NUR2392 Multidimensional Care II Exam 2 (2023), Exams of Nursing

Download NUR2392 Multidimensional Care II Exam 2 (2023) and more Exams Nursing in PDF only on Docsity!

(2023)

Uncompensated - correct answers pH and one other value is abnormal Partial compensation - correct answers pH, CO2, and HCO3 are all off Full compensation - correct answers pH is normal Acidosis - correct answers reduces the excitability of cardiovascular muscle, neurons, skeletal muscle, and smooth muscle. Alkalosis - correct answers increases the sensitivity of excitable tissues allowing them to OVERRESPOND without stimulation ABG considerations - correct answers - Assess cardiovascular w/ acidosis (cardiac arrest from hyperkalemia)

• Assess neuro status
• Fall precautions Bicarb HC03 - correct answers kidney compensation (slow and powerful) Respiratory PaC02 - correct answers Respiratory compensation (fast but limited) Metabolic acidosis causes - correct answers DKA, Starvation, diarrhea, kidney failure, dehydration, liver failure, pancreatitis, heavy exercise, seizure activity, fever, hypoxia, ischemia, ethanol/methanol intoxication Metabolic acidosis signs and symptoms - correct answers bradycardia, hypotension, thready pulse, CNS depression, hyporeflexia, kussmal resp (with resp compensation), warm, flushed, dry skin. Metabolic acidosis treatment - correct answers hydration and medication to treat underlying problems (DKA - give insulin).

(2023)

Metabolic alkalosis causes - correct answers antacids, blood transfusion, sodium bicarbonate, total parenteral nutrition (TPN), prolonged vomiting, nasogastric suctioning, hypercortisolism, hyperaldosteronism, Loop/Thiazide diuretics. Metabolic Alkalosis s/s - correct answers anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU, parathesis, hyperreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low BP, increased Digoxin toxicity, decreased respiratory effort (muscle weakness). metabolic alkalosis treatment - correct answers restore fluid/electrolyte imbalances Respiratory acidosis cause - correct answers Opioids, anesthetics, electrolyte imbalance, inadequate chest expansion, muscle weakness, airway obstruction, alveolar-capillary block. Respiratory acidosis s/s - correct answers bradycardia, hypotension, thready pulse, CNS depression, hyporeflexia, ineffective respirations, pale-to-cyanotic dry skin. Respiratory acidosis treatment - correct answers (Assess airway) Improve gas exchange, drug therapy (bronchodilators, anti-inflammatory), oxygen therapy (lowest flow possible), ventilation. Respiratory alkalosis cause - correct answers Hyperventilation (fear, anxiety), mechanical ventilation, salicylate toxicity, high altitudes, early-stage acute pulmonary issues. respiratory alkalosis s/s - correct answers anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU (hypocalcemia), parathesis, hyperreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low BP, increased Digoxin toxicity, hyperventilation respiratory alkalosis treatment - correct answers restore fluid/electrolyte imbalances How do acid/base imbalances affect electrolytes - correct answers - Potassium levels increase in acidosis as the body attempts to maintain electroneutrality during buffering.

(2023)

• Potassium is elevated in acute respiratory acidosis and normal/low in chronic respiratory acidosis when kidney compensation is present
• Alkalosis = hypocalcemia and hypokalemia
• Acidosis = HYPERkalemia alkalosis - correct answers hypocalcemia and hypokalemia acidosis - correct answers HYPERkalemia Upper GI consists of - correct answers mouth, pharynx, esophagus, stomach, and duodenum. Barret's Epithelium - correct answers premalignant; columnar epithelium that develops in lower esophagus Zollinger-Ellison syndrome (dumping syndrome) - correct answers happens in PT with gastrectomy, from rapid emptying of food contents into the small intestine. Dumping syndrome S/S - correct answers nausea, distension, cramping pains, diarrhea within 15 minutes after eating Leukoplakia - correct answers thickened, white, firmly attached patches; slightly raised/rounded; most benign Erythroplakia - correct answers precancerous, red, velvety, the floor of mouth, tongue, palate, mandibular mucosa; difficult to distinguish oral cancer - correct answers - 90% are squamous cell carcinomas from epithelium surface
• Squamous cells are found on the lips, tongue, basal mucosa, and oropharynx
• Grow slowly.

(2023)

• Patients who use tobacco products, consume alcohol, have a poor diet, use mouthwash with high alcohol content, and have poor dental hygiene. Early sign of oral cancer - correct answers - Erythroplasia is early sign
• Present on lips, tongue, buccal mucosa, oropharynx oral cancer s/s - correct answers bleeding from the mouth poor appetite difficulty chewing/swallowing unplanned weight loss thick or absent saliva painless oral lesions RED RAISED ERODED thick/lump in the cheek oral cancer treatment - correct answers surgical excision, radiation and surgery, chemotherapy; Promote gas exchange Stomatitis - correct answers painful inflammation within the oral cavity, occurring in single or multiple areas. The inflammation erodes the protective lining of the mouth. stomatitis risk - correct answers patient with viral infections, use of tobacco, consuming irritating foods or chemicals, chemotherapy, or radiation. Candidiasis - correct answers Fungal infection resulting from overgrowth of Candida albicans, a normal flora. Can occur in patients on antibiotics, steroids, radiation treatments, or antirejection medications.

(2023)

primary stomatitis - correct answers Common; ulcers; Aphthous ulcers or canker sores secondary stomatitis - correct answers results from infection (opportunistic infection, virus, fungi, immunocompromised from chemo, radiation, steroid medications) - Candida albicans stomatitis causes - correct answers infection, allergy, deficient vitamin B, folate, zinc, iron, systemic disease, irritants (alcohol/tobacco) gastritis - correct answers inflammation of the gastric mucosa lining. erosive or non-erosive. Most common stomach disorder. Categorized as Type A as a result of an autoimmune condition Type B which is caused by the bacteria Helicobacter Pylori. Caused by bacterial infections, overuse of NSAIDs, use of alcohol, stress, andage. type a gastritis - correct answers autoimmune condition type b gastritis - correct answers caused by h pylori gastritis caused by - correct answers Caused by bacterial infections (h. pylori), overuse of NSAIDs, use of alcohol, stress, and age. erosive gastritis - correct answers alcoholics and NSAID use. pain immediately after eating. nonerosive gastritis - correct answers most often caused by infection w helibacter pylori (H. pylori) Acid autodigestion - correct answers Prostaglandins provide protective mucosal barrier that prevents stomach from digesting itself.

(2023)

hiatal hernia - correct answers a condition in which a portion of the stomach has passed through the diaphragmatic opening into the chest. Classified as sliding or paraesophageal. Can occur in patients who have experienced trauma or injury to the area, are over the age of 50, or are obese. sliding hernia s/s - correct answers heart burn, regurgitation, pain, dysphagia, eructation Paraesophageal hernia s/s - correct answers feeling full, breathlessness, feeling suffocation, chest pain, worsening in recumbent position Hernia Diagnostic Tests - correct answers barium swallow hernia treatment - correct answers lifestyle change (weight loss, smaller meal, limit fat, fried, caffeine), Antacids, proton pump inhibitor

• nutrition and swallowing therapy GERD - correct answers due to the backward flow of gastrointestinal contents into the esophagus CAused by: slowed motility, esophageal sphincter dysfunction, and gastric emptying delay. This backward flow results in inflammation and erosions of the epithelium. Can occur in patients with obesity, poor diet, use of tobacco, connective tissue disorders, delayed stomach emptying, and use of nonsteroidal anti-inflammatory drugs (NSAID). Barret's esophagitis - correct answers Precancerous lesion associated with GERD GERD s/s - correct answers indigestion, regurgitation, eructation, flatulence GERD treatment - correct answers sit up 1hr after meal, balancing nutrition, antacid, proton pump inhibitor

(2023)

GI bleed - correct answers most often a result of gastroduodenal ulcer disease, esophagitis, and varices. Can occur with overuse of (NSAIDs) and the use of alcohol and tobacco. GI bleed s/s - correct answers rigid, hard abdomen(board-like) decreased BP coffee ground emesis black tar stools bloody stool Peptic Ulcer Disease (PUD) - correct answers development of a circumscribed lesion (ulcer) in the mucosal membrane of the lower esophagus, stomach, duodenum, or jejunum. These lesions can be duodenal or gastric. Gastric ulcers are a result of Helicobacter pylori. Can occur in patients who consume a spicy diet, use tobacco, consume alcohol, and overuse of (NSAIDs). PUD diagnostics - correct answers Labs/Diagnostics- H pylori test, chest, abdomen x-ray, EGD, nuclear med test if Gi bleed suspected complications of peptic ulcer disease - correct answers hemorrhage, perforation, pyloric obstruction, intractable disease gastric cancer - correct answers malignant cell growth in the stomach. Most commonly affected areas are the pylorus and antrum. Prognosis is dependent on the stage of the disease. Can occur in patients who consume a diet high in smoked and salted foods, positive family history, and use tobacco. gastric cancer risks - correct answers H. pylori, pernicious anemia, polyps, gastritis, achlorhydria; more males than female over 50

(2023)

Gastric Cancer Treatment - correct answers Treatment- Radiation (local), chemo (systemic), gastrectomy or subtotal (partial) gastrectomy Diagnostic studies for upper GI - correct answers Barium swallow with fluoroscopy - allows visualization of the esophagus in order to determine possible abnormalities. Esophagastroduodenoscopy (EGD) or Upper GI endoscopy - allows direct visualization of the esophagus to determine abnormalities. Biopsy can also be obtained during the procedure. Biopsy - removal of cells in order to determine the presence of malignancy. Barium swallow with fluoroscopy - correct answers allows visualization of the esophagus in order to determine possible abnormalities. Esophagastroduodenoscopy (EGD) or Upper GI endoscopy - correct answers allows direct visualization of the esophagus to determine abnormalities. endoscopy - correct answers allows direct visualization of the esophagus to determine abnormalities. biopsy - correct answers removal of cells in order to determine the presence of malignancy. Upper GI lab studies - correct answers Complete blood count - to determine fluid status, presence of infection, and clotting abilities. Serum Chemistry tests - to assess for electrolyte imbalances. Coagulation studies - to determine clotting ability. Blood urea nitrogen - to evaluate volume status. Tumor markers - to assess for the presence of gastrointestinal cancer. CBC (complete blood count) - correct answers to determine fluid status, presence of infection, and clotting abilities.

(2023)

serum chemistry test - correct answers to assess for electrolyte imbalances. Coagulation studies - correct answers to determine clotting ability. blood urea nitrogen (BUN) - correct answers to evaluate volume status. tumor markers - correct answers to assess for the presence of gastrointestinal cancer. PaO2 normal range - correct answers 80-100 mm Hg SpO2 normal - correct answers 95-100%