NUR 2349 / NUR2349 Exam 2 Study Guide (Latest 2021 / 2022): Professional Nursing I / PN 1, Study Guides, Projects, Research of Nursing

Download NUR 2349 / NUR2349 Exam 2 Study Guide (Latest 2021 / 2022): Professional Nursing I / PN 1 and more Study Guides, Projects, Research Nursing in PDF only on Docsity!

NUR 2349: Professional Nursing I Exam 2 Study Guide

MODULE 3: ELIMINATION

GI Elimination (Chapters 52 & 55-57):

• Assessment techniques o Start at RUQ o Inspection, auscultation, palpation ▪ Do NOT palpate if appendicitis or abdominal aneurysm is suspected. o Percussion and deep palpation: APRN’s & HCP’s
• Diagnostics (labs, endoscopy, ERCP, etc.) o Labs ▪ CBC ▪ PT, LFT’’s, bilirubin, & ammonia ▪ Renal panel ▪ Amylase/Lipase ▪ Urine tests ▪ Stool tests - Guiac fecal occult blood test (gFOBT) - Fecal immunochemical test (FIT) - Fecal Analysis o Imaging ▪ X-rays ▪ Double-contrast barium enema ▪ CT scan or MRI ▪ Endoscopy ▪ Esophagogastroduodenoscopy (EGD) ▪ Endoscopic retrograde cholangiopancreatography (ERCP) ▪ Colonoscopy ▪ Ultrasound
• Disease processes (Gastritis, PUD, Bowel obstruction, colorectal cancer, Crohn’s disease, UC, IBS, appendicitis, etc.) o Gastritis – inflammation of gastric mucosa ▪ Health Promotion & Maintenance - Balanced diet: o Limit caffeine o Limit acidic foods o Small, frequent meals o Avoid alcohol or tobacco - Regular exercise - Stress-reduction - Avoid excessive use of aspirin, NSAIDs. ▪ Diagnosis: - EGD w/ biopsy gold standard

• Cytologic examination (of biopsy): r/o gastric CA
• Rapid urease testing: H. pylori ▪ Interventions
• Symptom relief
• Elimination of causative agents (NSAID’s, H. pylori )
• Fluid/blood replacement (for active bleeding)
• Medications: o H 2 -receptor antagonists: Pepcid/Famotidine o Proton Pump inhibitors: Omeprazole/Prilosec & Pantoprazole/Protonix o Vitamin B 12 (chronic)
• Teaching! o Diet, stress reduction, NSAID’s o Peptic Ulcer Disease – PUD – mucosal lesion of stomach or duodenum ▪ Rigid abdomen w/rebound tenderness = perforation into peritoneal cavity!! ▪ Interventions
• Pain management
• Bland diet w/ small, frequent meals
• Medications (same as gastritis): PPI, H 2 -receptor antagonists, & antacids o Pepto-bismol: inhibhts H. pylori from binding to mucosal lining
• H. pylori treatment : o PPI + 2 Antibiotics (flagyl, & tetracycline OR clarithromycin & amoxicillin) x 10-14d
• CAM: o Herbal supplements o Relaxation techniques o Intestinal obstruction ▪ Nursing Interventions :
• Pain management - opioids
• NPO/Ice chips
• NGT placement – low continuous suction
• IVF replacement
• Daily weights
• Monitor VS & lab values ▪ Surgical Interventions :
• Exploratory laparotomy
• Adhesion lysis, embolectomy, &/or colon resection w/ colostomy o Colorectal Cancer ▪ Interventions
• Pain management
• Treat hemorrhage (if present)
• TNM Staging (tumor, nodes, metastasis)
• Radiation

• Chemotherapy
• Surgery: o Colon resection: removal of tumor and regional lymph nodes o Colectomy: colon removal o Often with temporary or permanent colostomy or ileostomy o Anastomosis: reattachment of the colon after colostomy o Colostomy ▪ Definition : Surgical creation of an opening of the colon onto the surface of the abdomen ▪ Appearance :
• Bright/beefy reddish-pink, resilient to touch
• Should protrude ¾”
• May bleed slightly if touched/rubbed ▪ Stoma Care :
• Change appliance q week & prn o Re-measure w/ every wafer change to ensure a proper pouch fit o Use skin barrier/protectant
• Empty when 1/3 to 1/2 full o May need to “burp” bag o Irritable Bowel Syndrome ▪ S/Sx :
• Weight change
• Fatigue/Malaise
• Abdominal pain
• Changes in bowel pattern (constipation or diarrhea – may alternate)
• Passage of mucus / change in stool consistency
• Causative factors: o Stress/anxiety o Diet o Certain foods (milk, spicy food, etc.) o Hemorrhoids ▪ Treatment/Interventions :
• Prevent constipation
• Topical anesthetics
• Stool softeners
• Hemorrhoidectomy o CDiff ▪ Nursing Care and Treatment :
• Contact Precautions
• WASH HANDS! (NO hand sanitizer)
• Probiotics (before infection)
• Antibiotics (infection treatment)
• Fecal microbiota transplantation (FMT)

o Peritonitis ▪ Infection prevention :

• Frequent VS assessment
• Neuro assessments
• Antibiotics
• Surgery ▪ Restore fluid volume balance
• Hypertonic IV fluids
• Daily weights
• Strict I/O’s
• NGT placement ▪ Manage pain o Chron’s Disease ▪ Definition : chronic inflammatory disease of the small intestine (most often), the colon, or both
• Thickened bowel wall, which can lead to strictures and deep ulcerations ▪ Etiology :
• Unknown

o Ulcerative Colitis ▪ Definition : widespread inflammation of mainly the rectum and rectosigmoid colon but can extend to the entire colon when the disease is extensive ▪ Etiology :

• Unknown
• Genetic, immunologic, and environmental factors

o IBD (chron’s/uc) ▪ Symptom management (diarrhea, pain) ▪ Perineal skin care ▪ Relapse prevention ▪ Pharmacologic :

• Aminosalicylates (Sulfasalazine)
• Glucocorticoids (predisone)
• Immunomodulators (Remicade & Humira)
• Immunosuppressants (CD): Imuran & methotrexate ▪ Nutrition :
• Avoid foods/drinks that cause symptoms

• fiber, dairy, carbonated beverages

• TPN if PO intolerance ▪ Surgery :
• Ostomy creation ▪ Complications
• Perforation
• Fistulas Ulcerative Colitis Crohn’s Disease

Location Rectum to Cecum Terminal ileum most common, but can affect any part(s) of the digestive tract

Etiology Unknown Unknown

Peak age of incidence

15 - 25 yrs & 55 - 65 yrs

15 - 40 yrs

Number of stools per day

10 - 20 liquid, bloody stools

5 - 6 soft, loose, & nonbloody stools

Complications Hemorrhage & nutritional deficiencies

Fistulas (common) & nutritional deficiencies

Need for surgery

Infrequent Frequent

o BROW diet – gluten free ▪ Barley, rye, oats, and wheat GU Elimination (Chapters 65-67):

• Diagnostics (UA, 24h/Composite urine specimens, Imaging studies [Intravenous pyelogram (IVP), KUB, cystoscopy, etc.]) o Blood tests : ▪ Serum Cr (Creatinine) - Elevation indicates loss of at least 50% of kidney function! ▪ BUN ▪ BUN to Cr ratio ▪ Blood osmolarity ▪ Renal panel: K+, Mg+, Na+, Phos, Ca++ o Urine Tests ▪ Urinalysis ▪ Urine culture ▪ Composite urine collections (24h urine) - Store on ice! ▪ Creatinine clearance ▪ Electrolytes ▪ Osmolarity
• Types of Urinary incontinence o Stress: Urinary leakage with laughing, coughing, sneezing, or other body movements causing increased bladder pressure ▪ Caused by: - Weak pelvic musculature - Urethra hypermobility ▪ NOT caused by emotional stress!

o Urge: Urgent need to void and inability to stop urinating o Mixed: Symptoms of both stress and urge o Overflow: continuous leakage or dribbling of urine o Functional: s/t decreased mobility or cognitive function o Treatment ▪ Avoid activities that elicit incontinent episodes ▪ Wear briefs or pads ▪ Kegal exercises ▪ Bladder training ▪ Intermittent self-catheterization ▪ Bladder compression techniques ▪ Surgery :

• Surgical sling or bladder suspension procedures – Stress incontinence
• Prostatectomy – Overflow incontinence ▪ Drug therapy :
• Ditropan (oxybutynin) – Urge incontinence
• UTI

o Prevention : ▪ Avoid unnecessary use ▪ Insert urinary catheters using aseptic technique ▪ Maintain the urinary catheter

• Hand hygiene
• Closed system
• Reduce kinking and dependent loops ▪ Avoid irrigation, disconnection, routine replacement, and antiseptic cleaning of meatus ▪ Soap and water is fine!
• Disease processes (Urolithiasis, Pyelonephritis, cystitis, glomerulonephritis, PKD, etc.) o Urolithiasis ▪ Intervention
• Pt’s expel on own if <5mm in size
• Pain management
• Adequate hydration
• Infection prevention
• Nutrition : o Accurate I/O’s! o 2-3 L/day fluid intake o Diet changes depending on stone type
• Lithotripsy : Use of sound, laser, or dry shock waves to break apart the stone for expulsion
• Surgery : o Stenting o Ureteroscopy o Ureto- or Nephro-lithotomy o PKD

▪ BP control

• goal 120/ ▪ Pain management
• NSAID’s, Tylenol, or opioids ▪ Prevention of infection ▪ Prevention of constipation
• 2-3L/day of water
• Regular exercise ▪ Slow progression of CKD
• Renal diet

MODULE 4: CLINICAL JUDGMENT AND ETHICS

Nursing Ethics (Journal Article & Chapter 1):

• EBP & QI o EBP: integration of current evidence to make decisions about and plan patient care – helps to guide high-quality care o Quality Improvement: process in which the interprofessional health care team uses data to monitor care outcomes and develop solutions to change and improve care ▪ Includes analysis of the problem, testing a potential solution, analyzing the effectiveness of the testing solution, and implementing the solution
• Ethical principles o Autonomy - the right of patients to make decisions about their medical care without their health care provider trying to influence the decision. o Beneficence - an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation o Nonmaleficence - non-harming or inflicting the least harm possible to reach a beneficial outcome o Fidelity – keeping promises o Veracity - legal principle that states that a health professional should be honest and give full disclosure to the patient, abstain from misrepresentation or deceit, and report known lapses of the standards of care to the proper agencies. o Justice - the ethical principle that persons who have similar circumstances and conditions should be treated alike Legal and Ethical Nursing Practice (Comprehensive Review for NCLEX-RN: Chapter 5):
• State and federal laws

o State ▪ Mandatory Reporting Laws

• Communicable diseases, abuse or neglect ▪ Good Samaritan Law
• Protection from liability to those who provide emergency care ▪ Nurse Practice Act
• Defines nursing practice o Federal ▪ Bill of rights
• Protecting the rights of the patient ▪ HIPAA (Health insurance portability and accountability act)
• Protects the patients health information ▪ EMTALA (Emergency medical treatment and active labor act)
• Provide emergency care regardless of ability to pay ▪ PSDA (Patient self-determination act)
• Right to make decisions regarding health care (Advanced Directives!) ▪ ADA (Americans with disabilities act)

• Torts
  • Protection against discrimination against those with disabilities

o Negligence vs. malpractice o Negligence : Unintentional failure to act as a reasonable person in similar circumstances would act ▪ Results in injury due to carelessness , not intention o Malpractice : Negligence by a professional to carry out or perform duties that result in injury ▪ Acting outside one’s scope of practice

• Informed consent o Legal protection of a client’s right to choose and make decisions regarding his/her health
• Advance directives o Living will – outlines medical treatment if pt can’t communicate decisions o Health care proxy/durable power of attorney for health care (DPOAHC) – appointed individual who is to make decisions if pt is unable to do so themselves

MODULE 5: SURGICAL INTEGRITY

Preoperative Care (Chapter 14):

• Reasons for surgery o Diagnostic— Determines origin and cause of disorder ▪ Ex: biopsy o Curative— Resolves health problem by repairing or removing cause ▪ Ex: tumor removals o Restorative —Improves patient’s functional ability ▪ Ex: orthopedics – hips, knees

o Palliative —Relieves symptoms of disease process, but does not cure ▪ Ex: removing aggressively growing tumor but it will come back o Cosmetic —Alters/enhances personal appearance ▪ Ex: plastic surgery

• Urgency of Surgery o Elective : planned correction of nonacute problem ▪ Ex: cataracts, hernias, total joint replacement o Urgent : Requires prompt intervention; life-threatening if treatment delayed 24-48h ▪ Ex: intestinal obstruction, bladder obstruction, bone fractures, acute cholecystitis o Emergent : Requires immediate intervention d/t life-threatening consequences ▪ Ex: gunshot, appendectomy, AAA, brain bleeds
• Approach/Extent of surgery o Simple : Involves only the affected area ▪ Ex: simple mastectomy o Minimally Invasive : Surgery performed in a body cavity through one or more endoscopes

▪ Ex: arthroscopy, tubal ligations, hysterectomy o Radical : Extensive surgery beyond area obviously involved to find root causes of disease or illness ▪ Ex: radical prostatectomy or hysterectomy

• Preop assessment (what info do we need?, patient restrictions, education on complications, etc.)
• Informed consent Intraoperative Care (Chapter 15):
• Surgical Scrub
• Anesthesia: o Role of providers o Complications ▪ Sore throat ▪ N/v ▪ Constipation ▪ Anesthetic overdose (slow to wake) ▪ Hypoventilation ▪ Malignant hyperthermia ** EMERGENT ** - Treatment: IV Dantrolene Sodium
• Intraop complications (MH) Postoperative Care (Chapter 16):
• What are common postoperative complications of surgery?

o What S/Sx of complications might we see? o How do we prevent pneumonia? Constipation? UTI? Kidney injury? Bleeding? Infection?

• Postop assessment (what do we assess?, What is normal/abnormal postop?)
• Surgical incision care

o Dehiscence : partial or complete separation of the outer wound layers o Evisceration : EMERGENCY; total separation of all wound layers, so that internal organs protrude

• Transition to home

o What does pt need education on? ▪ Pain control ▪ Safety ▪ Infection ▪ Drain management and dressing changes ▪ Nutrition

• Increase protein, Cals, Vit C ▪ Activity restrictions ▪ Medications (i.e. ABX)