283 - Transition to Registered Nurse Practice - Comp 1
1. Details on inserting NG tube for gastric decompression - pg. 1013
Saunders
-: & patient should be in high-fowlers position
& measure & tape tube to indicate length to be inserted
& lubricate tip before inserting in nasopharynx & advancing
& as tube enters back of throat - have pt swallow sip of water (unless
contraindicated)
- flex head toward chest while passing tube down throat into the stomach
& secure tube
& confirm placement w/ x-ray
& connect to suction
2. Patients experiencing a PE - heparin therapy is prescribed for at least 5
days - warfarin is also started on most patients on day 1 or 2 of heparin
therapy - the patient will receive both heparin & warfarin until the INR
reaches 2-3. Heparin is infused for 24 hours after the INR is greater than 2,
then the Heparin is discontinued. The overlap period of at least 5 days for
Warfarin & Heparin is necessary because the drug action of each is
different. Warfarin works in the liver to inhibit the synthesis of Vit K-
dependent clotting factors and takes 3-4 days before a therapeutic effect is
realized.:
3. As an entry level nurse, it is important that you understand monitoring
of lab values for patient prescribed anticoagulants such as Heparin and
Warfarin. What are normal values for PT/INR, PTT and aPTT for these
patients?: & PT - prothrombin time -
- normal is 11-12.5 seconds
- 1.5 to 2.5 times the normal control (*16-31) for patients receiving Warfarin
& INR - international normalized ratio -
normal is 0.9-1.2 seconds
- desirable therapeutic level is 2-3 times the normal for patients receiving Warfarin
- for patients w/ mechanical heart valve replacement an INR of 3-4 may be the goa
& PTT - partial thromboplastin time -
- 1.5-2.5 times the normal control (*30-75) for patients receiving Heparin
& aPTT - activated partial thromboplastin time -
normal is 30-40 seconds
- 5-2.5 times the normal control (*40-100) on Heparin
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, 283 - Transition to Registered Nurse Practice - Comp 1
4. Post-op abdominal surgery patients often have an NG placed for
decompression of the stomach, it's important for entry level nurses to
understand care of patients w/ an NG tube. This includes post-op colorectal
cancer patients, who may also have a colostomy depending on procedure
performed.
You learned about cancers, include colon cancer in med surg. Colorectal
cancer (CRC) is cancer of the rectum or colon. Colorectal cancer is the 3rd
most common cause of cancer death in this country.
Most CRCs are adenocarcinoma, a tumor that arises from a gland in the
epithelial layer of the colon. Adenocarcinoma begins as a polyp and is
benign in the early stages. If left untreated, the polyp will grown and the risk
of malignancy increases.
CRC can metastasize (through blood or lymph) to the liver (most common
site), lungs, brain, or bones. Spreading can occur as a result of peritoneal
seeding (during surgical resection of tumor).
What are the risk factors for colon cancer and what screenings are
recommended?: & Major risk factors for colon cancer are:
& Over the age of 50
& Family Hx of cancer
& First degree relative w/ colon cancer increases risk 3-4x
& Crohn's disease & ulcerative colitis
& Pylori and HPV increase risk
& African Americans are at higher risk
& Smoking, obesity, high-fat diet, inactivity, and alcohol consumption
& Screening recommendations for those over the age of 50 without a family Hx:
- Fecal occult blood yearly AND one of the following:
** Colonoscopy every 10 years
** Sigmoidoscopy every 5 years
** Double-contrast barium enema every 5 years
- With increased risk factors screening may be indicated at an earlier age
- Teaching points for colon cancer prevention:
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