Med-Surg Inflammation and Nutrition

Inflammation and Nutrition

By. Miranda Smith Ed.D, AGACNP-BC

HPI: Mr. James is a 41-year-old male who has been admitted to the hospital with a flare-up of Ulcerative Colitis. He has been having severe abdominal pain for about 5-6 days and has not been able to eat.
PMH: Ulcerative Colitis
Meds: Infliximab
Vital Signs: BP 101/65 (77), HR 112, Sp02 95 %/RA, RR 25, Temp 99.7 F
Assessment: alert and oriented x4, acute distress from pain, CV tachycardia, S1S2, no rubs/murmurs, RR tachypnea, BBS clear, even and unlabored, Abd soft, diffuse tenderness, hyperactive bowel sounds, Int: Pale, Brisk CRT, no wounds

Multiple Choice

Which question would be MOST important to ask Mr. James at this time?

• Have you noticed blood in your stool?

• What is your pain level?

• When did you last take your infliximab?

• When did your fever start?

HPI: Mr. James is a 41-year-old male who has been admitted to the hospital with a flare-up of Ulcerative Colitis. He has been having severe abdominal pain for about 5-6 days and has not been able to eat.
PMH: Ulcerative Colitis
Meds: Infliximab
Vital Signs: BP 101/65 (77), HR 112, Sp02 95 %/RA, RR 25, Temp 99.7 F
Assessment: alert and oriented x4, acute distress from pain, CV tachycardia, S1S2, no rubs/murmurs, RR tachypnea, BBS clear, even and unlabored, Abd soft, diffuse tenderness, hyperactive bowel sounds, Int: Pale, Brisk CRT, no wounds

Drag and Drop

Which finding(s) should concern the nurse​

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Pale skin

tachycardia

SP02

currently taking infliximab

Laboratory Data:
WBC: 18,600 Na+ 131
RBC: 2,500 K+ 5.3
Hgb: 6.5 CO2 14
Hct: 22% Ca++ 9.6
Platelets: 165,000 BUN 18
PT: 12 Creatinine 1.8
INR: 1.2 Glucose 78
PTT: 30

Dropdown

After reviewing the laboratory data, which finding is the MOST concerning? ​

Select answer

Multiple Choice

Which acid-base values would the nurse expect to find on this client?

• pH 7.45

  PCO2 47

  HCO3 20

• pH 7.33

  pCO2 30

  HCO3 18

• pH 7.4

  pCO2 40

  HCO3 23

• pH 7.34

  pCO2 47

  HCO3 28

Multiple Choice

What do you think is happening to Mr. James?

• Dehydrated from diarrhea

• I have no idea

• He is bleeding due to his UC

• He is vomiting and got dehydrated

Multiple Select

Which order(s) would be appropriate to implement?

• Type and Crossmatch for blood

• Obtain blood cultures x 2

• CT of Abdomen

• NPO

• Nutritional consult

Multiple Choice

The CT results return and the RN notices the results and there is an abscess in the large intestine. What should the nurse do?

• Ignore the results and continue with routine care
• Inform the patient's family before the healthcare provider
• Notify the healthcare provider.
• Administer antibiotics immediately

Multiple Select

Which data helps to support the findings of an abscess on the CT from the assessment data?

• fever

• WBC

• BP

• Na+

Multiple Choice

The dietician has rounded and has decided to order TPN on the client. Why is TPN ordered and not enteral feedings?

• Enteral feedings are not recommended when TPN is the better option.

• TPN is ordered to improve oral intake
• TPN is more cost effective and easier on the client.

• TPN is ordered when the client is unable to tolerate enteral feedings or has a non-functional gastrointestinal tract.

​Mr. James has a triple lumen CVL placed and his TPN is started on night shift. The pharmacist has ordered labs for the am.

The physician also places the client on metronidazole 500 mg IVPB q 8 hr
and Vancomycin 1 gram IVPB now and to be dosed by pharmacy.
Also to infuse 2 units of PRBCs when ready.

Laboratory Data AM: (pt has received 2 units prbc)
WBC: 17,500 Na+ 132
RBC: 3,100 K+ 5.1
Hgb: 7.3 CO2 18
Hct: 25% Ca++ 9.3
Platelets: 167,000 BUN 15
PT: 12 Creatinine 1.7
INR: 1.2 Glucose 82
PTT: 30 prealbumin Low
Albumin Low

Multiple Choice

Which complication(s) should the nurse be aware of when providing TPN to a client?

• Hypotension, hypokalemia, kidney failure
• Respiratory distress, sepsis, anemia
• Hypoglycemia, hypertension, pancreatitis
• Infection, thrombosis, hyper/hypoglycemia, electrolyte imbalances

Multiple Choice

The nurse is preparing to change out the TPN bag for the day. The pump is beeping the bag is out but there is no bag ready in the medication room. What would be appropriate for the nurse to do at the point?

• Stop the infusion and wait for the new TPN to come

• Hang D10W at the same rate as the TPN

• Call and fuss at pharmacy for not having the medication ready

• Give the client food so their blood sugar won't drop

Drag and Drop

What are some nursing safety measures when handling TPN? ​

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2 nurses must verify the order

The bag and tubing has to be changed every 24 hr

They need to be on glucose checks

Monitor the CVL or peripheral line

Monitor their electrolytes

Multiple Choice

The next day, the nurse is reviewing the laboratory data: WBC 15,000, RBC 2.5, Hgb 7.0, Hct 27%, MCV 112 Na+ 136, K+ 3.2, glucose 97, CO2 20. Which type of anemia does this client have?

• Normocytic anemia

• Iron deficiency anemia

• B12 deficiency anemia

Match

Match the MCV values to the type of anemia

• MCV 120

• MCV 70

• MCV 95

B12/Folic Acid Deficiency

Iron Deficiency

Anemia of Chronic Disease

• B12/Folic Acid Deficiency

• Iron Deficiency

• Anemia of Chronic Disease

Drag and Drop

Which assessment findings would indicate improvements in Mr. James condition?

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BP 125/76

HR 90

Hgb 5.4

Hct 37%

Temp 98.9

WBC 25,000

platelets 75,000

Now Lets Review OTHER Inflammatory Issues

Multiple Choice

Which finding in peptic ulcer disease is the MOST CONCERNING?

• abdominal pain

• vomiting blood

• fever

• diarrhea

Multiple Choice

Which test is the MOST diagnostic for PUD?

• H. Pylori

• BMP

• ESR

• CRP

Dropdown

The provider has prescribed ibuprofen for a client to help with arthritis pain. The nurse understands that which medication(s) can be given with ibuprofen to help decrease the risk of PUD? ​

Select answer

​

Select answer

Hotspot

The provider suspects the client has an appendicitis. Where on the client would the nurse suspect the client to be complaining of pain with palpation?

Multiple Choice

Which diagnostic tool is priority for a client who is suspected of having an appendicitis?

• CT scan
• X-ray
• Ultrasound
• MRI scan

Hotspot

A client presents to the ED with complaints of cramping like abdominal pain, diarrhea, and bloating. The provider suspects the client has diverticulitis. Where would the nurse expect the client to have pain upon palpation?

Dropdown

A finding of a​

Select answer

would be the most concerning because the client could potentially be developing ​

Select answer

Multiple Select

Which interventions would be appropriate for a client who has diverticulitis?

• NPO

• Place a NGT

• NS at 125 ml/hr

• Daily BMP/CBC

• Morphine 2 mg IVP q4 hrs prn pain

Drag and Drop

You are providing discharge teaching to a client who was admitted with diverticulitis. Which teaching should be included? ​

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eat a high fiber diet

You can continue to drink your normal alcohol

Increase water to 2 L daily

Avoid kernel foods such as popcorn, corn, etc

Use stool softeners if needed

Match

Match the vitamins with the description

• Vitamin A

• Vitamin C

• Vitamin D

• Thiamine

• Vitamin B12

Avoid in pregnancy

Helps with iron absorption

Absorbed better with calcium

Common in malnourished pts/ nervous syst

Can cause nerve issues if not corrected

• Avoid in pregnancy

• Helps with iron absorption

• Absorbed better with calcium

• Common in malnourished pts/ nervous syst

• Can cause nerve issues if not corrected

Multiple Choice

The nurse is caring for a client who is receiving enteral feedings through a NGT. Which assessment finding would concern the nurse the most?

• Poorly healing wound to the buttocks

• Sunken abdomen

• Persistent coughing

• HR 124

Multiple Choice

A client underwent gastric bypass surgery a year ago and is presenting to the ED with complaints of nausea/vomiting, abdominal pain, fatigue, and diarrhea. Which complication is this client experiencing?

• Dumping syndrome

• Anastomosis leak

• Ulcers

• Thombus