Study guide for med surge test

The nurse is caring for a client who is malnourished what would

the nursing priority intervention B?

-determine the client's food preferences.

Low levels may indicate anemia recent hemorrhage or hemo

delusion caused by fluid retention. HEMOGLOBIN

Low levels may reflect anemia hemorrhage excessive fluid renal

disease or cirrhosis. HEMATOCRIT

Reflects nutritional status a few weeks before testing. SERUM

ALBUMIN

A better indicator of protein deficiency due to short half-life of two

days PRE ALBUMIN

Values are typically low with malabsorption, liver disease, and

pernicious anemia, terminal stages of cancer or sepsis.
CHOLESTEROL

Is used to assess immune function TOTAL LYMPHOCYTES

COUNT

The nurse is caring for a group of clients the nurse knows that
which client is total parenteral nutrition contraindicated?

When administering TPN what does the nurse do? -nurse is

assessing client and giving TPN at 100 ml per hour the back runs
out of solution which should the nurse do? INFUSE 10%
DEXTROSE AND WATER UNTIL THE NEW BAG IS BROUGHT.

Wait at least 1 hour after medication administration before

accessing PH level.

CHAPTER 41 OBESITY
Health risk of cardiovascular problems associated with low LD
L's and high HDL is also associated with hypertension and you
must use a larger cuff for blood-pressure or it will not be accurate.
Will show artificial increase, use the leg.

If they have respiratory problems, hypo ventilation syndrome,

reduced chest wall compliance, increased work of breathing,
decreased total lung capacity and an FRC.

Obesity is the major risk factor for type 1 diabetes.

Calcium problems: Hyper uricemia and gout are often

occurrences in people who are obese.

GI and liver problems: reflux reflux, and gallstones are more

prevalent nonalcoholic hepatitis is more prominent in obese
patients. Fatty liver leading to cirrhosis of the liver which can be
fatal.

Cancer, obesity is the leading cause of cancer.

Metabolic syndrome: also known as syndrome X is a collection

of risk factors that increase an individual's chance of developing
cardiovascular disease, and diabetes mellitus.

Upper GI tract:

GI bleeds: the color of the emesis used to identify the presence in

sources of bleeding

Coffee ground appearance related TO gastric bleeding

where blood changes to dark brown in reaction two its
mixture with hydrochloric acid.

Bright red blood indicates active bleeding. This could be

due to tears in the esophageal lining, or esophageal
verices.
Early morning vomiting occurs in pregnancy

Drug therapy: Anticholinergics, anti histamine s,

zofran: serotonin antagonist

Drugs with Cholinergic action are contraindicated in

patients with glaucoma prostatic hyperplasia, pyloric, or
bladder neck obstruction

Most ulcers result from H pylori or NSAIDS.

(motrin)Asprin, medications, alka seltzer excedrine. Stress
ulcers. we hang protonix to prevent stress ulcers.

The cause of the bleed must be identified and treatment

initiated immediately.

A complete history leading to the bleed is performed after

emergency care is performed.

Evaluation deals with the patient's condition with an

emphasis on blood pressure, rate and character of pulse
peripheral perfusion with capillary refill, and observation
for the presence or absence of neck vein distention.

Vital signs every 15 or 30 minutes. If you are bleeding

and we don't stop it you are at risk for hypovolemic shock.

Signs and symptoms of shock are evaluated and treatment

is started immediately.

Checked the respiratory status along with a a thorough

abdominal examination presence or lack of bowel sounds
should be noted. Board like abdomen may indicate
peritonitis due to bleed, rupture.

Labs: CBC, BUN, H and H, serum electrolytes, blood

glucose, prothrombin time, liver enzymes, blood gas, type
and cross match for possible transfusion.

All emesis and stool tested four occult blood, A UA

including specific gravity to assess electrolyte balance.

IV for infusion , lactated ringers, whole blood or plasma

used for massive hemm. watch for fluid overload. H and H
are not immediate help but they provide a baseline that's
why they're done.

Initially hemoglobin may be normal until 6 hours after

infusion has taken place. Since initially the loss of plasma
and RB C.s is the equal.

In acute phase drugs are used to decrease bleeding,

decrease hydrochloric acid, neutralize acid.

For vericeal bleeding Vassopressin is used. Four upper GI

bleeding in patients who don't respond to other therapies
and are poorer surgery risks. Side effects are chest pain,

Protocol for GI bleed: nursing management assess LOC,

vitals, appearance of neck veins, skin color, vitals will be
down, hypovolemic symptoms. Check the abdomen four
distention and guarding, measure abdomen. Vitals every
15 to 30.

Who is at risk for this:

Cytotec:

Acute intervention: infusion has been started, I V line

maintained an accurate I and O at a rate of 0.5 kgs per
hour (30ml)indicates normal renal function multiply.
Urine-specific gravity provides information about patients
hydration.

When using gastric lavage, do not aspi rate if resistance is

felt. Monitor agent H every 4 to 6 when bleeding.

Bacteria cause elevated B UN levels.

ORAL INFLAMMATION

Barrets syndrome

Meds for GERD.

Thefts of a