MEDICAL-SURGICAL NX

(Rationalization)
QUESTION # 1
ANSWER: Anticipate that any emotional stress can increase intestinal peristalsis

Emotional stress of any kind can stimulate peristalsis and thereby increase the volume
of drainage.

Client should be encouraged to eat a regular diet if possible.

Ileostomy drainage is liquefied and continuous, so irrigations are not indicated

The stoma will start to drain within the first 24 hours after surgery.
QUESTION #2
TERMINAL ILEUM – site of absorption of Vit B12-intrinsic factor complex

Parietal cells – produce intrinsic factor

Vitamin B12 - (extrinsic factor)
B12 + intrinsic factor forms a hemopoiectic factor Absorbed in the ileum
bone marrow and stimulates erythropoiesis
QUESTION # 3
AVOID CONTACT SPORTS = possible injury to the stoma from a severe blow or
because the pouching system may slip
AVOID WEIGHTLIFTING = could cause a hernia at the stoma

Skiing, Track events, Swimming (tape edges with waterproof tape)

QUESTION # 4
NEOMYCIN
-limited absorption from the GI tract, it exerts its antibiotic effect the intestinal
mucosa
-preparation for GI surgery, the level of microbial organism will be reduced
-INDICATED for HEPATIC ENCEPHALOPATHY: DIMINISH BLOOD AMMONIA LEVEL
–interfere with bacterial protein synthesis
QUESTION # 5
ACCEPTANCE
Mastery of the techniques of colostomy care
and optimal use of community resources
QUESTION # 6
WHAT SYMPTOM IS SEEN FIRST IN A PERFORATED ABDOMINAL ULCER?

GASTRODUODENAL CONTENTS empty into PERITONEAL CAVITY = PERITONITIS,

SEPTICEMIA, SHOCK

Initial S/Sx: Pain-sudden, sharp, begins mid-epigastric, rigid boardlike

abdomen
FEVER – later with peritonitis
QUESTION #7
ANSWER: . Place him in Fowler’s position – relieves pressure on abdomen : HOB
elevated 45-60
QUESTION #8
PARACENTESIS -procedure in which a
needle or catheter is inserted into the
peritoneal cavity to obtain ascitic fluid for
diagnostic or therapeutic purposes
BEFORE PROCEDURE: Have the client void
–AVOIDS PUNCTURING BLADDER
POSITION:
sitting with his lower extremities well
supported – CORRECT: Fowler’s position
or sitting on side of bed with feet on stool;
easy access to abdominal area; allows
intestines to float to prevent laceration
QUESTION #9
1ST ACTION : REMOVE VICTIM FROM SOURCE OF FURTHER INJURY
QUESTION #10
MASS CASUALTY/DISASTER
GOAL: when need exceeds resources, is to benefit the largest number; helping
those who need less care first benefits the largest number by not tying up
personnel and by making these victims available to serve others

Non- Disaster
To provide the best care for each individual patient
QUESTION # 11
The excreted ammonia combines with hydrogen ions in the glomerular filtrate
(acid excretion)
This mechanism helps rid the body of excess hydrogen, maintaining acid base
balance.
QUESTION # 12
Albumin =hypertonic =draws fluids from tissue to intravascular space

Psyllium (Metamucil) - This will absorb the watery diarrhea, giving more bulk to the stool
Potassium supplements - appropriate because diarrhea causes potassium loss.
Half normal saline solution - a hypotonic solution, which can correct dehydration
QUESTION # 13
RATIONALIZATION
Gastric lavage = excessive loss of gastric fluid (HCl) = ALKALOSIS
HCL is not available to neutralize the sodium bicarbonate (NaHCO3) secreted into the
duodenum by the pancreas.
The intestinal tract absorbs the excess bicarbonate, and alkalosis results.
QUESTION # 18
Prostigmin/NEOSTIGMINE - anticholinesterase, inhibits the breakdown of Ach
used in patients with postoperative ileus, urinary retention, myasthenia gravis,
and in anesthesia to reverse the effects of nondepolarizing muscle relaxants.