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Wednesday, October 31, 2007

Nursing Resource: PDAs for Nursing Students

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Nursing Resource: PDAs for Nursing Students: Technology at Your Fingertips Slide Transcript
Slide 1: PDAs for Nursing Students: Technology at Your Fingertips Stacy Garza Jerry Russell Rebecca Show Brenda Stalls Kelli Young

Slide 2: Identified Problem BCHS needs to continue being a leader in educating nursing students who have experience with the latest technologies that support the provision of evidence-based care for positive patient outcomes. Other schools of nursing require students to use PDAs in their undergraduate programs. We were interested in collecting information that could help BCHS administration & faculty decide whether to initiate a PDA requirement.

Slide 3: Triggers for the Study • Students need fast access to a variety of information at the point of care • Books & printed reference materials are out of date as quickly as they are printed • BCHS students are not keeping up with the competition

Slide 4: Significance to Nursing Practice • PDAs are portable • PDAs are timesavers • PDAs promote evidence-based decision- making by providing reliable, trustworthy information

Slide 5: Examples of Required PDA Software • Quick Drug References • Calculators • Diagnostic Tests • Clinical Reference • Dictionary George, L. E., & Davidson, L. J. (2005). PDA use in nursing education: Prepared for today, poised for tomorrow. Online Journal of Nursing Informatics, 9(2). Retrieved November 6, 2006, from http://eaa-knowledge.com/ojni/ni/9_2/george.htm

Slide 6: Quick Drug References • Latest drug updates • Many free programs • Adult & pediatric dosages • ePocrates: >3,300 brand and generic drugs, including dosing, interactions, black box warnings, safety & monitoring, adverse reactions, & pricing • MultiCheck multiple-drug interaction checker • Replace outdated unit medication manuals ePocrates

Slide 7: Calculators • Drug dosages • IV drip rates • Pediatric/adult conversions • BMI • Glasgow coma scale • Urine output • Mean arterial pressure • Pregnancy calculator • And more! MedCalc

Slide 8: Diagnostic Tests • Laboratory, imaging, & microbiology tests • Unbound Medicine’s Pocket Guide to Diagnostic Tests: – Which test is best to diagnose, screen, or follow a certain condition? – How do I interpret an abnormal diagnostic test? – How do I collect the appropriate specimen or prepare the patient for testing? – Where can I find more Unbound Medicine information on this test in the medical literature?

Slide 9: Clinical Reference • Look up diseases & diagnoses • Differential diagnosis information • Recommended diagnostic tests • Recommended treatments • Updated frequently Unbound Medicine with web resources

Slide 10: Dictionary • Definitions of medical terms • Cross-links to other content in dictionary • Pronunciations for some terms Unbound Medicine

Slide 11: Research Questions • What are the attitudes, opinions, & experiences of BCHS and UTHSC senior nursing students about PDAs? • How do the attitudes, opinions, & experiences of the two groups compare? • We hoped to obtain data that could assist BCHS administration & faculty to identify the need for & recognize possible issues associated with instituting a PDA requirement for nursing students.

Slide 12: Rationales for PDA Use in Nursing Schools The American Association of Colleges of Nursing, National League for Nursing, and the Institute of Medicine all recommend the incorporation of technology into the processes of nursing education.1 • Two distinct benefits:2 – Instant access to a tremendous amount of clinical information in one small mobile device – Gain technical skills from using the devices that can be used throughout their careers 1 George, L. E., & Davidson, L. J. (2005). PDA use in nursing education: Prepared for today, poised for tomorrow. Online Journal of Nursing Informatics, 9(2). Retrieved November 6, 2006, from http://eaa-knowledge.com/ojni/ni/9_2/george.htm White, A., Allen, P., Goodwin, L., Breckinridge, D., Dowell, J., & Garvey, R. (2005). 2 Infusing PDA technology into nursing education. Nurse Educator, 30, 150-154.

Slide 13: How Schools Implement PDAs in Nursing Programs • Selection of software & web-based programs most supportive of BSN program & clinical course objectives • Orientation of students & faculty to PDAs • Provision of support services to students & faculty • Evaluation of program Miller, J., Shaw-Kokot, J. R., Arnold, M. S., Boggin, T., Crowell, K. E., Allgri, F., et al. (2005). A study of personal digital assistants to enhance undergraduate clinical nursing education. Journal of Nursing Education, 44, 19-26.

Slide 14: Examples of Schools Currently Using PDAs in Nursing Education

Slide 15: Other Benefits & Challenges of Using PDAs in Nursing Education Programs • • Anywhere/anytime use Complying with HIPAA regulations • Increase student-faculty time • management in documenting Protecting patient clinical performance confidentiality • Encourages timely recording of • Encouraging consistent use by events from clinical setting faculty & students • Reduces paper use through • Troubleshooting wireless transmission synchronization problems • Breakage or inoperable units • Acquiring software beyond available freeware White, A., Allen, P., Goodwin, L., Breckinridge, D., Dowell, J., & Garvey, R. (2005). Infusing PDA technology into nursing education. Nurse Educator, 30, 150-154.

Slide 16: Gaps Found in the Literature • Sample sizes too small • Research needs to be broadened • More schools need to be included in research • Research needs to be more rigorous – Most studies used surveys – Most data based on personal opinions

Slide 17: Steps of the Research Project • Used an exploratory/descriptive survey approach • Data to be used to provide the basis for BCHS to explore instituting a PDA requirement for nursing students Advantages of Surveys Limitations of Surveys Obtain large amount of Obtain superficial information information from a variety of (breadth vs. depth) people Unable to clarify responses Easily administered

Slide 18: Survey Process & Sample COMMONALITIES • Senior graduating class • Anonymous • Everyone asked to respond • All questions pertained to PDAs • Yes/No, Likert-type scale, Open-ended BCHS UTHSC N=35 n=30, 86% N=31 n=11, 35% PDAs not required PDAs required In-class survey Online survey

Slide 19: Online Survey Process • Online survey program • No-cost My name is Jerry and I am a senior nursing • UTHSC students commonly student at Baptist College of Health Sciences. respond to surveys in this Like you, I will be graduating in December. I am in my last class and we are required to do a program project. Our group decided to do a survey on • Survey okayed by the PDAs in nursing school. I understand at UTHSC that you are required to purchase and use a Director of the Professional PDA. Please take a few minutes to answer the Entry Program few questions on our survey, located at http://CTLSilhouette.wsu.edu/surveys/ZS56802. The survey • Survey link distributed by the is anonymous. If you would, please help out your Assistant Director of the fellow nursing students by responding no later than 8am Monday, November 20. Thank you so Professional Entry Program much, in advance, for your help. • UTHSC faculty member entered questions in program & printed off final results for our group

Slide 20: Validity & Reliability Issues • • Diverse questions used yes/no because of the exploratory • Likert-type scale nature of the survey • open-ended • Questions were worded • What do you think about this differently because of the versus difference between the two • What was your experience groups • We primarily focused on taking • We enhanced the reliability of steps to enhance the validity of our study by using inter-rater our study, realizing this was an reliability procedures exploratory study whose results should be viewed as a first step Haber, J., & LoBiondo-Wood, G. (2006). Reliability and validity. In G. LoBiondo-Wood & J. Haber (Eds.), Nursing research: Methods and critical appraisal for evidence-based practice (6th ed., pp. 335-356). St. Louis, MO: Mosby.

Slide 21: Validity • Do the survey items • Does the survey adequately reflect the appear to needed breadth of appropriately explore students’ opinions, opinions, attitudes, & attitudes, & experiences with experiences with PDAs in an PDAs? understandable way? • Survey content • Survey items determined by: reviewed by: – Reviewing literature – Students – Consulting with faculty – Faculty experts in use experts in use of PDAs of PDAs

Slide 22: Inter-rater Reliability • Independent analysis of answers to open- ended questions • Comparison of our analysis • Discussion of rationales for coding where we disagreed • Arrive at consensus on the final coding

Slide 23: Survey Questions COMMONALITIES • Costs of PDA • Learning about PDA • Beneficial effects of PDA • Effect of PDA use on stress • Recommendations for future use • Advantages/Disadvantages of PDA BCHS UTHSC • Likelihood of attending • Other programs installed BCHS if PDA required on PDA • PDA ownership • Coverage of PDA costs • Observations of PDA use • Faculty encouragement

Slide 24: PDA Ownership Do you own a PDA? Did you own a PDA • Yes = 2 before coming to UTHSC? • No = 28 • Yes = 1 • No = 10 Use in clinical setting: • Yes = 1 • No = 1

Slide 25: Likelihood of Attending BCHS if PDA were Required 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% y y y e y el el el el ur lik li k lik li k ns un un ry l/U t ha Ve ry t t ra ha ew Ve eu ew m N So m So

Slide 26: Type of Person Observed Using PDA in Clinical Setting Nursing Administrator Student 4% 7% Faculty Physician 10% 37% Resident 17% 80% of respondents reported seeing others Nurse use PDAs in the 25% clinical setting.

Slide 27: Learning About PDAs 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% On my own One-on-one Small group Prior to class Integrated in class

Slide 28: Learning about PDAs 100% Very Helpful Somewhat Helpful Not at all Helpful 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% On my own One-on-one Small group Prior to class Integrated in Faculty Other students class

Slide 29: Advantages of PDA Use Responses: BCHS = 53 UTHSC = 39 140% BCHS UTHSC 120% 100% 80% 60% 40% 20% 0% Fast Access Medications Easy Labs Organization Compact Reliable Other

Slide 30: 0% 5% 10% 15% 20% 25% 30% 35% Ex pe ns e Lo sin g it O ve r-r el ia nc e O ut -o f- d at e Di s tra ct Te in g ch no lo gy gl it ch es Le ar ni ng He av y Fe ar O th er Un su re /N on e BCHS UTHSC Responses: BCHS = 39 UTHSC = 13 Disadvantages of PDA Use

Slide 31: Required & Other Programs on PDA • Games (4) • Mosby's 2006 Nursing Drug Reference • Medication program (2) • Mosby’s Nursing PDQ. • Medical dictionary (1) • Mosby's Diagnostic and • Spanish-English Laboratory Test dictionary (1) Reference (7th ed.). • Music (1) • Taber's Cyclopedic • Pictures (1) Medical Dictionary (20th ed.).

Slide 32: Perceptions of how Beneficial a PDA would have been in School 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% l l e l l ia ia ta ta ur fi c fi c en en ns ne ne m m l/U tri tri be be t ra de de ry t ha eu ry t Ve ha ew N Ve ew m m So So

Slide 33: Benefits of PDAs 100% Yes No 90% Unsure 80% 70% 60% 50% 40% 30% 20% 10% 0% Replaced reference books Helped in education Saved time Will continue using

Slide 34: Perceptions of Effects of PDA use on Stress Levels 100% BCHS 90% UTHSC 80% 70% 60% 50% 40% 30% 20% 10% 0% Greatly increase my Somewhat increase Neutral/Unsure Somewhat decrease Greatly decrease my stress my stress my stress stress

Slide 35: Maximum Amount to Pay for PDA Hardware & Software >$350 $251-$300 1% 13% $150-$200 50% $201-$250 36%

Slide 36: Actual Cost of PDA $251-$300 11% $150-$200 45% $201-$250 44%

Slide 37: Additional Costs 100% Hardware 90% Software 80% 70% 60% 50% 40% 30% 20% 10% 0% <$50 $51-$100 >$100

Slide 38: Recommend PDA for Future Nursing Students 100% BCHS 90% UTHSC 80% 70% 60% 50% 40% 30% 20% 10% 0% Yes No Unsure

Slide 39: Implications for Nursing Education • Coordinated effort to incorporate PDAs • Involve students, faculty, library, information technology, & administration • Develop PDA hardware & software requirements • Design PDA training – variety of methods • Identify PDA support system

Slide 40: Implications for Nursing Practice • All nurses on a unit use PDAs • Hospitals provide PDA hardware, software, & docking stations • PDA training provided by hospitals • PDA support groups developed across units • Develop PDA competencies • Administrator, nurse, & patient satisfaction & perception of usefulness

Slide 41: Evaluation • Does BCHS institute a PDA requirement? • Do faculty evaluations of students who use PDAs differ from those who do not? • Do student evaluations support the usefulness of PDAs? • Do students continue using PDAs after graduation?

Slide 42: Summary • Embrace the future: PDAs are here to stay – Several schools implementing PDA use – BCHS should explore implementing PDA use • Conduct further research on PDA use • Our findings showed: – Most students would have attended BCHS even with PDA requirement – Perception & experience of stress levels with PDA use – Other people observed using PDAs in clinical settings – There needs to be support for PDA use – Cost & financial aid are considerations





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Tuesday, October 30, 2007

Genito Urinary System :: Medical Surgical Nursing :: Review For Nursing Licensure Examination

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Genito Urinary System :: Medical Surgical Nursing :: Review For Nursing Licensure Examination Slide Transcript
Slide 1: The Genito-Urinary System Medical Surgical Nursing Review

Slide 2: Outline of review  Recall the anatomy and physiology of the Renal System  Renal Assessment  Renal Laboratory Procedure  Common Conditions:  UTI  Kidney Stones  ARF and CRF

Slide 3: Outline of review  BPH  Prostatic cancer

Slide 4: Kidney function Impaired urine production The Nephron produces and azotemia urine to eliminate waste Secretes Erythropoietin ANEMIA to increase RBC Metabolism of Vitamin D Calcium and Phosphate imbalances Produces bicarbonate Metabolic ACIDOSIS and secretes acids Excretes excess HYPERKALEMIA POTASSIUM

Slide 5: Urological Assessment  Nursing History  Reason for seeking care  Current illness  Previous illness  Family History  Social History  Sexual history

Slide 6: Urological Assessment Key Signs and Symptoms of Urological Problems EDEMA associated with fluid retention Renal dysfunctions usually produce ANASARCA

Slide 7: Urological Assessment Key Signs and Symptoms of Urological Problems PAIN  Suprapubic pain= bladder  Colicky pain on the flank= kidney

Slide 8: Urological Assessment Key Signs and Symptoms of Urological Problems HEMATURIA  Painless hematuria may indicate URINARY CANCER!  Early-stream hematuria= urethral lesion  Late-stream hematuria= bladder lesion

Slide 9: Urological Assessment Key Signs and Symptoms of Urological Problems DYSURIA  Pain with urination= lower UTI

Slide 10: Urological Assessment Key Signs and Symptoms of Urological Problems POLYURIA  More than 2 Liters urine per day OLIGURIA  Less than 400 mL per day ANURIA  Less than 50 mL per day

Slide 11: Urological Assessment Key Signs and Symptoms of Urological Problems Urinary Urgency Urinary retention Urinary frequency

Slide 12: Urological Assessment PHYSICAL EXAMINATION Inspection Auscultation Percussion Palpation

Slide 13: Urological Assessment Laboratory examination 2. Urinalysis 3. BUN and Creatinine levels of the serum 4. Serum electrolytes

Slide 14: Urological Assessment Laboratory examination Radiographic  IVP  KUB x-ray  KUB ultrasound  CT and MRI  Cystography

Slide 15: Implementation Steps for selected problems Provide PAIN relief  Assess the level of pain  Administer medications usually narcotic ANALGESICS

Slide 16: Implementation Steps for selected problems Maintain Fluid and Electrolyte Balance  Encourage to consume at least 2 liters of fluid per day  In cases of ARF, limit fluid as directed  Weigh client daily to detect fluid retention

Slide 17: Implementation Steps for selected problems Ensure Adequate urinary elimination  Encourage to void at least every 2-3 hours  Promote measures to relieve urinary retention:  Alternating warm and cold compress  Bedpan  Open faucet  Provide privacy  Catheterization if indicated

Slide 18: Urinary Tract Infection (UTI) Bacterial invasion of the kidneys or bladder (CYSTITIS) usually caused by Escherichia coli

Slide 19: Urinary Tract Infection (UTI)  Predisposing factors include 2. Poor hygiene 3. Irritation from bubble baths 4. Urinary reflux 5. Instrumentation 6. Residual urine, urinary stasis

Slide 20: Urinary Tract Infection (UTI) PATHOPHYSIOLOGY  The invading organism ascends the urinary tract, irritating the mucosa and causing characteristic symptoms  Ureter= ureteritis  Bladder= cystitis  Urethra=Urethritis  Pelvis= Pyelonephritis

Slide 21: Urinary Tract Infection (UTI) Assessment findings  Low-grade fever  Abdominal pain  Enuresis  Pain/burning on urination  Urinary frequency  Hematuria

Slide 22: Urinary Tract Infection (UTI) Assessment findings: Upper UTI  Fever and CHIILS  Flank pain  Costovertebral angle tenderness

Slide 23: Urinary Tract Infection (UTI) Laboratory Examination 2. Urinalysis 3. Urine Culture

Slide 24: Urinary Tract Infection (UTI) Nursing interventions  Administer antibiotics as ordered  Provide warm baths and allow client to void in water to alleviate painful voiding.  Force fluids. Nurses may give 3 liters of fluid per day  Encourage measures to acidify urine (cranberry juice, acid-ash diet).

Slide 25: Urinary Tract Infection (UTI)  Provide client teaching and discharge planning concerning a. Avoidance of tub baths b. Avoidance of bubble baths that might irritate urethra c. Importance for girls to wipe perineum from front to back d. Increase in foods/fluids that acidify urine.

Slide 26: Urinary Tract Infection (UTI) Pharmacology  1. Sulfa drugs  Highly concentrated in the urine  Effective against E. coli!  2. Quinolones

Slide 27: Nephrolithiasis/Urolithiasis  Presence of stones anywhere in the urinary tract  Calcium  oxalate  and uric acid

Slide 28: Nephrolithiasis/Urolithiasis Pathophysiology  Predisposing factors a. Diet: large amounts of calcium and oxalate b. Increased uric acid levels c. Sedentary life-style, immobility d. Family history of gout or calculi e. Hyperparathyroidism

Slide 29: Nephrolithiasis/Urolithiasis Pathophysiology Supersaturation of crystals due to stasis Stone formation May pass through the urinary tract OBSTRUCTION, INFECTION and HYDRONEPHROSIS

Slide 30: Nephrolithiasis/Urolithiasis Assessment findings 2. Abdominal or flank pain 3. Renal colic radiating to the groin 3. Hematuria 4. Cool, moist skin 5. Nausea and vomiting

Slide 31: Nephrolithiasis/Urolithiasis Diagnostic tests 1. KUB Ultrasound and X-ray: pinpoints location, number, and size of stones 2. IVP: identifies site of obstruction and presence of non-radiopaque stones 3. Urinalysis: indicates presence of bacteria, increased protein, increased WBC and RBC (hematuria)

Slide 32: Nephrolithiasis/Urolithiasis Medical management 1. Surgery  a. Percutaneous nephrostomy: tube is inserted through skin and underlying tissues into renal pelvis to remove calculi.  b. Percutaneous nephrostolithotomy: delivers ultrasound waves through a probe placed on the calculus.

Slide 33: Nephrolithiasis/Urolithiasis Medical management 2. Extracorporeal shock-wave lithotripsy: delivers shock waves from outside the body to the stone, causing pulverization 3. Pain management : Morphine or Meperidine 4. Diet modification

Slide 34: Nephrolithiasis/Urolithiasis Nursing interventions  1. Strain all urine through gauze to detect stones and crush all clots.  2. Force fluids (3000—4000 cc/day).  3. Encourage ambulation to prevent stasis.

Slide 35: Nephrolithiasis/Urolithiasis Nursing interventions  4. Relieve pain by administration of analgesics as ordered and application of moist heat to flank area.  5. Monitor intake and output

Slide 36: Nephrolithiasis/Urolithiasis Nursing interventions  6. Provide modified diet, depending upon stone consistency: Calcium, Oxalate and Uric acid stones

Slide 37: Nephrolithiasis/Urolithiasis Nursing interventions Calcium stones  limit milk/dairy products; provide acid-ash diet to acidify urine (cranberry or prune juice, meat, eggs, poultry, fish, grapes, and whole grains)

Slide 38: Nephrolithiasis/Urolithiasis Nursing interventions Oxalate stones  avoid excess intake of foods/ fluids high in oxalate (tea, chocolate, rhubarb, spinach); maintain alkaline- ash diet to alkalinize urine (milk; vegetables; fruits except prunes, cranberries, and plums)

Slide 39: Nephrolithiasis/Urolithiasis Nursing interventions Uric acid stones  reduce foods high in purine (liver, beans, kidneys, venison, shellfish, meat soups, gravies, legumes); maintain alkaline urine

Slide 40: Nephrolithiasis/Urolithiasis Nursing interventions  7. Administer allopurinol (Zyloprim) as ordered, to decrease uric acid production

Slide 41: Nephrolithiasis/Urolithiasis 8. Provide client teaching and discharge planning concerning  Prevention of Urinary stasis by maintaining increased fluid intake especially in hot weather and during illness; mobility; voiding whenever the urge is felt and at least twice during the night  Adherence to prescribed diet  Need for routine urinalysis (at least every 3 —4 months)  Need to recognize and report signs/ symptoms of recurrence (hematuria, flank pain).

Slide 42: Acute renal failure  Sudden interruption of kidney function to regulate fluid and electrolyte balance and remove toxic products from the body

Slide 43: Acute renal failure PATHOPHYSIOLOGY 2. Pre-renal failure 4. Intra-renal failure 6. Post-renal failure

Slide 45: Acute renal failure PATHOPHYSIOLOGY Prerenal CAUSE:  Factors interfering with perfusion and resulting in diminished blood flow and glomerular filtrate, ischemia, and oliguria; include CHF, cardiogenic shock, acute vasoconstriction, hemorrhage, burns, septicemia, hypotension, anaphylaxis

Slide 46: Acute renal failure PATHOPHYSIOLOGY Intrarenal CAUSE:  Conditions that cause damage to the nephrons; include acute tubular necrosis (ATN), endocarditis, diabetes mellitus, malignant hypertension, acute glomerulonephritis, tumors, blood transfusion reactions, hypercalcemia, nephrotoxins (certain antibiotics, x-ray dyes, pesticides, anesthetics)

Slide 47: Acute renal failure PATHOPHYSIOLOGY Postrenal CAUSE:  Mechanical obstruction anywhere from the tubules to the urethra; includes calculi, BPH, tumors, strictures, blood clots, trauma, and anatomic malformation

Slide 48: Acute renal failure Three phases of acute renal failure 3. Oliguric phase 5. Diuretic phase 7. Convalescence or recovery phase

Slide 49: Acute renal failure Four phases of acute renal failure (Brunner and Suddarth) 2. Initiation phase 3. Oliguric phase 4. Diuretic phase 5. Convalescence or recovery phase

Slide 50: Acute renal failure Assessment findings: The Three Phases of Acute Renal Failure 1. Oliguric phase  Urine output less than 400 cc/24 hours  duration 1—2 weeks  Manifested by dilutional hyponatremia, hyperkalemia, hyperphosphatemia, hypocalcemia, hypermagnesemia, and metabolic acidosis  Diagnostic tests: BUN and creatinine elevated

Slide 51: Acute renal failure Assessment findings: The Three Phases of Acute Renal Failure 2. Diuretic phase  Diuresis may occur (output 3—5 liters/day) due to partially regenerated tubule’s inability to concentrate urine  Duration: 2—3 weeks; manifested by hyponatremia, hypokalemia, and hypovolemia  Diagnostic tests: BUN and creatinine slightly elevated

Slide 52: Acute renal failure Assessment findings: The Three Phases of Acute Renal Failure 3. Recovery or convalescent phase:  Renal function stabilizes with gradual improvement over next 3—12 months

Slide 53: Acute renal failure Laboratory findings: 2. Urinalysis: Urine osmo and sodium 3. BUN and creatinine levels increased 4. Hyperkalemia 5. Anemia 6. ABG: metabolic acidosis

Slide 54: Acute renal failure Nursing interventions  Monitor fluid and Electrolyte Balance  Reduce metabolic rate  Promote pulmonary function  Prevent infection  Provide skin care  Provide emotional support

Slide 55: Acute renal failure Nursing interventions 1. Monitor and maintain fluid and electrolyte balance.  Measure l & O every hour. note excessive losses in diuretic phase  Administer IV fluids and electrolyte supplements as ordered.  Weigh daily and report gains.  Monitor lab values; assess/treat fluid and electrolyte and acid-base imbalances as needed

Slide 56: Acute renal failure Nursing interventions 2. Monitor alteration in fluid volume.  Monitor vital signs, PAP, PCWP, CVP as needed.  Weigh client daily.  Maintain strict I & O records.

Slide 57: Acute renal failure Nursing interventions 2. Assess every hour for hypervolemia  Maintain adequate ventilation.  Restrict FLUID intake  Administer diuretics and antihypertensives

Slide 58: Acute renal failure Nursing interventions 3. Promote optimal nutritional status.  Weigh daily.  Administer TPN as ordered.  With enteral feedings, check for residual and notify physician if residual volume increases.  Restrict protein intake to 1 g/kg/day  Restrict POTASSIUM intake  HIGH CARBOHYDRATE DIET, calcium supplements

Slide 59: Acute renal failure Nursing interventions 4. Prevent complications from impaired mobility (pulmonary embolism, skin breakdown, and atelectasis) 5. Prevent fever/infection.  Assess for signs of infection.  Use strict aseptic technique for wound and catheter care.

Slide 60: Acute renal failure Nursing interventions 6. Support client/significant others and reduce/ relieve anxiety.  Explain pathophysiology and relationship to symptoms.  Explain all procedures and answer all questions in easy-to-understand terms  Refer to counseling services as needed 7. Provide care for the client receiving dialysis

Slide 61: Acute renal failure Nursing interventions 8. Provide client teaching and discharge planning concerning  Adherence to prescribed dietary regimen  Signs and symptoms of recurrent renal disease  Importance of planned rest periods  Use of prescribed drugs only  Signs and symptoms of UTI or respiratory infection need to report to physician immediately

Slide 62: Chronic Renal Failure  Gradual, Progressive irreversible destruction of the kidneys causing severe renal dysfunction.  The result is azotemia to UREMIA

Slide 63: Chronic Renal Failure Predisposing factors:  DM= worldwide leading cause  Recurrent infections  Exacerbations of nephritis  urinary tract obstruction  hypertension

Slide 64: Chronic Renal Failure PATHOPHYSIOLOGY As renal functions decline Retention of end-products of metabolism

Slide 65: Chronic Renal Failure PATHOPHYSIOLOGY STAGE 1= reduced renal reserve, 40- 75% loss of nephron function STAGE 2= renal insufficiency, 75- 90% loss of nephron function STAGE 3= end-stage renal disease, more than 90% loss. DIALYSIS IS THE TREATMENT!

Slide 66: Chronic Renal Failure Assessment findings  1. Nausea, vomiting; diarrhea or constipation; decreased urinary output  2. Dyspnea  3. Stomatitis  4. Hypertension (later), lethargy, convulsions, memory impairment, pericardial friction rub

Slide 67: Chronic Renal Failure dry skin, pruritus, uremic Dermatologic frost seizures, altered LOC, CNS anorexia, fatigue Acute MI, edema, CVS hypertension, pericarditis Pulmo Uremic lungs Hema Anemia loss of strength, foot Musculoskeletal drop, osteodystrophy

Slide 68: Chronic Renal Failure Diagnostic tests:  a. 24 hour creatinine clearance urinalysis  b. Protein, sodium, BUN, Crea and WBC elevated  c. Specific gravity, platelets, and calcium decreased  D. CBC= anemia

Slide 69: Chronic Renal Failure Medical management  1. Diet restrictions  2. Multivitamins  3. Hematinics and erythropoietin  4. Aluminum hydroxide gels  5. Anti-hypertensive  6. Anti-seizures  DIALYSIS

Slide 70: Chronic Renal Failure Nursing interventions 1. Prevent neurological complications.  Assess every hour for signs of uremia (fatigue, loss of appetite, decreased urine output, apathy, confusion, elevated blood pressure, edema of face and feet, itchy skin, restlessness, seizures).

Slide 71: Chronic Renal Failure Nursing interventions 1. Prevent neurological complications.  Assess for changes in mental functioning.  Orient confused client to time, place, date, and persons; institute safety measures to protect client from falling out of bed.  Monitor serum electrolytes, BUN, and creatinine as ordered

Slide 72: Chronic Renal Failure Nursing interventions 2. Promote optimal GI function.  Assess/provide care for stomatitis  Monitor nausea, vomiting, anorexia  Administer antiemetics as ordered.  Assess for signs of Gl bleeding

Slide 73: Chronic Renal Failure Nursing interventions  3. Monitor/prevent alteration in fluid and electrolyte balance  4. Assess for hyperphosphatemia (paresthesias, muscle cramps, seizures, abnormal reflexes), and administer aluminum hydroxide gels (Amphojel) as ordered

Slide 74: Chronic Renal Failure Nursing interventions 5. Promote maintenance of skin integrity.  Assess/provide care for pruritus.  Assess for uremic frost (urea crystallization on the skin) and bathe in plain water

Slide 75: Chronic Renal Failure Nursing interventions 6. Monitor for bleeding complications, prevent injury to client.  Monitor Hgb, hct, platelets, RBC.  Hematest all secretions.  Administer hematinics as ordered.  Avoid lM injections

Slide 76: Chronic Renal Failure Nursing interventions 7. Promote/maintain maximal cardiovascular function.  Monitor blood pressure and report significant changes.  Auscultate for pericardial friction rub.  Perform circulation checks routinely.

Slide 77: Chronic Renal Failure Nursing interventions 7. Promote/maintain maximal cardiovascular function.  Administer diuretics as ordered and monitor output.  Modify drug doses 8. Provide care for client receiving dialysis.

Slide 78: DIALYSIS  a procedure that is used to remove fluid and uremic wastes from the body when the kidneys cannot function

Slide 79: DIALYSIS  Two methods  1. Hemodialysis  2. Peritoneal dialysis

Slide 82: DIALYSIS  Diffusion  Osmosis  Ultrafiltration

Slide 83: DIALYSIS Nursing management 2. Meet the patient's psychosocial needs 3. Remember to avoid any procedure on the arm with the fistula (HEMO)  Monitor WEIGHT, blood pressure and fistula site for bleeding

Slide 84: DIALYSIS Nursing management 3. Monitor symptoms of uremia 4. Detect complications like infection, bleeding (Hepatitis B/C and HIV infection in Hemodialysis) 5. Warm the solution to increase diffusion of waste products (PERITONEAL) 6. Manage discomfort and pain

Slide 85: DIALYSIS Nursing management 7. To determine effectiveness, check serum creatinine, BUN and electrolytes

Slide 86: Male reproductive disorders  BPH  Prostatic cancer

Slide 87: Male reproductive disorders DIGITAL RECTAL EXAMINATION- DRE  Recommended for men annually with age over 40 years  Screening test for cancer  Ask patient to BEAR DOWN

Slide 89: Male reproductive disorders TESTICULAR EXAMINATION  Palpation of scrotum for nodules and masses or inflammation  BEGINS DURING ADOLESCENCE

Slide 90: Male reproductive disorders Prostate specific antigen (PSA)  Elevated in prostate cancer  Normal is 0.2 to 4 nanograms/mL  Cancer= over 4

Slide 91: Male reproductive disorders BENIGN PROSTATIC HYPERPLASIA  Enlargement of the prostate that causes outflow obstruction  Common in men older than 50 years old

Slide 93: Male reproductive disorders BENIGN PROSTATIC HYPERPLASIA Assessment findings 3. DRE: enlarged prostate gland that is rubbery, large and NON-tender 4. Increased frequency, urgency and hesitancy 5. Nocturia, DECREASE IN THE VOLUME AND FORCE OF URINE STREAM

Slide 94: Male reproductive disorders BENIGN PROSTATIC HYPERPLASIA Medical management 3. Immediate catheterization 4. Prostatectomy 5. TRANSURETHRAL RESECTION of the PROSTATE (TURP) 6. Pharmacology: alpha-blockers, alpha- reductase inhibitors. SAW palmetto

Slide 97: BPH NURSING INTERVENTION 2. Encourage fluids up to 2 liters per day 3. Insert catheter for urinary drainage 4. Administer medications – alpha adrenergic blockers and finasteride 5. Avoid anticholinergics 6. Prepare for surgery or TURP 7. Teach the patient perineal muscle exercises. Avoid valsalva until healing

Slide 98: BPH NURSING INTERVENTION: TURP  Maintain the three way bladder irrigation to prevent hemorrhage  Only initially the drainage is pink- tinged and never reddish  Administer anti-spasmodic to prevent bladder spasms

Slide 99: Prostate Cancer  a slow growing malignancy of the prostate gland  Usually an adenocarcinoma  This usualy spread via blood stream to the vertebrae

Slide 101: Prostate Cancer  Predisposing factor  Age

Slide 102: Prostate Cancer  Assessment Findings 2. DRE: hard, pea-sized nodules on the anterior rectum 3. Hematuria 4. Urinary obstruction 5. Pain on the perineum radiating to the leg

Slide 103: Prostate Cancer  Diagnostic tests 2. Prostatic specific antigen (PSA) 3. Elevated SERUM ACID PHOSPHATASE indicates SPREAD or Metastasis

Slide 104: Prostate Cancer Medical and surgical management 2. Prostatectomy 3. TURP 4. Chemotherapy: hormonal therapy to slow the rate of tumor growth 5. Radiation therapy

Slide 105: Prostate Cancer Nursing Interventions 2. Prepare patient for chemotherapy 3. Prepare for surgery

Slide 106: Prostate Cancer Nursing Interventions: Post- prostatectomy 2. Maintain continuous bladder irrigation. Note that drainage is pink tinged w/in 24 hours 3. Monitor urine for the presence of blood clots and hemorrhage 4. Ambulate the patient as soon as urine begins to clear in color





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Monday, October 29, 2007

Nursing Reference: Facts About Nursing

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Nursing Reference: Facts About Nursing Slide Transcript
Slide 2: The following is a breakdown of the current population licensed by the Board as of June 30, 2007: DESCRIPTION ACTIVE INACTIVE TOTAL REGISTERED NURSES 324,911 18,584 343,495 CLINICAL NURSE 2,504 17 2,521 SPECIALISTS NURSE ANESTHETISTS 1,875 26 1,901 NURSE-MIDWIVES 1,147 17 1,164 NURSE-MIDWIFE 695 4 699 FURNISHING NURSE PRACTITIONERS 13,990 308 14,298 NURSE PRACTITIONER 9,752 73 9,825 FURNISHING PSYCHIATRIC/MENTAL 384 25 409 HEALTH PUBLIC HEALTH 44,721 2,569 47,290 NURSES CONTINUING 3,387 N/A 3,387 EDUCATION PROVIDERS http://www.rn.ca.gov/about/status.htm

Slide 4: Highest paid registered nurses are in California On average, the 2.4 million registered nurses in the U.S. earned $28.71 per hour in May 2006. Registered nurses in California were the highest paid among all of the States, with an average hourly wage of $36.12. http://www.bls.gov/opub/ted/2007/may/wk2/art05.htm

Slide 5: Quick Facts on Registered Nurses Registered Nurses (RNs) were the largest healthcare occupation in 2005, with employment of over 2.4 million jobs. Job opportunities for RNs in all specialties are expected to be excellent. Employment of registered nurses is expected to grow much faster than average for all occupations through 2014. Registered nurses are projected to create the second largest number of new jobs among all occupations between 2004 and 2014, increasing by 29.4 percent. Women comprised 92.3% of RNs in 2005. According to the Bureau of Labor Statistics (BLS), in 2005, 10 percent of all RNs were black, 6.4 percent were Asian, and 4.3 percent were Hispanic. BLS also projects that total job openings due to growth and net replacements will result in 1.2 million job openings for RNs alone by 2014. Earnings of RNs are above average. The median weekly earnings of full-time wage and salary workers employed as RNs were $935 compared to $651 for all workers in 2005. Source: U.S. Department of Labor, Bureau of Labor Statistics.

Slide 7: NCLEX Examination Application Requirements  Appropriate Fees.  Completed Application for Licensure by Examination.  Completed fingerprints using either the Live Scan Process or the Applicant Fingerprint Card (Hard Card) processing method One recent 2\" x 2\" passport-type photograph. Completed Request for Accommodation of Disabilities form(s), if applicable. Request For Transcript form(s) completed and forwarded directly from the nursing school(s) with certified transcripts. For International Graduates: Breakdown of Educational Program for International Nursing Programs Request for Transcript Certified English Translation license or diploma

Slide 8: The Eight Steps of the NCLEX Examination Process 2007 1. Apply for licensure to the board of nursing in the state or territory where you wish to be licensed. 2. Register for the NCLEX examination with Pearson VUE by mail, telephone or via the internet. 3. Receive Confirmation of Registration from Pearson VUE. 4. Receive eligibility from the state board of nursing you applied for licensure with. 5. Receive the Authorization to Test (ATT) from Pearson VUE. 6. Schedule an appointment to test by visiting www.pearsonvue.com/nclex or by calling Pearson VUE. 7. Present one form of acceptable identification and your ATT on the day of the examination. A. The only acceptable forms of identification in test centers in the U.S., American Samoa, Guam, Northern Mariana Islands and Virgin Islands are: • U.S. drivers license (not a temporary or learners permit) • U.S. state identification • Passport B. For all other test (international) centers, only a passport is acceptable. All identification must be written in English, have a signature in English, be valid (not expired) and include a photograph. Candidates with identification from a country on the U.S. embargoed countries list will not be admitted to test. C. You will not be admitted to the examination without acceptable identification and your ATT. If you arrive without these materials, you forfeit your test session and must re-register; this includes re-payment of the $200 registration fee. 8. Receive your NCLEX examination results from the board of nursing you applied for licensure with within one month from your examination date.

Slide 9: INTERIM PERMIT First-time examination candidates may apply for an Interim Permit to work while awaiting the results of their examination. Important facts to keep in mind about Interim Permits: Interim Permits cannot be issued until all nursing requirements are completed applicant should be eligible for the examination issued one time only valid for no longer than six months. expire immediately if an applicant fails the examination not renewable and is in effect to the expiration date or until the results of the examination are mailed, at which time it becomes null and void \"A permittee shall practice under the direct supervision of a registered nurse who shall be present and available on the patient care unit during all the time the permittee is rendering professional services. The supervising registered nurse may delegate to the permittee any function taught in the permittee's basic nursing program which, in the judgment of the supervising registered nurse, the permittee is capable of performing.\" (Section 1414(c), Title 16, California Code of Regulations.) To qualify for an Interim Permit, the examination applicant must submit: 1. Appropriate Fees. 2. Application for Licensure by Examination. 3. One completed Fingerprint Card (Hard Card) or second copy of the Live Scan Service Applicant Submission form (BCII 8016). 4. For International Graduates, a copy of your license or diploma that allows you to practice professional nursing in the country where you were educated. 5. Proof of passage of an English comprehension examination if you are from a non-English speaking country or did not take your country's licensing examination in English. Passage of the Test of English as a Foreign Language (TOEFL) is acceptable. It is suggested that if you decide to take the TOEFL, you should apply as soon as possible as it takes several months from the time of filing until your TOEFL results are received.

Slide 11: Participating States in the NLC The following tables and map indicate which states have enacted the RN and LPN/VN Nurse Licensure Compact (NLC). Please note that although Colorado and Rhode Island have enacted the NLC, they have not yet implemented the NLC.

Slide 12: Licensure by Endorsement Application Fees: Endorsement - permanent license (required) $50.00 Fingerprint Fee (required) $56.00 Temporary License (optional) $30.00 Verification of License: Nursys Fingerprints: Two completed fingerprint cards Transcripts: All endorsement applicants must request transcripts be sent directly from their school of nursing http://www.rn.ca.gov/lic/lic-end.htm

Slide 14: VisaScreen Requirements 1. Complete the VisaScreen application. 2. Complete the forms to send to your nursing school(s). Academic transcripts must come directly from the nursing school(s). 3. Complete the forms to send to your licensing authority(ies). Validations of all licenses, past and present, must come directly from the licensing authorities. 4. Pass an English language proficiency test and have the scores directly forwarded to CGFNS/ICHP from the testing agency. 5. Pass either the CGFNS International Qualifying Exam or the NCLEX-RN® examination if you are a registered nurse. 6. Send a copy of your high school diploma or equivalent. 7. Pay the appropriate application fee. You can apply for the VisaScreen Program in one of three ways: • Apply online at www.cgfns.org • Download VisaScreen Program Handbook and Application from www.cgfns.org. • Request a copy of the VisaScreen Program Application from CGFNS International by mail or phone.

Slide 15: Health Care Worker Certification What is a Health Care Worker Certification? A health care worker certification identifies and documents that a foreign health care worker has met minimum requirements for training, licensure, and English proficiency in order to be able to fulfill their professional role as a(n): • Licensed practical nurse, licensed vocational nurse, or registered nurse • Occupational therapist • Physical therapist • Speech language pathologist and audiologist • Medical technologist (clinical laboratory scientist) • Physician assistant • Medical technician (clinical laboratory technician)

Slide 16: Who Must Obtain a Health Care Worker Certification? Any non-U.S. citizen coming to the United States for employment as a health care worker Which Organizations Are Currently Authorized to Issue Health Care Worker Certificates? The Commission on Graduates of Foreign Nursing Schools (CGFNS) is authorized to issue certificates to all 7 2. health care occupations. The National Board for Certification in Occupational Therapy is authorized to issue certificates for occupational 3. therapists. The Foreign Credentialing Commission on Physical Therapy is authorized to issue certificates for physical 4. therapists. Which English Language Testing Organizations Are Approved for Purposes of Health Care Worker Certification? 2. Educational Testing Service (ETS) 3. Test of English in International Communication (TOEIC) 4. International English Language Testing System (IELTS)

Slide 17: ENGLISH TEST Passing Score By Profession OPTION 1 OPTION 2 OPTION 3 OPTION 4 TOEFL Test of English TWE TSE TOEIC Test of TWE TSE TOEFL as a Test of Test of English for Test of Test of IELTS iBT Foreign Written Spoken International Written Spoken IELTS Spoken TOEFL Speaking Healthcare Profession Language English English Communication English English IELTS, Inc. Band iBT Total Section 6.5 Registered Nurse 207 (540 *) 4.0 50 725 4.0 50 (Academic) 7.0 83 26 Practical/Vocational Nurse (LPN/LVN) 197 (530) 4.0 50 700 4.0 50 6.0 (General) 7.0 79 26 Physical Therapist 220 (560) 4.5 50 89 26 Occupational Therapist 220 (560) 4.5 50 89 26 Speech Language 6.5 Pathologist 207 (540) 4.0 50 725 4.0 50 (Academic) 7.0 83 26 6.5 Audiologist 207 (540) 4.0 50 725 4.0 50 (Academic) 7.0 83 26 Clinical Laboratory Scientist 6.5 (Medical Technologist) 207 (540) 4.0 50 725 4.0 50 (Academic) 7.0 83 26 Clinical Laboratory Technician (Medical Technician) 197 (530) 4.0 50 700 4.0 50 6.0 (General) 7.0 79 26 6.5 Physician Assistant 207 (540 4.0 50 725 4.0 50 (Academic) 7.0 83 26 *Scores in parentheses refer to the minimum passing score acceptable on the paper-based version of the TOEFL examination Note: English scores are valid only for two years from date of testing. All scores must be valid at the time that the VisaScreen® Certificate is issued.



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Nursing Students Taking the Nursing Licensure Examination (NLE) December 2007

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Crunch Time! Good luck to those who will take the Nursing Licensure Examination (NLE) this December 1 & 2 2007.

As usual, the list of examination passers for this December NLE Board Exam 2007 will be posted here immediately after the PRC has released the Nursing board exam result.

To those who want to get a FREE copy of the passers for NLE Board Exam December 2007, you please leave your email address (post a comment).

Think Positive!








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Nursing News: Nursing Education Situation in the Philippines

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Nursing Resource: Nursing Education Situation in the Philippines Slide Transcript
Slide 1: Export of Filipino Nurses: From Brain Drain to National Hemorrhage to NLE Leakage Health Alliance for Democracy (HEAD) 13 September 2006

Slide 2: Exporting Health Human Resource No. 1 Exporter of Nurses  “An estimated 85% of employed Filipino nurses (more than 150,000) are working internationally.” (Aiken et al 2004) “70% of all Filipino nursing graduates are working overseas.” (Bach 2003) No. 2 Exporter of Doctors  “68% of Filipino doctors work overseas, next to India.” (Mejia, WHO 1975) (NIH 2004)

Slide 3: Hemorrhage of Human Resources: Nurses 13,536 nurses left in 2001.  2000-2003: approx 50,000 nurses left.  “Data casts doubt on the underreporting of the Philippine Overseas Employment Agency (POEA) that shows only 91 nurses left for the USA in 2000, 304 nurses in 2001, and 320 nurses in 2002.” (Tan et al 2004)

Slide 4: Top 5 Destinations of Filipino Nurses United States of America  United Kingdom  Saudi Arabia  Ireland  Singapore  “The number of nurses that left in the last 4 years (50,000) far exceeds the production of nurses of only 20,000 in the same period.” (NIH 2004)

Slide 5: Deteriorating Quality of Nursing Education The number of nursing  schools have increased 1970s: only 40 1990s: 170 June 2003: 251 April 2004: 370 June 2005: 441 June 2006: 470 By June 2006, almost  200% increase in nursing schools nationwide since 2003 (NIH 2004)

Slide 6: Deteriorating Quality of Nursing Education Decreasing proportion of nursing graduates who pass the  national nursing licensure examinations 1970s and 80s: 80%-90% 1991: below 61% 2001-2003: 44%-48% 2004: 55.9% 2005: 49.7% 2006: 42.42% (NIH 2004, PRC 2005)

Slide 7: Deteriorating Quality of Nursing Education In 2001  116 nursing schools: passing rate of <50% 124 nursing schools: passing rate of >50% In 2002, 150 nursing schools had a passing  rate <50%, which was already 63% of the 237 nursing schools then. In the last 3 NLE 2005, at least 20 schools  consistently a <30% passing rate. (NIH 2004)

Slide 8: Hemorrhage of Human Resources: Other Professionals At least 37 Philippine nursing schools offer abbreviated 2-  year courses for doctors to become nurses. More than 60% of nursing schools are geared mainly for  “second coursers” (non-health professionals who want to take up nursing, e.g. engineers, accountants, teachers, soldiers). (HSA 2005, PNA 2005)

Slide 9: Hemorrhage of Human Resources: Other Professionals Initial HEAD estimates:  around 30% of nursing students are “second-coursers” at least 80% of those taking up nursing are planning to work abroad between 75%-90% of faculty members are planning to work abroad (HSA 2005, PNA 2005)

Slide 10: Hemorrhage of Human Resources: Other Professionals Biggest review centers:  INRESS – P10,000 for 6 weeks Gapuz – P13,400 for 3 weeks Pentagon – P14,500 from Sept to Dec Most nursing colleges also have compulsory “in-house”  reviews that are paid for by the students (separate from tuition and other expenses) Students/graduates spend around P40,000+ just for  review

Slide 11: Exploited Health Human Resources Health workers and professionals are ► overworked and underpaid.

Slide 12: Exploited Health Human Resources Doctor to patient ratio (population) ► Cuba 1:225 USA 1:450 Philippines 1:10,000-26,000 WHO (Ideal) 1:600 Nurses to patient ratio ► PGH 1:15-26 per shift Davao del Sur 1:44-45 per shift Ideal 1:4 per shift Philippines 1:16,000 (population) (AHW 2004, HealthWrights 2004)

Slide 13: The Unhealthy Philippine Health Care System “A health care system that cannot maintain its own health human resource is not healthy at all.”

Slide 14: The Nursing Exam Leakage The Nursing Licensure Examination (NLE)  Given by the PRC twice a year Exam questions are prepared by members of the Board of Nursing Has 5 parts: Test I (Community Nursing), Test II (Maternal and Child), Test III (Medical-Surgical Nursing), Test IV (Fundamentals), Test V (Psychiatric Nursing)

Slide 15: The Nursing Exam Leakage Basic chronology of the NLE leak  A few days before the June 2006 NLE, INRESS held an “final coaching” at one of the cinemas in SM North EDSA Shortly after the NLE, the leakage was exposed in Baguio City. PRC-CAR immediately informed PRC national office.

Slide 16: The Nursing Exam Leakage Basic chronology of the NLE leak  PRC initially said it would investigate before releasing the list of those who passed. Mass resignation of the Technical Committee on Nursing Education (TCNE) on July 7, citing “that CHED has instead (of implementing past memos) buckled down to pressure from poor performing schools, politicians and MalacaƱang, sacrificing quality for mediocrity and business interest.”

Slide 17: The Nursing Exam Leakage Basic chronology of the NLE leak  But even without an investigation, the PRC released the list of those who passed and stated there was no leak involved. PNA President George Cordero also lobbied the PNA chapter in Baguio to keep the matter under wraps as it might jeopardize the country’s request to be made an NCLEX center.

Slide 18: The Nursing Exam Leakage Basic chronology of the NLE leak  Nursing groups were formed to pressure the PRC. The UST-led group called for a nullification of the entire NLE and a re-take. The nursing community became embroiled and divided on the re-take debate. The PRC allowed the oath-taking of those who passed even after promising the ADPCN that it will defer such action.

Slide 19: The Nursing Exam Leakage Basic chronology of the NLE leak  The UST-led group filed a TRO against the PRC for the oath-taking. The processing of papers also stopped. The Senate and the HOR Committees on Health began conducting their respective investigations, but the gov’t agencies involved did not attend the hearings. Witness testimonies already point to the involvement of key leaders/members of the PNA and BON.

Slide 20: The Nursing Exam Leakage Major groups implicated  Dr. George Cordero: owner of INRESS and Philippine Colleges of Health Sciences (PCHS); President of the Philippine Nurses Association (PNA) BON members Anesia B. Dionisio and Virginia D. Madeja Gapuz and Pentagon Review centers PRC Chair Leonor Tripon-Rosero

Slide 21: The Nursing Exam Leakage Major government agencies involved  Professional Regulation Commission (PRC) Board of Nursing (BON) Commission on Higher Education (CHED) Dante Ang (Commission on Overseas Filipino and Presidential Task Force on the National Licensure Exam/EO 550) National Bureau of Investigation

Slide 22: The Nursing Exam Leakage Major groups of stakeholders  Association of Deans of Philippine Colleges of Nursing (President Carmelita Divinagracia, Dean UERM CN) PNA and PNA-CAR Concerned Nurses… (UST, FEU) ANSWER (broad inter-school alliance) BSN (Bukluran ng mga Samahang Nurses) Health Alliance for Democracy (HEAD)

Slide 23: The Nursing Exam Leakage Positions regarding the issue  PRC: “No Leakage”  No Re-take  Voluntary re-take for free  Bonus 2% Dante Ang/Arroyo admin: Compulsory Re-take  Compulsory re-take of Tests III and V PNA: Re-take all  No re-take UST, UE, UP: Compulsory re-take of Tests III, V CHED: “Wala kaming kinalaman dyan!”

Slide 24: The Nursing Exam Leakage HEAD analysis Leakage is only a symptom of a long- • standing deterioration of the nursing education Like other exams given by the PRC, the • NLE has been fraught with leakages that have exemplified the collusion between gov’t officials and big business

Slide 25: The Nursing Exam Leakage HEAD analysis Gov’t agencies (PRC, CHED, BON) have • eroded the quality of nursing education and the integrity of the nursing profession The actions of gov’t agencies are divisive • and meant to distract stakeholders from the main issue

Slide 26: The Nursing Exam Leakage HEAD analysis The commercialization of nursing • education has worsened the quality of nursing education This commercialization is rooted in the • Labor Export Policy of the Arroyo regime Rather than seek solutions, the Arroyo • gov’t seeks to centralize everything (e.g. regulate review centers under gov’t control) to increase its revenues

Slide 27: Health Under the Arroyo Regime Filipino nurses have become a commodity: subject to TRADE and PROFITS The national government has ABANDONED its responsibility to ensure the HEALTH of their PEOPLE

Slide 28: WHAT WE WANT HEAD proposals: IMMEDIATE Conduct a speedy, thorough, impartial, and • independent investigation of the leakage Identify and prosecute the guilty • Completely revamp the PRC, BON, and CHED • Allow those who have passed to seek jobs • without discrimination

Slide 29: WHAT WE WANT HEAD proposals: LONG-TERM Review and uphold the recommendations set by • the TCNE. Set the standards for nursing schools to operate and ensure compliance Ensure the quality of education through a • thorough review of the curricula and quality of nursing faculty Ensure the integrity of the conduct of • examinations and other tests pertinent to the competence of Filipino nurses

Slide 30: WHAT WE WANT HEAD calls: Unite and Uphold the Integrity of the Nursing • Profession! Conduct a Speedy, Thorough, and Independent • Investigation! Identify and Prosecute the Guilty! Stop the Commercialization of Nursing • Education! Stop the Arroyo Administration’s Labor Export • Policy!

Slide 31: HEAL. STRUGGLE. LIBERATE. Health Alliance for Democracy (HEAD)






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How to effectively answer questions in your exam

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Slideshow transcript
Slide 1: E xam Tip No. 1

Slide 2: = Structu re The way you answer a question has a big impact upon how many points you will be awarded. The key to understanding this is that answers MUST have a structure - Eg: they must have a beginning, a middle and an end. This power point will show you how to do this along with other tips in which to pick up higher marks.

Slide 4: Identify and Underline the key words (… and directly use them throughout your answer) How wa s Hitle r a b le to b e c om e Dic ta tor of G e rm a ny a fte r h e b e c a m e C h a nc e llor? Which key words would you underline and use throughout you answer?

Slide 5: Always begin your answer with the words from the question QUESTION: How was Hitler able to become Dictator of Germany after he became Chancellor? ANSWER: Hitler was able to become Dictator of Germany after he became Chancellor because

Slide 6: SMACK the Then…. examiner in the face. Therefore – directly answer the question in your 1st paragraph. Make him/her realise that you know what you are talking about. SOURCE A: An example of how to do it. This also creates a structure as the Do you know how long it takes next paragraph will an experienced examiner to include explanation mark an exam paper that would about your main take you 90 minutes to points. complete? 8 minutes!

Slide 7: QUESTION: How was Hitler able to become Dictator of Germany after he became Chancellor? ANSWER: Hitler was able to become Dictator of Germany after he became Chancellor because of the Reichstag fire, the enabling law and the banning of political parties. This then acts as an introduction and therefore the 1st part of your structure!

Slide 8: 2nd paragraph – Back up your points by using the words:

Slide 9: Finish off with a paragraph beginning with the word: This allows you to sum up your points in relation to what the question is asking you to do (and therefore completing your STRUCTURE)

Slide 10: For higher marks include the most important reason within your conclusion. As you should be aware of by now – making a judgement about which reason was the most important should get you to an A grade. Overall, it is clear that there were a combination of reasons that ultimately allowed Hitler to become Dictator after he became Chancellor. I think that the most important reason was _______ because….

Slide 11: Summary = Structur Then…. SMACK the e examiner in the face. 2nd paragraph – Back up your points by using the words: Identify and Underline the key words (… and directly use them throughout your answer) Finish off with a paragraph beginning with the word: Always begin your answer with the words from the question





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Gastrointestinal System :: Medical Surgical Nursing :: Review For Nursing Licensure Examination

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-Neurology Part 2



Gastrointestinal System :: Medical Surgical Nursing :: Review For Nursing Licensure Examination Slide Transcript
Slide 1: Medical Surgical Nursing The GASTRO-INTESTINAL System Nurse Licensure Examination Review

Slide 2: The Gastro-Intestinal System Review of the GIT Anatomy and Physiology  Review of Common laboratory procedures  Review of Common Symptoms and their  nursing interventions Review of common disorders of the:  Esophagus -gallbladder   Stomach -exocrine pancreas  Small intestine -liver  Large Intestine

Slide 4: The GIT System: Anatomy and Physiology The GIT is composed of two general parts  The main GIT starts from the mouth EsophagusStomachSILI The accessory organs are the  Salivary glands   Liver  Gallbladder  Pancreas

Slide 5: The GIT ANATOMY The Mouth  Contains the lips, cheeks, palate, tongue, teeth, salivary glands, masticatory/facial muscles and bones  Anteriorly bounded by the lips  Posteriorly bounded by the oropharynx

Slide 6: The GIT Physiology The Mouth  Important for the mechanical digestion of food  The saliva contains SALIVARY AMYLASE or PTYALIN that starts the INITIAL digestion of carbohydrates

Slide 7: The GIT ANATOMY The Esophagus  A hollow collapsible tube  Length- 10 inches  Made up of stratified squamos epithelium

Slide 8: The GIT ANATOMY The Esophagus  The upper third contains skeletal muscles  The middle third contains mixed skeletal and smooth muscles  The lower third contains smooth muscles and the esophago-gastric/ cardiac sphincter is found here

Slide 9: The GIT PHYSIOLOGY The Esophagus  Functions to carry or propel foods from the oropharynx to the stomach  Swallowing or deglutition is composed of three phases:

Slide 10: The GIT ANATOMY The stomach  J-shaped organ in the epigastrium  Contains four parts- the fundus, the cardia, the body and the pylorus  The cardiac sphincter prevents the reflux of the contents into the esophagus  The pyloric sphincter regulates the rate of gastric emptying into the duodenum  Capacity is 1,500 ml!

Slide 11: The GIT PHYSIOLOGY The functions of the stomach are  generally to digest the food (proteins) and to propel the digested materials into the SI for final digestion  The Glands and cells in the stomach secrete digestive enzymes:

Slide 12: The GIT PHYSIOLOGY Stomach:  1. Parietal cells- HCl acid and Intrinsic  factor 2. Chief cells- pepsin digestion of  PROTEINS! 3. Antral G-cells- gastrin  4. Argentaffin cells- serotonin  5. Mucus neck cells- mucus 

Slide 13: The GIT ANATOMY The Small intestine  Grossly divided into the Duodenum, Jejunum and Ileum  The duodenum contains the two openings for the bile and pancreatic ducts  The ileum is the longest part (about 12 feet)

Slide 14: The GIT physiology The intestinal glands secrete digestive  enzymes that finalize the digestion of all foodstuff Enzymes for carbohydrates disaccharidases Enzymes for proteins dipeptidases and  aminopeptidases Enzyme for lipids intestinal lipase 

Slide 15: The GIT ANATOMY The Large intestine  Approximately 5 feet long, with parts:  1. The cecum widest diameter, prone to rupture  2. The appendix  3. The ascending colon  4. The transverse colon  5. The descending colon  6. The sigmoid most mobile, prone to twisting  7. The rectum

Slide 16: The GIT Physiology Absorbs water  Eliminates wastes  Bacteria in the colon synthesize Vitamin K  Appendix participates in the immune system 

Slide 17: The GIT Physiology SYMPATHETIC PARASYMPATHETIC  Generally INHIBITORY!  Generally EXCITATORY!  Decreased gastric  Increased gastric secretions secretions  Decreased GIT motility  Increased gastric motility But: Increased sphincteric But: Decreased sphincteric   tone and constriction of tone and dilation of blood blood vessels vessels

Slide 18: The GIT ANATOMY The Liver  The largest internal organ  Located in the right upper quadrant  Contains two lobes- the right and the left  The hepatic ducts join together with the cystic duct to become the common bile duct

Slide 19: The GIT Physiology: LIVER Functions to store excess glucose, fats and  amino acids Also stores the fat soluble vitamins- A, D  and the water soluble- Vitamin B12 Produces the BILE for normal fat digestion  The Von Kupffer cells remove bacteria in the  portal blood Detoxifies ammonia into urea 

Slide 20: The GIT anatomy The gallbladder  Located below the liver  The cystic duct joins the hepatic duct to become the bile duct  The common bile duct joins the pancreatic duct in the sphincter of Oddi in the first part of the duodenum

Slide 21: The GIT Physiology Stores and concentrates bile  Contracts during the digestion of fats to  deliver the bile Cholecystokinin is released by the duodenal  cells, causing the contraction of the gallbladder and relaxation of the sphincter of Oddi

Slide 22: The GIT anatomy The pancreas  A retroperitoneal gland  Functions as an endocrine and exocrine gland  The pancreatic duct (major) joins the common bile duct in the sphincter of Oddi

Slide 23: The GIT Physiology The exocrine function of the pancreas is the  secretion of digestive enzymes for carbohydrates, fats and proteins Pancreatic amylase carbohydrates  Pancreatic lipase (steapsin) fats  Trypsin, Chymotrypsin and Peptidases proteins Bicarbonate to neutralize the acidic  chyme. Stimulated by SECRETIN!

Slide 24: Gastrointestinal Assessment Laboratory Procedures

Slide 25: COMMON LABORATORY PROCEDURES FECALYSIS  Examination of stool consistency, color and the presence of occult blood.  Special tests for fat, nitrogen, parasites, ova, pathogens and others

Slide 26: COMMON LABORATORY PROCEDURES FECALYSIS: Occult Blood Testing  Instruct the patient to adhere to a 3-day meatless diet  No intake of NSAIDS, aspirin and anti-coagulant  Screening test for colonic cancer

Slide 27: COMMON LABORATORY PROCEDURES Upper GIT study: barium swallow  Examines the upper GI tract  Barium sulfate is usually used as contrast

Slide 28: COMMON LABORATORY PROCEDURES Upper GIT study: barium swallow  Pre-test: NPO post-midnight  Post-test: Laxative is ordered, increase pt fluid intake, instruct that stools will turn white, monitor for obstruction

Slide 31: COMMON LABORATORY PROCEDURES Lower GIT study: barium enema  Examines the lower GI tract  Pre-test: Clear liquid diet and laxatives, NPO post-midnight, cleansing enema prior to the test

Slide 32: COMMON LABORATORY PROCEDURES Lower GIT study: barium enema  Post-test: Laxative is ordered, increase patient fluid intake, instruct that stools will turn white, monitor for obstruction

Slide 34: COMMON LABORATORY PROCEDURES Gastric analysis  Aspiration of gastric juice to measure pH, appearance, volume and contents  Pre-test: NPO 8 hours, avoidance of stimulants, drugs and smoking  Post-test: resume normal activities

Slide 35: COMMON LABORATORY PROCEDURES EGD (esophagogastroduodenoscopy)  Visualization of the upper GIT by endoscope  Pre-test: ensure consent, NPO 8 hours, pre-medications like atropine and anxiolytics

Slide 37: COMMON LABORATORY PROCEDURES EGD esophagogastroduodenoscopy  Intra-test: position : LEFT lateral to facilitate salivary drainage and easy access

Slide 38: COMMON LABORATORY PROCEDURES EGD (esophagogastroduodenoscopy)  Post-test: NPO until gag reflex returns, place patient in SIMS position until he awakens, monitor for complications, saline gargles for mild oral discomfort

Slide 39: COMMON LABORATORY PROCEDURES Lower GI- scopy  Use of endoscope to visualize the anus, rectum, sigmoid and colon  Pre-test: consent, NPO 8 hours, cleansing enema until return is clear

Slide 41: COMMON LABORATORY PROCEDURES Lower GI- scopy  Intra-test: position is LEFT lateral, right leg is bent and placed anteriorly  Post-test: bed rest, monitor for complications like bleeding and perforation

Slide 43: COMMON LABORATORY PROCEDURES Cholecystography  Examination of the gallbladder to detect stones, its ability to concentrate, store and release the bile  Pre-test: ensure consent, ask allergies to iodine, seafood and dyes; contrast medium is administered the night prior, NPO after contrast administration

Slide 44: COMMON LABORATORY PROCEDURES Cholecystography Post-test: Advise that dysuria is common as the dye is excreted in the urine, resume normal activities

Slide 45: COMMON LABORATORY PROCEDURES Paracentesis Removal of peritoneal fluid for analysis

Slide 46: COMMON LABORATORY PROCEDURES Paracentesis  Pre-test: ensure consent, instruct to VOID and empty bladder, measure abdominal girth

Slide 47: COMMON LABORATORY PROCEDURES Paracentesis Intra-test: Upright on the edge of the bed, back supported and feet resting on a foot stool

Slide 48: COMMON LABORATORY PROCEDURES Liver biopsy  Pretest  Consent  NPO  Check for the bleeding parameters

Slide 49: COMMON LABORATORY PROCEDURES Liver biopsy  Intratest  Position: Semi fowler’s LEFT lateral to expose right side of abdomen

Slide 50: COMMON LABORATORY PROCEDURES Liver biopsy  Post-test: position on RIGHT lateral with pillow underneath, monitor VS and complications like bleeding, perforation. Instruct to avoid lifting objects for 1 week

Slide 51: The NURSING PROCESS in GIT Disorders Assessment  Health history Nursing History  PE  Laboratory procedures

Slide 52: The ABDOMINAL examination The sequence to follow is:  Inspection  Auscultation  Percussion  Palpation

Slide 54: COMMON GIT SYMPTOMS AND MANAGEMENT CONSTIPATION DIARRHEA DUMPING SYNDROME

Slide 55: COMMON GIT SYMPTOMS AND MANAGEMENT CONSTIPATION  An abnormal infrequency and irregularity of defecation  Multiple causations

Slide 56: COMMON GIT SYMPTOMS AND MANAGEMENT CONSTIPATION: Pathophysiology  Interference with three functions of the colon  1. Mucosal transport  2. Myoelectric activity  3. Process of defecation

Slide 57: COMMON GIT SYMPTOMS AND MANAGEMENT NURSING INTERVENTIONS  1. Assist physician in treating the underlying cause of constipation  2. Encourage to eat HIGH fiber diet to increase the bulk  3. Increase fluid intake  4. Administer prescribed laxatives, stool softeners  5. Assist in relieving stress

Slide 58: COMMON GIT SYMPTOMS AND MANAGEMENT Diarrhea  Abnormal fluidity of the stool Multiple causes   Gastrointestinal Diseases  Hyperthyroidism  Food poisoning

Slide 59: COMMON GIT SYMPTOMS AND MANAGEMENT Diarrhea Nursing Interventions 1. Increase fluid intake- ORESOL is the most important treatment! 2. Determine and manage the cause 3. Anti-diarrheal drugs

Slide 60: COMMON GIT SYMPTOMS AND MANAGEMENT DUMPING SYNDROME  A condition of rapid emptying of the gastric contents into the small intestine usually after a gastric surgery  Symptoms occur 30 minutes after eating

Slide 61: COMMON GIT SYMPTOMS AND MANAGEMENT PATHOPHYSIOLOGY  Foods high in CHO and electrolytes must be diluted in the jejunum before absorption takes place.

Slide 62: COMMON GIT SYMPTOMS AND MANAGEMENT PATHOPHYSIOLOGY The rapid influx of stomach contents will cause distention of the jejunum early symptoms

Slide 63: COMMON GIT SYMPTOMS AND MANAGEMENT PATHOPHYSIOLOGY The hypertonic food bolus will draw fluid from the blood vessels to dilute the high concentrations of CHO and electrolytes in the food bolus

Slide 64: COMMON GIT SYMPTOMS AND MANAGEMENT Later, there is increased blood glucose stimulating the increased secretion of insulin

Slide 65: COMMON GIT SYMPTOMS AND MANAGEMENT Then, blood glucose will fall causing reactive hypoglycemia

Slide 66: COMMON GIT SYMPTOMS AND MANAGEMENT DUMPING SYNDROME ASSESSMENT FINDINGS: early symptoms  1. Nausea and Vomiting  2. Abdominal fullness  3. Abdominal cramping  4. Palpitation  5. Diaphoresis

Slide 67: COMMON GIT SYMPTOMS AND MANAGEMENT DUMPING SYNDROME ASSESSMENT FINDINGS: LATE symptoms:  6. Drowsiness  7. Weakness and Dizziness  8. Hypoglycemia

Slide 68: COMMON GIT SYMPTOMS AND MANAGEMENT DS NURSING INTERVENTIONS  1. Advise patient to eat LOW- carbohydrate HIGH-fat and HIGH- protein diet  2. Instruct to eat SMALL frequent meals, include MORE dry items.  3. Instruct to AVOID consuming FLUIDS with meals

Slide 69: COMMON GIT SYMPTOMS AND MANAGEMENT DS NURSING INTERVENTIONS  4. Instruct to LIE DOWN after meals  5. Administer anti-spasmodic medications to delay gastric emptying

Slide 70: GIT SYMPTOMS AND MANAGEMENT PERNICIOUS ANEMIA  Results from Deficiency of vitamin B12 due to autoimmune destruction of the parietal cells, lack of INTRINSIC FACTOR or total removal of the stomach

Slide 71: GIT SYMPTOMS AND MANAGEMENT PERNICIOUS ANEMIA ASSESSMENT  Severe pallor  Fatigue  Weight loss  SMOOTH BEEFY-RED TONGUE  Mild jaundice  Paresthesia of extremities  Balance disturbance

Slide 72: GIT SYMPTOMS AND MANAGEMENT NURSING INTERVENTION for Pernicious Anemia  Lifetime injection of Vitamin B 12 weekly initially, then MONTHLY

Slide 73: Conditions of the GIT UPPER GI system

Slide 74: CONDITION OF THE ESOPHAGUS HIATAL HERNIA  Protrusion of the esophagus into the diaphragm thru an opening  Two types- Sliding hiatal hernia ( most common) and Axial hiatal hernia

Slide 75: CONDITION OF THE ESOPHAGUS ASSESSMENT Findings in Hiatal hernia  1. Heartburn  2. Regurgitation  3. Dysphagia  4. 50%- without symptoms

Slide 76: CONDITION OF THE ESOPHAGUS DIAGNOSTIC TEST  Barium swallow and fluoroscopy

Slide 77: CONDITION OF THE ESOPHAGUS NURSING INTERVENTIONS  1. Provide small frequent feedings  2. AVOID supine position for 1 hour after eating  3. Elevate the head of the bed on 8- inch block  4. Provide pre-op and post-op care

Slide 78: CONDITION OF THE ESOPHAGUS Esophageal Varices  Dilation and tortuosity of the submucosal veins in the distal esophagus  ETIOLOGY: commonly caused by PORTAL hypertension secondary to liver cirrhosis  This is an Emergency condition!

Slide 79: CONDITION OF THE ESOPHAGUS ASSESSMENT findings for EV  1. Hematemesis  2. Melena  3. Ascites  4. jaundice  5. hepatomegaly/splenomegaly

Slide 80: CONDITION OF THE ESOPHAGUS ASSESSMENT findings for EV  Signs of Shock- tachycardia, hypotension, tachypnea, cold clammy skin, narrowed pulse pressure

Slide 81: CONDITION OF THE ESOPHAGUS DIAGNOSTIC PROCEDURE Esophagoscopy

Slide 82: CONDITION OF THE ESOPHAGUS NURSING INTERVENTIONS FOR EV  1. Monitor VS strictly. Note for signs of shock  2. Monitor for LOC  3. Maintain NPO

Slide 83: CONDITION OF THE ESOPHAGUS NURSING INTERVENTIONS FOR EV  4. Monitor blood studies  5. Administer O2  6. prepare for blood transfusion

Slide 84: CONDITION OF THE ESOPHAGUS INTERVENTIONS FOR EV  7. prepare to administer Vasopressin and Nitroglycerin  8. Assist in NGT and Sengstaken- Blakemore tube insertion for balloon tamponade

Slide 85: CONDITION OF THE ESOPHAGUS NURSING INTERVENTIONS FOR EV  9. Prepare to assist in surgical management:  Endoscopic sclerotherapy  Variceal ligation  Shunt procedures

Slide 86: Conditions of the Stomach Gastro-esophageal reflux  Backflow of gastric contents into the esophagus  Usually due to incompetent lower esophageal sphincter , pyloric stenosis or motility disorder  Symptoms may mimic ANGINA or MI

Slide 87: Conditions of the Stomach ASSESSMENT ( for GERD)  Heartburn  Dyspepsia  Regurgitation  Epigastric pain  Difficulty swallowing  Ptyalism

Slide 88: Conditions of the Stomach Diagnostic test  Endoscopy or barium swallow  Gastric ambulatory pH analysis  Note for the pH of the esophagus, usually done for 24 hours  The pH probe is located 5 inches above the lower esophageal sphincter  The machine registers the different pH of the refluxed material into the esophagus

Slide 89: Conditions of the Stomach NURSING INTERVENTIONS  1. Instruct the patient to AVOID stimulus that increases stomach pressure and decreases GES pressure  2. Instruct to avoid spices, coffee, tobacco and carbonated drinks  3. Instruct to eat LOW-FAT, HIGH- FIBER diet

Slide 90: Conditions of the Stomach NURSING INTERVENTIONS  4. Avoid foods and drinks TWO hours before bedtime  5. Elevate the head of the bed with an approximately 8-inch block

Slide 91: Conditions of the Stomach NURSING INTERVENTIONS  6. Administer prescribed H2- blockers, PPI and prokinetic meds like cisapride, metochlopromide  7. Advise proper weight reduction

Slide 92: Conditions of the Stomach GASTRITIS  Inflammation of the gastric mucosa  May be Acute or Chronic  Etiology: Acute- bacteria, irritating foods, NSAIDS, alcohol, bile and radiation  Etiology: Chronic- Ulceration, bacteria, Autoimmune disease, diet, alcohol, smoking

Slide 93: Conditions of the Stomach PATHOPHYSIOLOGY OF Gastritis  Insults cause gastric mucosal damage inflammation, hyperemia and edema superficial erosions  decreased gastric secretions, ulcerations and bleeding

Slide 94: Conditions of the Stomach ASSESSMENT ASSESSMENT (Chronic) (Acute)  Pyrosis  Dyspepsia  Singultus  Headache  Sour taste in the  Anorexia mouth  Dyspepsia  Nausea/Vomiting  N/V/anorexia  Pernicious anemia

Slide 95: Conditions of the Stomach DIAGNOSTIC PROCEDURE  EGD- to visualize the gastric mucosa for inflammation  Low levels of HCl  Biopsy to establish correct diagnosis whether acute or chronic

Slide 96: Conditions of the Stomach NURSING INTERVENTIONS  1. Give BLAND diet  2. Monitor for signs of complications like bleeding, obstruction and pernicious anemia  3. Instruct to avoid spicy foods, irritating foods, alcohol and caffeine

Slide 97: Conditions of the Stomach NURSING INTERVENTIONS  4. Administer prescribed medications- H2 blockers, antibiotics, mucosal protectants  5. Inform the need for Vitamin B12 injection if deficiency is present

Slide 98: Conditions of the Stomach PEPTIC ULCER DISEASE  An ulceration of the gastric and duodenal lining  May be referred as to location as Gastric ulcer in the stomach, or Duodenal ulcer in the duodenum  Most common Peptic ulceration: anterior part of the upper duodenum

Slide 99: Conditions of the Stomach PATHOPHYSIOLOGY of PUD  Disturbance in acid secretion and mucosal protection  Increased acidity or decreased mucosal resistance erosion and ulceration

Slide 100: Conditions of the Stomach GASTRIC ULCER Ulceration of the gastric mucosa, submucosa and rarely the muscularis

Slide 101: Conditions of the Stomach GASTRIC ULCER  Risk factors: Stress, smoking, NSAIDS abuse, Alcohol, Helicobacter pylori infection, type A personality and History of gastritis  Incidence is high in older adults  Acid secretion is NORMAL

Slide 102: Conditions of the Stomach ASSESSMENT (Gastric Ulcer)  Epigastric pain  Characteristic: Gnawing, sharp pain in the mid-epigastrium 1-2 hours AFTER eating, often NOT RELIEVED by food intake, sometimes AGGRAVATING the pain!

Slide 103: Conditions of the Stomach ASSESSMENT (Gastric Ulcer)  Nausea  Vomiting is more common  Hematemesis  Weight loss

Slide 104: Conditions of the Stomach DIAGNOSTIC PROCEDURES  1. EGD to visualize the ulceration  2. Urea breath test for H. pylori infection  3. Biopsy- to rule out gastric cancer

Slide 105: Conditions of the Stomach NURSING INTERVENTIONS  1. Give BLAND diet, small frequent meals during the active phase of the disease  2. Administer prescribed medications- H2 blockers, PPI, mucosal barrier protectants and antacids

Slide 106: Conditions of the Stomach NURSING INTERVENTIONS  3. Monitor for complications of bleeding, perforation and intractable pain  4. provide teaching about stress reduction and relaxation techniques

Slide 107: Conditions of the Stomach NURSING INTERVENTIONS FOR BLEEDING  1. Maintain on NPO  2. Administer IVF and medications  3. Monitor hydration status, hematocrit and hemoglobin

Slide 108: Conditions of the Stomach NURSING INTERVENTIONS FOR BLEEDING  4. Assist with SALINE lavage  5. Insert NGT for decompression and lavage

Slide 109: Conditions of the Stomach NURSING INTERVENTIONS FOR BLEEDING  6. Prepare to administer blood transfusion  7. Prepare to give VASOPRESSIN to induce vasoconstriction to reduce bleeding  8. Prepare patient for SURGERY if warranted

Slide 110: Conditions of the Stomach SURGICAL PROCEDURES FOR PUD  Total gastrectomy, vagotomy, gastric resection, Billroth I and II, pyloroplasty

Slide 112: Conditions of the Stomach SURGICAL PROCEDURES FOR PUD Post-operative Nursing management  1. Monitor VS  2. Post-op position: FOWLER’S  3. NPO until peristalsis returns  4. Monitor for bowel sounds  5. Monitor for complications of surgery

Slide 113: Conditions of the Stomach Post-operative Nursing management  6. Monitor I and O, IVF  7. Maintain NGT  8. Diet progress: clear liquid full liquid six bland meals  9. Manage DUMPING SYNDROME

Slide 114: Condition of the Duodenum DUODENAL ULCER Ulceration of duodenal mucosa and submucosa Usually due to increased gastric acidity

Slide 115: Condition of the Duodenum DUODENAL ULCER ASSESSMENT  PAIN characteristic: Burning pain in the mid- epigastrium 2-4 HOURS after eating or during the night, RELIEVED by food intake

Slide 117: Condition of the Duodenum DIAGNOSTIC TESTS EGD and Biopsy

Slide 120: Condition of the Duodenum NURSING INTERVENTIONS  1. Same as for gastric ulceration  2. Patient teaching-avoid alcohol, smoking, caffeine and carbonated drinks Take NSAIDS with meals Adhere to medication regimen

Slide 121: Ulcers GASTRIC DUODENAL Older Younger Normal Acidity INCREASED acidity Pain early after eating Pain late after eating (2-4 hours) WORSENS by food, RELIEVES by food RELIEVED by VOMITING Bleeding, weight loss and Less likely bleeding and vomiting vomiting (+) cancer (-) cancer

Slide 122: Conditions of the Lower Tract Small and Large Intestine

Slide 123: CONDITIONS OF THE SMALL INTESTINE CROHN’S DISEASE  Also called Regional Enteritis  An inflammatory disease of the GIT affecting usually the small intestine

Slide 124: CONDITIONS OF THE SMALL INTESTINE CROHN’S DISEASE  ETIOLOGY: unknown  The terminal ileum thickens, with scarring, ulcerations, abscess formation and narrowing of the lumen

Slide 125: CONDITIONS OF THE SMALL INTESTINE ASSESSMENT findings for CD  1. Fever  2. Abdominal distention  3. Diarrhea  4. Colicky abdominal pain  5. Anorexia/N/V  6. Weight loss  7. Anemia

Slide 126: CONDITIONS OF THE LARGE INTESTINE ULCERATIVE COLITIS  Ulcerative and inflammatory condition of the GIT usually affecting the large intestine  The colon becomes edematous and develops bleeding ulcerations  Scarring develops overtime with impaired water absorption and loss of elasticity

Slide 127: CONDITIONS OF THE LARGE INTESTINE ASSESSMENT findings for UC  1. Anorexia  2. Weight loss  3. Fever  4. SEVERE diarrhea with Rectal bleeding  5. Anemia  6. Dehydration  7. Abdominal pain and cramping

Slide 128: NURSING INTERVENTIONS for CD and UC 1. Maintain NPO during the active phase  2. Monitor for complications like severe  bleeding, dehydration, electrolyte imbalance 3. Monitor bowel sounds, stool and blood  studies 4. Restrict activities  5. Administer IVF, electrolytes and TPN if  prescribed

Slide 129: NURSING INTERVENTIONS for CD and UC 6. Instruct the patient to AVOID gas-forming  foods, MILK products and foods such as whole grains, nuts, RAW fruits and vegetables especially SPINACH, pepper, alcohol and caffeine 7. Diet progression- clear liquid LOW residue,  high protein diet 8. Administer drugs- anti-inflammatory,  antibiotics, steroids, bulk-forming agents and vitamin/iron supplements

Slide 130: CONDITIONS OF THE LARGE INTESTINE APPENDICITIS Inflammation of the vermiform appendix

Slide 132: CONDITIONS OF THE LARGE INTESTINE APPENDICITIS  ETIOLOGY: usually fecalith, lymphoid hyperplasia, foreign body and helminthic obstruction

Slide 133: CONDITIONS OF THE LARGE INTESTINE APPENDICITIS PATHOPHYSIOLOGY  Obstruction of lumen increased pressure decreased blood supply  bacterial proliferation and mucosal inflammation ischemia  necrosis rupture

Slide 134: CONDITIONS OF THE LARGE INTESTINE ASSESSMENT FINDINGS for Appendicitis  1. Abdominal pain: begins in the umbilicus then localizes in the RLQ (Mc Burney’s point)  2. Anorexia  3. Nausea and Vomiting

Slide 135: CONDITIONS OF THE LARGE INTESTINE ASSESSMENT FINDINGS for Appendicitis  4. Fever  5. Rebound tenderness and abdominal rigidity (if perforated)  6. Constipation or diarrhea

Slide 136: CONDITIONS OF THE LARGE INTESTINE DIAGNOSTIC TESTS  1. CBC- reveals increased WBC count  2. Ultrasound  3. Abdominal X-ray

Slide 137: CONDITIONS OF THE LARGE INTESTINE NURSING INTERVENTIONS 1. Preoperative care  NPO  Consent  Monitor for perforation and signs of shock

Slide 138: CONDITIONS OF THE LARGE INTESTINE NURSING INTERVENTIONS 1. Preoperative care  Monitor bowel sounds, fever and hydration status  POSITION of Comfort: RIGHT SIDELYING in a low FOWLER’S  Avoid Laxatives, enemas & HEAT APPLICATION

Slide 139: CONDITIONS OF THE LARGE INTESTINE 2. Post-operative care  Monitor VS and signs of surgical complications  Maintain NPO until bowel function returns  If rupture occurred, expect drains and IV antibiotics

Slide 140: CONDITIONS OF THE LARGE INTESTINE 2. Post-operative care  POSITION post-op: RIGHT side-lying, semi- fowler’s to decrease tension on incision, and legs flexed to promote drainage  Administer prescribed pain medications

Slide 141: CONDITIONS OF THE LARGE INTESTINE Hemorrhoids  Abnormal dilation and weakness of the veins of the anal canal  Variously classified as Internal or External, Prolapsed, Thrombosed and Reducible

Slide 142: CONDITIONS OF THE LARGE INTESTINE Hemorrhoids PATHOPHYSIOLOGY  Increased pressure in the hemorrhoidal tissue due to straining, pregnancy, etc dilatation of veins

Slide 143: CONDITIONS OF THE LARGE INTESTINE Internal hemorrhoids  These dilated veins lie above the internal anal sphincter  Usually, the condition is PAINLESS

Slide 144: CONDITIONS OF THE LARGE INTESTINE External hemorrhoids  These dilated veins lie below the internal anal sphincter  Usually, the condition is PAINFUL

Slide 145: CONDITIONS OF THE LARGE INTESTINE ASSESSMENT findings for Hemorrhoids  1. Internal hemorrhoids- cannot be seen on the peri-anal area  2. External hemorrhoids- can be seen  3. Bright red bleeding with each defecation

Slide 146: CONDITIONS OF THE LARGE INTESTINE ASSESSMENT findings for Hemorrhoids  4. Rectal/ perianal pain  5. Rectal itching  6. Skin tags

Slide 147: CONDITIONS OF THE LARGE INTESTINE DIAGNOSTIC TEST 1. Anoscopy 2. Digital rectal examination

Slide 148: CONDITIONS OF THE LARGE INTESTINE NURSING INTERVENTIONS  1. Advise patient to apply cold packs to the anal/rectal area followed by a SITZ bath  2. Apply astringent like witch hazel soaks

Slide 149: CONDITIONS OF THE LARGE INTESTINE NURSING INTERVENTIONS  3. Encourage HIGH-fiber diet and fluids  4. Administer stool softener as prescribed

Slide 150: CONDITIONS OF THE LARGE INTESTINE Post-operative care for hemorrhoidectomy  1. Position: Prone or Side-lying  2. Maintain dressing over the surgical site

Slide 151: CONDITIONS OF THE LARGE INTESTINE Post-operative care for hemorrhoidectomy  3. Monitor for bleeding  4. Administer analgesics and stool softeners  5. Advise the use of SITZ bath 3-4 times a day

Slide 152: CONDITIONS OF THE LARGE INTESTINE DIVERTICULOSIS AND DIVERTICULITIS Diverticulosis  Abnormal out-pouching of the intestinal mucosa occurring in any part of the LI most commonly in the sigmoid Diverticulitis  Inflammation of the diverticulosis

Slide 153: CONDITIONS OF THE LARGE INTESTINE PATHOPHYSIOLOGY  Increased intraluminal pressure, LOW volume in the lumen and Decreased muscle strength in the colon wall herniation of the colonic mucosa

Slide 154: CONDITIONS OF THE LARGE INTESTINE ASSESSMENT findings for D/D  1. Left lower Quadrant pain  2. Flatulence  3. Bleeding per rectum  4. nausea and vomiting  5. Fever  6. Palpable, tender rectal mass

Slide 155: CONDITIONS OF THE LARGE INTESTINE DIAGNOSTIC STUDIES  1. If no active inflammation,  COLONOSCOPY and Barium Enema 2. CT scan is the procedure of choice!  3. Abdominal X-ray 

Slide 156: CONDITIONS OF THE LARGE INTESTINE NURSING INTERVENTIONS  1. Maintain NPO during acute phase  2. Provide bed rest  3. Administer antibiotics, analgesics like meperidine (morphine is not used) and anti- spasmodics  4. Monitor for potential complications like perforation, hemorrhage and fistula  5. Increase fluid intake

Slide 157: CONDITIONS OF THE LARGE INTESTINE NURSING INTERVENTIONS  6. Avoid gas-forming foods or HIGH- roughage foods containing seeds, nuts to avoid trapping  7. introduce soft, high fiber foods ONLY after the inflammation subsides  8. Instruct to avoid activities that increase intra-abdominal pressure

Slide 158: Conditions of the GIT accessory organs The liver

Slide 159: CONDITION OF THE LIVER Liver Cirrhosis  A chronic, progressive disease characterized by a diffuse damage to the hepatic cells  The liver heals with scarring, fibrosis and nodular regeneration

Slide 160: CONDITION OF THE LIVER Liver Cirrhosis ETIOLOGY: Post-infection, Alcohol, Cardiac diseases, Schisostoma, Biliary obstruction

Slide 162: Liver physiology and Pathophysiology Normal Function Abnormality in function 1. Stores glycogen = Hypoglycemia 2. Synthesizes proteins = Hypoproteinemia 3. Synthesizes globulins =Decreased Antibody formation 4. Synthesizes Clotting factors = Bleeding tendencies 5. Secreting bile = Jaundice and pruritus 6. Converts ammonia to urea =Hyperammonemia 7. Stores Vit and minerals =Deficiencies of Vit and min 8. Metabolizes estrogen = Gynecomastia, testes atrophy

Slide 163: CONDITION OF THE LIVER ASSESSMENT FINDINGS  1. Anorexia and weight loss  2. Jaundice  3. Fatigue

Slide 164: CONDITION OF THE LIVER ASSESSMENT FINDINGS  4. Early morning nausea and vomiting  5. RUQ abdominal pain  6. Ascites  7. Signs of Portal hypertension

Slide 166: CONDITION OF THE LIVER NURSING INTERVENTIONS  1. Monitor VS, I and O, Abdominal girth, weight, LOC and Bleeding  2. Promote rest. Elevated the head of the bed to minimize dyspnea

Slide 167: CONDITION OF THE LIVER NURSING INTERVENTIONS 3. Provide Moderate to LOW-protein (1 g/kg/day) and LOW-sodium diet 4. Provide supplemental vitamins (especially K) and minerals

Slide 168: CONDITION OF THE LIVER NURSING INTERVENTIONS 5. Administer prescribed Diuretics= to reduce ascites and edema Lactulose= to reduce NH4 in the bowel Antacids and Neomycin= to kill bacterial flora that cause NH production

Slide 169: CONDITION OF THE LIVER NURSING INTERVENTIONS 6. Avoid hepatotoxic drugs Paracetamol Anti-tubercular drugs

Slide 170: CONDITION OF THE LIVER NURSING INTERVENTIONS  7. Reduce the risk of injury Side rails reorientation Assistance in ambulation Use of electric razor and soft- bristled toothbrush

Slide 171: CONDITION OF THE LIVER NURSING INTERVENTIONS  8. Keep equipments ready including Sengstaken- Blakemore tube, IV fluids, Medications to treat hemorrhage

Slide 172: CONDITION OF THE LIVER Nursing Interventions Rationale 1. Low sodium Diet To reduce edema 2. Low protein diet To reduce NH production 3. Benadryl and mild soap To relieve pruritus 4. Pressure onto injection site To prevent bleeding Done to relieve abdominal pressure 5. Assist in paracentesis 6. Administer Medications: Diuretics, Neomycin, Lactulose Albumin, Amino acid Vitamin K (menadione)

Slide 173: Conditions of the Accessory organs The Gallbladder

Slide 174: CONDITION OF THE GALLBLADDER Cholecystitis  Inflammation of the gallbladder  Can be acute or chronic

Slide 175: CONDITION OF THE GALLBLADDER Cholecystitis  Acute cholecystitis usually is due to gallbladder stones

Slide 176: CONDITION OF THE GALLBLADDER Cholecystitis  Chronic cholecystitis is usually due to long standing gall bladder inflammation

Slide 178: Cholelithiasis  Formation of GALLSTONES in the biliary apparatus

Slide 179: Predisposing FACTORS “F”  Female  Fat  Forty  Fertile  Fair

Slide 181: Pathophysiology Supersaturated bile, Biliary stasis Stone formation Blockage of Gallbladder Inflammation, Mucosal Damage and WBC infiltration

Slide 182: Pathophysiology Less bile in the duodenum Impaired fat digestion and absorption Vitamin ADEK mal-absorption, STEATORHEA with increased gas formation Jaundice ACHOLIC stools

Slide 183: CONDITION OF THE GALLBLADDER ASSESSMENT findings for cholecystitis  1. Indigestion, belching and flatulence  2. Fatty food intolerance, steatorrhea

Slide 184: CONDITION OF THE GALLBLADDER ASSESSMENT findings for cholecystitis  3. Epigastric pain that radiates to the scapula or localized at the RUQ  4. Mass at the RUQ

Slide 185: CONDITION OF THE GALLBLADDER ASSESSMENT findings for cholecystitis  5. Murphy’s sign  6. Jaundice  7. dark orange and foamy urine

Slide 186: CONDITION OF THE GALLBLADDER DIAGNOSTIC PROCEDURES   1. Ultrasonography- can detect the stones  2. Abdominal X-ray  3. Cholecystography

Slide 187: CONDITION OF THE GALLBLADDER DIAGNOSTIC PROCEDURES   4. WBC count increased  5. Oral cholecystography cannot visualize the gallbladder  6. ERCP: revels inflamed gallbladder with gallstone

Slide 188: CONDITION OF THE GALLBLADDER NURSING INTERVENTIONS  1. Maintain NPO in the active phase  2. Maintain NGT decompression

Slide 189: CONDITION OF THE GALLBLADDER NURSING INTERVENTIONS  3. Administer prescribed medications to relieve pain. Usually Demerol (MEPERIDINE)  Codeine and Morphine may cause spasm of the Sphincter increased pain. Morphine cause MOREPAIN

Slide 190: CONDITION OF THE GALLBLADDER  4. Instruct patient to AVOID HIGH- fat diet and GAS-forming foods  5. Assist in surgical and non- surgical measures  6. Surgical procedures- Cholecystectomy, Choledochotomy, laparoscopy

Slide 191: CONDITION OF THE GALLBLADDER PHARMACOLOGIC THERAPY  Analgesic- Meperidine 2. Chenodeoxycholic acid= to 3. dissolve the gallstones Antacids 4. Anti-emetics 5.

Slide 194: CONDITION OF THE GALLBLADDER Post-operative nursing interventions  1. Monitor for surgical complications  2. Post-operative position after recovery from anesthesia- LOW FOWLER’s

Slide 195: CONDITION OF THE GALLBLADDER Post-operative nursing interventions  3. Encourage early ambulation  4. Administer medication before coughing and deep breathing exercises  5. Advise client to splint the abdomen to prevent discomfort during coughing

Slide 196: CONDITION OF THE GALLBLADDER Post-operative nursing interventions  6. Administer analgesics, antiemetics, antacids  7. Care of the biliary drainageor T-tube drainage  8. Fat restriction is only limited to 4-6 weeks. Normal diet is resumed

Slide 197: Conditions of the accessory organs The pancreas: Exocrine function

Slide 198: CONDITION OF THE PANCREAS Pancreatitis Inflammation of the pancreas Can be acute or chronic

Slide 199: CONDITION OF THE PANCREAS Pancreatitis  Etiology and predisposing factors Alcoholism Hypercalcemia Trauma Hyperlipidemia

Slide 200: CONDITION OF THE PANCREAS Pancreatitis  Etiology and predisposing factors Biliary tract disease - cholelithiasis Bacterial disease PUD Mumps

Slide 201: CONDITION OF THE PANCREAS PATHOPHYSIOLOGY of acute pancreatitis  Self-digestion of the pancreas by its own digestive enzymes principally TRYPSIN

Slide 202: CONDITION OF THE PANCREAS PATHOPHYSIOLOGY of acute pancreatitis  Spasm, edema or block in the Ampulla of Vater reflux of proteolytic enzymes auto digestion of the pancreas inflammation

Slide 203: CONDITION OF THE PANCREAS PATHOPHYSIOLOGY of acute pancreatitis Autodigestion of pancreatic tissue Hemorrhage, Necrosis and Inflammation KININ ACTIVATION will result to increased permeability Loss of Protein-rich fluid into the peritoneum HYPOVOLEMIA

Slide 204: CONDITION OF THE PANCREAS ASSESSMENT findings  1. Abdominal pain- acute onset, occurring after a heavy meal or alcohol intake  2. Abdominal guarding

Slide 205: CONDITION OF THE PANCREAS ASSESSMENT findings  3. Bruising on the flanks and umbilicus  4. N/V, jaundice  5. Hypotension and hypovolemia  6. HYPERGLYCEMIA, HYPOCALCEMIA  7. Signs of shock

Slide 206: CONDITION OF THE PANCREAS DIAGNOSTIC TESTS  1. Serum amylase and serum lipase  2. Ultrasound  3. WBC  4. Serum calcium  5. CT scan  6. Hemoglobin and hematocrit

Slide 207: CONDITION OF THE PANCREAS NURSING INTERVENTIONS  1. Assist in pain management. Usually, Demerol is given. Morphine is AVOIDED  2. Assist in correction of Fluid and Blood loss

Slide 208: CONDITION OF THE PANCREAS NURSING INTERVENTIONS  3. Place patient on NPO to inhibit pancreatic stimulation  4. NGT insertion to decompress distention and remove gastric secretions  5. Maintain on bed rest

Slide 209: CONDITION OF THE PANCREAS NURSING INTERVENTIONS  7. Position patient in SEMI- FOWLER’s to decrease pressure on the diaphragm  8. Deep breathing and coughing exercises  9. Provide parenteral nutrition

Slide 210: CONDITION OF THE PANCREAS NURSING INTERVENTIONS  10. Introduce oral feedings gradually- HIGH carbo, LOW FAT  11. Maintain skin integrity  12. Manage shock and other complications

Slide 211: Quick Summary Peptic Ulcer  Ulceration of mucosa; In the stomach or  duodenum  Outstanding Symptom: PAIN  Nursing Goal: Allow ulcer to heal, prevent complication  Rest: physical and Mental  Eliminate certain foods  Medications: antacid, H2 blockers, Proton Pump inhibitors, antibiotics, mucosal protectants  Surgery: Vagotomy, Billroth 1 and 2

Slide 212: Quick Summary Liver Cirrhosis  Destruction of liver with replacement by scars   Common causes: alcoholism, post-hepatitic  Manifestations related to liver derangements  Jaundice, Ascites, splenomegaly, bleeding, enceph  Nursing goal: Control manifestations and maximize liver function

Slide 213: Quick Summary Liver Cirrhosis  Encourage rest   Avoid hepatotoxic drugs  Diet: HIGH calorie, Restricted protein, LOW Na  Weight client and measure abdominal girth daily  Provide skin care for jaundice and edema  Assess for bleeding: esophageal, rectal, cutaneous  DRUGS: Antacids, Diuretics, Albumin, Neomycin and Lactulose

Slide 214: Quick Summary Cholecystitis  Inflammation of the gallbladder commonly caused  by cholelithiasis (Female, Fat, Forty, Fertile, Fair)  Manifestations: Fat intolerance, RUQ pain, Nausea and vomiting, Jaundice, Murphy’s sign  Nursing Goal: Relieve symptoms and assist in stone removal

Slide 215: Quick Summary Cholecystitis  Administer MEPERIDINE, avoid morphine   Maintain Fluid and electrolyte balance  Maintain a LOW fat diet  Semi-fowler’s position  Assist in surgery  Care of the T-tube

Slide 216: Quick Summary Pancreatitis  Inflammation of the pancreas brought about by the  digestion of the organ by the enzyme it produces  Common causes: Alcoholism, stone  Manifestations: Extreme upper abdominal pain radiating into the back, vomiting, nausea, Abdominal distention, Steatorrhea and weight loss  Laboratory: ELEVATED lipase and amylase

Slide 217: Quick Summary Pancreatitis  Nursing Goal : relieve symptoms, maintain blood  volume and GIT rest  NPO  Provide IVF and Parenteral nutrition  Drugs: MEPERIDINE, never morphine, Antacids, anticholinergics  After Acute phase: LOW fat diet, avoid alcohol, fat and vitamin replacements





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