Potential N and V.

o Patient Teaching

▪ Patients should eat high fiber foods, like raw fruits and veggies.

▪ Drink lots of water

▪ Do not use routine laxatives as they have a potential to become

abused. and cause damage to the abdominal muscles.

▪ Daily exercise needed to promote gastric motility

▪ Take bulk forming products and a stool softener.

▪ Sit on the toilet or commode rather than the bedpan.

▪ Must report and abdominal pain, distention, N,V,constipation

▪ Teach about incision care

▪ Drug therapy will often include percocet, stool softener.

● Polyps

o Small growths that are attached to the intestinal mucosa that are often

benign but can become malignant.

o Adenomatous: polyps that have the potential to become malignant

▪ Villious

▪ Tubular

o Hyperplastic: little chance to become cancerous polyps

o Malignant: those polyps that are cancerous when developed

o Familial adenomatous polyposis and hereditary nonpolyposis are

inherited that will eventually progress to colorectal cancer

o Assessment:

▪ Asymptomatic and usually discovered on a routine colonoscopy

screening

▪ May cause bleeding, obstruction or intussusception

o Diagnostics: biopsy and will often be removed at time of finding.

o Patient teaching: follow ups may be needed for complete polyp removals.

Teach about bleeding, abdominal distention and pain and blood in the

stool after the procedure.

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● Colorectal cancer labs (CEA), diagnostics

o Fecal occult blood test (FOBT) – positive test indicates bleeding in the GI

tract

▪ Patient needs to avoid aspirin, vitamin C, iron and red meat for 48

hours before giving stool specimen

▪ Also, assess whether the patient is taking anti-inflammatory

drugs, need to be discontinued

▪ Negative results do not completely rule out the possibility of CRC

o Carcinoembryonic antigen (CEA) – an oncofetal antigen is elevated in

many people with CRC

▪ Normal value is less than 5 ng/mL

▪ This protein is not specifically associated with the CRC, and it

may be elevated in the presence of other benign or malignant

diseases and in smokers

▪ It is often used to monitor the effectiveness of treatment and to

identify disease recurrence

● Imaging Assessment

○ Sigmoidoscopy – provides visualization of the lower colon using a

fiberoptic scope

○ Colonoscopy – provides better visualization of polyps and small

lesions than does a barium enema alone

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● Irritable bowel syndrome health teaching and testing (hydrogen breath test)

o Types

▪ IBS C: constipation

▪ IBS D: diarrhea

▪ IBS M: mixed constipation and diarrhea 

▪ IBS A/U: alternating constipation and diarrhea or unknown

o Hydrogen breath test or small-bowel bacterial overgrowth breath test.

When small-intestinal bacterial overgrowth or malabsorption of nutrients

is present, an excess of hydrogen is produced. Some of this hydrogen is

absorbed into the bloodstream and travels to the lungs where it is

exhaled. Patients with IBS often exhale an increased amount of

hydrogen.

o Teach the patient that he or she will need to be NPO (may have water) for

at least 12 hours before the hydrogen breath test. At the beginning of the

test, the patient blows into a hydrogen analyzer. Then, small amounts of

test sugar are ingested, depending on the purpose of the test, and

additional breath samples are taken every 15 minutes for 1 to 5 hours

● Teaching and nutrition

● Dietary fiber and bulk help produce bulky, soft stools and

establish regular elimination habits.

● The patient should consume 30-40 g of fiber each day

● Eating regular meals, drinking 8-10 glasses of water each day,

and chewing food slowly help promote normal bowel function.

● Drug therapy depends on main symptoms of IBS

○ Constipation-predominant IBS treated with bulk forming

laxatives

○ Diarrhea-predominant treated with antidiarrheals

● Patient with intestinal bacterial overgrowth are recommended to

use probiotic supplements

● Stress management

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Ch. 57 – Care of Patients with Inflammatory Intestinal Disorders

● Peritonitis symptoms

○ Peritonitis is a life-threatening, acute inflammation and infection of the

visceral/parietal peritoneum and endothelial lining of the abdominal

cavity.

○ Peritoneal cavity is contaminated by bacteria from peritoneum

perforation from appendicitis, diverticulitis, PUD, penetrating wounds,

gangrene gallbladder, bowel obstruction, tumors, surgery.

○ Inflammation spreads resulting in peritonitis

○ Fluid is shifting into the peritoneal cavity causing a significant decrease

in circulatory volume and hypovolemic shock.

○ Decreased circulatory volume results in insufficient perfusion to kidneys

leading to acute kidney injury and impaired fluid and electrolyte balance.

○ Peristalsis slows or stops

○ Bacteria can enter the bloodstream causing septicemia

○ Respiratory problems can occur as result of increased abdominal

pressure

○ Key Features:

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