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NUR2392 Multidimensional Care II Exam 2 Questions with Answers, Exams of Nursing

NUR2392 Multidimensional Care II Exam 2 Questions with Answers

Typology: Exams

2023/2024

Available from 07/07/2024

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NUR2392 Multidimensional Care II Exam 2 Questions with Answers

  1. Uncompensated pH and one other value is abnormal 2. Partial **compen- sation
  2. Full compensa-** tion pH, CO2, and HCO3 are all off pH is normal
  3. Acidosis reduces the excitability of cardiovascular muscle, neurons, skeletal muscle, and smooth muscle.
  4. Alkalosis increases the sensitivity of excitable tissues allowing them to OVERRESPOND without stimulation 6. ABG considera- tions - Assess cardiovascular w/ acidosis (cardiac arrest from hyperkalemia) - Assess neuro status - Fall precautions
  5. Bicarb HC03 kidney compensation (slow and powerful) 8. Respiratory **PaC
  6. Metabolic acido-** sis causes 10.Metabolic acido- sis signs and symptoms 11.Metabolic acido- sis treatment 12.Metabolic alkalo- sis causes

Respiratory compensation (fast but limited) DKA, Starvation, diarrhea, kidney failure, dehydration, liv- er failure, pancreatitis, heavy exercise, seizure activity, fever, hypoxia, ischemia, ethanol/methanol intoxication bradycardia, hypotension, thready pulse, CNS depres- sion, hyporeflexia, kussmal resp (with resp compensa- tion), warm, flushed, dry skin. hydration and medication to treat underlying problems (DKA - give insulin). antacids, blood transfusion, sodium bicarbonate, total parenteral nutrition (TPN), prolonged vomiting, naso- gastric suctioning, hypercortisolism, hyperaldosteronism, Loop/Thiazide diuretics.

13.Metabolic Alkalo- sis s/s 14.metabolic alkalo- sis treatment 15.Respiratory aci- dosis cause 16.Respiratory aci- dosis s/s 17.Respiratory aci- dosis treatment 18.Respiratory alka- losis cause 19.respiratory alka- losis s/s 20.respiratory alka- losis treatment 21.How do acid/base imbal- ances affect elec- trolytes anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU, parathesis, hy- perreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low BP, increased Digoxin toxicity, decreased respiratory effort (muscle weakness). restore fluid/electrolyte imbalances Opioids, anesthetics, electrolyte imbalance, inadequate chest expansion, muscle weakness, airway obstruction, alveolar-capillary block. bradycardia, hypotension, thready pulse, CNS depres- sion, hyporeflexia, ineffective respirations, pale-to-cyanot- ic dry skin. (Assess airway) Improve gas exchange, drug therapy (bronchodilators, anti-inflammatory), oxygen therapy (low- est flow possible), ventilation. Hyperventilation (fear, anxiety), mechanical ventilation, salicylate toxicity, high altitudes, early-stage acute pul- monary issues. anxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK, POSITIVE TROUSSEAU (hypocalcemia), parathesis, hyperreflexia, muscle cramping/twitching, skeletal muscle weakness, Tachycardia, norm/low BP, in- creased Digoxin toxicity, hyperventilation restore fluid/electrolyte imbalances

  • Potassium levels increase in acidosis as the body at- tempts to maintain electroneutrality

during buffering.

  • 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
  1. (^) alkalosis hypocalcemia and hypokalemia
  2. acidosis HYPERkalemia
  3. Upper GI con- mouth, pharynx, esophagus, stomach, and duodenum. sists of
  4. Barret's Epitheli- premalignant; columnar epithelium that develops in lower um esophagus
  5. Zollinger-Ellison happens in PT with gastrectomy, from rapid emptying of syndrome food contents into the small intestine. (dumping syndrome)
  6. Dumping syn- nausea, distension, cramping pains, diarrhea within 15 drome S/S minutes after eating
  7. Leukoplakia thickened, white, firmly attached patches; slightly raised/rounded; most benign
  8. Erythroplakia precancerous, red, velvety, the floor of mouth, tongue, palate, mandibular mucosa; difficult to distinguish
  9. oral cancer - 90% are squamous cell carcinomas from epithelium surface
  • Squamous cells are found on the lips, tongue, basal mucosa, and oropharynx
  • Grow slowly.
  • Patients who use tobacco products, consume alcohol,

have a poor diet, use mouthwash with high alcohol con- tent, and have poor dental hygiene.

  1. Early sign of oral - Erythroplasia is early sign cancer - Present on lips, tongue, buccal mucosa, oropharynx
  2. oral cancer s/s

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

  1. oral cancer treat- ment surgical excision, radiation and surgery, chemotherapy; Promote gas exchange
  2. Stomatitis painful inflammation within the oral cavity, occurring in single or multiple areas. The inflammation erodes the protective lining of the mouth.
  3. stomatitis risk patient with viral infections, use of tobacco, consuming irritating foods or chemicals, chemotherapy, or radiation.
  4. Candidiasis Fungal infection resulting from overgrowth of Candida al- bicans, a normal flora. Can occur in patients on antibiotics, steroids, radiation treatments, or antirejection medications.
  5. primary stomati- tis Common; ulcers; Aphthous ulcers or canker sores
  6. secondary stom- atitis results from infection (opportunistic infection, virus, fungi, immunocompromised from chemo, radiation, steroid med- ications) - Candida albicans
  7. stomatitis caus- es infection, allergy, deficient vitamin B, folate, zinc, iron, systemic disease, irritants (alcohol/tobacco)
  8. gastritis 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 Py- lori. Caused by bacterial infections, overuse of NSAIDs, use of alcohol, stress, andage.

  1. type a gastritis autoimmune condition
  2. type b gastritis caused by h pylori 43.gastritis caused by Caused by bacterial infections (h. pylori), overuse of NSAIDs, use of alcohol, stress, and age.
  3. erosive gastritis alcoholics and NSAID use. pain immediately after eating. 45.nonerosive gas- tritis 46.Acid autodiges- tion most often caused by infection w helibacter pylori (H. pylori) Prostaglandins provide protective mucosal barrier that prevents stomach from digesting itself.
  4. hiatal hernia 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.
  5. sliding hernia s/s heart burn, regurgitation, pain, dysphagia, eructation 49.Paraesophageal hernia s/s 50.Hernia Diagnos- tic Tests feeling full, breathlessness, feeling suffocation, chest pain, worsening in recumbent position barium swallow
  1. hernia treatment lifestyle change (weight loss, smaller meal, limit fat, fried, caffeine), Antacids, proton pump inhibitor
    • nutrition and swallowing therapy
  2. GERD due to the backward flow of gastrointestinal contents into the esophagus

CAused by: slowed motility, esophageal sphincter dys- function, 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 tobac- co, connective tissue disorders, delayed stomach emp- tying, and use of nonsteroidal anti- inflammatory drugs (NSAID).

  1. Barret's esophagitis Precancerous lesion associated with GERD
  2. GERD s/s indigestion, regurgitation, eructation, flatulence
  3. GERD treatment sit up 1hr after meal, balancing nutrition, antacid, proton pump inhibitor
  4. GI bleed most^ often^ a^ result^ of^ gastroduodenal^ ulcer disease, esophagitis, and varices. Can occur with overuse of (NSAIDs) and the use of alcohol and tobacco.
  5. GI bleed s/s rigid, hard abdomen(board- like) decreased BP coffee ground emesis black tar stools bloody stool
  6. Peptic Ulcer Dis- ease (PUD) development of a circumscribed lesion (ulcer) in the mu- cosal membrane of the lower esophagus, stomach, duo- denum, 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).
  7. PUD diagnostics Labs/Diagnostics- H pylori test, chest, abdomen x-ray, EGD, nuclear med test if Gi bleed suspected

complications of peptic ulcer dis- ease hemorrhage, perforation, pyloric obstruction, intractable disease

  1. gastric cancer 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. 62.gastric cancer risks 63.Gastric Cancer Treatment 64.Diagnostic stud- ies for upper GI 65.Barium swallow with fluoroscopy 66.Esophagastro- duodenoscopy (EGD) or Upper GI endoscopy H. pylori, pernicious anemia, polyps, gastritis, achlorhy- dria; more males than female over 50 Treatment- Radiation (local), chemo (systemic), gastrec- tomy or subtotal (partial) gastrectomy Barium swallow with fluoroscopy - allows visualization of the esophagus in order to determine possible abnormali- ties. Esophagastroduodenoscopy (EGD) or Upper GI en- doscopy - 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 pres- ence of malignancy. allows visualization of the esophagus in order to deter- mine possible abnormalities. allows direct visualization of the esophagus to determine abnormalities.
  2. endoscopy allows direct visualization of the esophagus to determine abnormalities.
  1. biopsy removal of cells in order to determine the presence of malignancy.
  1. Upper GI lab studies Complete blood count - to determine fluid status, presence of infection, and clotting abilities. Serum Chemistry tests - to assess for electrolyte imbal- ances. Coagulation studies - to determine clotting ability. Blood urea nitrogen - to evaluate volume status. Tumor markers - to assess for the presence of gastroin- testinal cancer.
  2. CBC (complete blood count) to determine fluid status, presence of infection, and clot- ting abilities.
  3. serum chemistry test to assess for electrolyte imbalances.
  4. Coagulation studies to determine clotting ability.
  5. blood urea nitro- gen (BUN) to evaluate volume status.
  6. tumor markers to assess for the presence of gastrointestinal cancer.
  7. PaO normal range 80-100 mm Hg
  8. (^) SpO2 normal 95-100%