Eunice Aguilar

STUDENT NAME
Assessing abdominal distensión after gastrectomy 47
DISORDER/DISEASE PROCESS REVIEW MODULE CHAPTER

Alterations in Health Pathophysiology Related Health Promotion and

(Diagnosis) to Client Problem Disease Prevention
Position the client in an upright position, either on the
Enteral feedings are instituted for a client who has Malnutrition (decreased prealbumin, decreased edge of the bed with feet supported or a high-
a functioning GI tract but is unable to swallow or transferrin or total iron-binding capacity) Fowler’s position in the bed. Clients who have ascites
take in adequate calories and protein orally. It can ● Aspiration pneumonia are typically more comfortable sitting up.
be in addition to an oral diet, or it can be the only ● Review baseline vital signs, record weight, and
source of nutrition. measure abdominal girth.

ASSESSMENT SAFETY
CONSIDERATIONS
Risk Factors Expected Findings
Compromised lung expansion, increased abdominal girth, Check facility policy regarding
rapid weight gain residual check, which is
usually every 4 to 6 hr, and
take corrective actions as
prescribed. Some facilities no
longer require residual checks.
● Follow protocol for slowing
or withholding feedings
for excess residual volumes.
Many facilities hold for
Laboratory Tests Diagnostic Procedures residual volumes of 100 to
200 mL and then restart at a
lower rate after a period of
rest.
● Check pump for proper
operation and ensure feeding
infused at correct rate.

PATIENT-CENTERED CARE
Complications
Nursing Care Medications Client Education
retention of contrast material (constipation) or
Overfeeding results from
infusion of a greater quantity
Determine the client’s readiness for the diarrhea accompanied by weakness. of feeding than can be readily
procedure. ● An over-the-counter medication can be needed digested, resulting in
● Variables (the age of the client and to prevent constipation resulting from the barium. abdominal distention, nausea,
chronic and acute diseases) can influence ● Stools will be white for 24 to 72 hr until and vomiting.
ability to tolerate and recover barium clears. Report abdominal fullness, pain, or
from this procedure delay in return to brown stool.

Therapeutic Procedures Interprofessional Care

ACTIVE LEARNING TEMPLATES THERAPEUTIC PROCEDURE A11

 Eunice Aguilar
STUDENT NAME Chronic inflammatory bowel disease
DISORDER/DISEASE PROCESS REVIEW MODULE CHAPTER

Alterations in Health Pathophysiology Related Health Promotion and

(Diagnosis) to Client Problem Disease Prevention
CHRONIC INFLAMMATORY BOWEL DISEASE Edema and inflammation primarily in the Etiology of ulcerative colitis and Crohn’s disease is
Ulcerative colitis and Crohn’s disease are characterized rectum and rectosigmoid colon unknown but possibly due to a combination of genetic,
by frequent stools, cramping abdominal pain, environmental, and immunological causes.
exacerbations, and remissions.

ASSESSMENT SAFETY
CONSIDERATIONS
Risk Factors Expected Findings
Genetics: Ulcerative colitis and Crohn’s disease Abdominal pain/cramping: often left-lower quadrant pain
Culture: Caucasians (ulcerative colitis), Jewish heritage (ulcerative colitis and ● Anorexia and weight loss, Fever, Diarrhea: up to 15 to 20 liquid
Crohn’s disease), and African Americans (diverticular disease) Sex and age: The
stools/day, Stools containing mucus, blood, or pus, Abdominal
incidence of ulcerative colitis peaks at adolescence to young adulthood (more
often in females) and older adulthood (more often in males). Crohn’s disease distention, tenderness, and/or firmness upon palpation High-
usually develops in adolescents and young adults, but can occur at any age. pitched bowel sounds, Rectal bleeding
Diverticulitis occurs more often in older adults and affects males more
frequently than females. Tobacco use: Crohn’s diseases

Laboratory Tests Diagnostic Procedures

Sigmoidoscopy or colonoscopy: Can diagnose ulcerative
Hematocrit and hemoglobin: Decreased Erythrocyte colitis
sedimentation rate (ESR): Increased WBC: Increased Barium enema: Helpful to distinguish ulcerative colitis
C-reactive protein: Increased from other disease processes
Albumin: Decreased CT scan or MRI: Can identify the presence of
Stool for occult blood: Can be positive abscesses Stool examination: For the presence of
K+, Na, Mg, Ca, and Cl: Decreased parasites or microbes

PATIENT-CENTERED CARE
Complications
Nursing Care
The client should receive instructions regarding the usual
Medications Client Education Complications of ulcerative colitis,
Seek emergency care for indications of bowel obstruction or Crohn’s disease, and diverticulitis
course of the disease process. The client should receive
5-aminosalicylic acid perforation (fever, severe abdominal pain, vomiting).
include bleeding and fluid and
instructions regarding medication therapy and vitamin
Anti-inflammatory ● For extreme or long exacerbations, NPO status and
supplements. Monitor by colonoscopy due to the increased risk electrolyte imbalance. Peritonitis
administration of total parenteral nutrition promotes bowel
of colon cancer. Assist the client in identifying foods that Corticosteroids can occur due to perforation of the
rest while providing adequate nutrition.
trigger manifestations. Monitor for electrolyte imbalance, Immunosuppressants ● Avoid caffeine and alcohol. bowel. Abscess formation can occur
especially potassium. Diarrhea can cause a loss of fluids and Immunomodulators ● Take a multivitamin that contains iron. as a complication of diverticular
electrolytes. Monitor I&O, and assess for dehydration. Educate
● Small, frequent meals can reduce the occurrence disease and Crohn’s disease.
the client to eat high-protein, high-calorie, low-fiber foods.
of manifestations.

Therapeutic Procedures Interprofessional Care

Clients who do not have success with medical Refer the client for nutritional counseling.
treatment or who have complications (bowel ● The client might benefit from
perforation, colon cancer) are candidates for complementary therapy
surgery. (biofeedback, massage, yoga).
Ulcerative colitis: Colectomy with or without ● Recommend community support groups or
ileostomy a mental
health referral for assistance with coping.

ACTIVE LEARNING TEMPLATES THERAPEUTIC PROCEDURE A11

 Eunice Aguilar
STUDENT NAME Nuclear imaging
PROCEDURE NAME REVIEW MODULE CHAPTER

Description of Procedure
Common imaging techniques are used as secondary tools to assist in the treatment of cancer. Imaging is completed around the time of diagnosis to measure the severity
of cancer.

CONSIDERATIONS
Indications
Altered body function (fatigue, weakness, anorexia)
● Change in body structure (weight loss, masses)
● Change in body symmetry or onset of recent findings
(pain, nausea, vomiting) Nursing Interventions (pre, intra, post)
Metastasis
● Secondary sites of discomfort ● Complete a health history and physical assessment including client
● Swelling and/or tenderness of lymph nodes or areas report of findings and family history of cancer or genetic disorder.
of the body ● Inspect for changes in color, symmetry, movement, or body function.
● Presence of masses ● Auscultate for adventitious sounds that indicate altered body system
● Altered function of another body system function.
● Bone pain

Interpretation of Findings
Client Education
Nuclear imaging: Evaluates the function of organs and structures by Perform self-examination practices at home.
detecting the presence of radiation in the body after the client is given a ● Understand the general findings that could
radioactive tracer (IV or oral). Used for detection and staging of cancer. indicate cancer. If found, notify the provider for further screening. Change
Cancerous tissues can absorb more or less tracer than expected. These in bowel or bladder habits, change in shape or texture of a body or skin
tissues are distinguishable by nuclear imaging. region. Difficulty eating, chewing, swallowing, or decreased appetite. Non-
healing sores or wounds, or a cough or hoarseness that does not go away.
Unexplained pain, night sweats, fatigue, weight loss, or weight gain. Unusual
bleeding.

Potential Complications Nursing Interventions

Educate the client about routine cancer screenings as part of health
promotion and disease prevention.
● Provide care before, during, and after the procedure as indicated by
procedure type.
● Provide teaching and resources for client about self-care in the home
environment.

ACTIVE LEARNING TEMPLATES THERAPEUTIC PROCEDURE A3

 Eunice Aguilar
STUDENT NAME 49
Peptic Ulcer Disease
DISORDER/DISEASE PROCESS REVIEW MODULE CHAPTER

Alterations in Health Pathophysiology Related Health Promotion and

(Diagnosis)
A peptic ulcer is an erosion of the mucosal lining of the stomach,
to Client Problem Disease Prevention
esophagus, or duodenum. The most common area for a peptic ulcer is Most peptic ulcers are caused by an infection from gram-negative Engage regularly in exercise
the duodenum. The mucous membranes can become eroded to the point bacteria Helicobacter pylori (H. pylori). Contact with the bacteria Drink alcohol in moderation
that the epithelium is exposed to gastric acid and pepsin, which can occurs from food, water, or exposure to body fluids such as saliva.
Limit caffeine-containing beverages. ● Consume
precipitate bleeding and perforation. Perforation that extends through Some people infected with the H. pylori bacteria do not develop
ulcers. Stress ulcer occurs from an acute period of physiological a balanced diet.
all the layers of the stomach or duodenum can cause peritonitis. An
individual who has a peptic ulcer has peptic ulcer disease. stressful events, such as burns, shock, severe sepsis, or multiple
organ trauma.

ASSESSMENT SAFETY
CONSIDERATIONS
Risk Factors Expected Findings
● Helicobacter pylori (H. pylori) infection ● NSAID and
Dyspepsia: heartburn, bloating, nausea, and vomiting (vomiting
corticosteroid use, Severe stress, Familial tendency
is rare but can be caused by a gastric outlet obstruction).
● Hypersecretory states, Gastrin-secreting benign or malignant
Can be perceived as uncomfortable fullness or hunger.
tumors of the pancreas Type O blood Excess alcohol consumption
● Dull, gnawing pain or burning sensation at the
● Chronic pulmonary or kidney disease zollinger-Ellison syndrome
midepigastrium or the back
(combination of peptic ulcers, hypersecretion of gastric acid, and
gastrin-secreting tumors) ● Pernicious anemia

Laboratory Tests Diagnostic Procedures

H. pylori testing
Urea breath testing Esophagogastroduodenoscopy
Stool sample tests
Hemoglobin and hematocrit (unexpected findings
secondary to bleeding)
Stool sample

—
PATIENT-CENTERED CARE
Complications
Nursing Care Medications Client Education Perforation/hemorrhage
Instruct clients to avoid foods that cause distress (coffee, Lying down after a meal slows the movement of food within
Pernicious anemia
tea, carbonated beverages). Monitor for orthostatic Antibiotics the intestines. Limit the amount of fluid ingested at one
changes in vital signs and tachycardia, as these findings time. Eliminate liquids with meals, for 1 hr prior to and
Dumping syndrome
Histamine2-receptor antagonists
are suggestive of gastrointestinal bleeding or perforation. following a meal. Pyloric obstruction
Proton-pump inhibitors
Administer saline lavage via nasogastric tube. Administer Consume a high-protein, high-fat, low-fiber, and
medication as prescribed. Decrease environmental stress. Antacids low- to moderate-carbohydrate diet. Avoid milk and sugars
Encourage rest periods. Encourage smoking cessation and Mucosal protectants (sweets, fruit juice, sweetened fruit, milk shakes, honey,
avoiding alcohol consumption. Monitor laboratory results syrup, jelly). Consume small, frequent meals rather than
(hemoglobin, hematocrit, coagulation studies). large meals.

Therapeutic Procedures
Areas of bleeding can be treated with
Interprofessional Care
Nutrition consult: Diet that restricts acid-
epinephrine or laser coagulation.
producing foods: milk products, caffeine,
NURSING ACTIONS
decaffeinated coffee, spicy foods, medications
● PREPROCEDURE: Initiate two large-bore
(NSAIDs)
IV catheters.
● POSTPROCEDURE: Monitor vital signs.
Keep client NPO
until gag reflex returns.

ACTIVE LEARNING TEMPLATES THERAPEUTIC PROCEDURE A11

 Individual Performance Profile
RN Targeted Medical Surgical Gastrointestinal Online Practice
2019

Individual Name: EUNICE AGUILAR Individual Score: 66.7%

Student Number: 889462431 Practice Time: 23 min
Institution: Los Angeles Trade Tech ADN Focused Review Time 2 hr 39 min
Program Type: ADN
Test Date: 5/18/2021
# of Questions: 30

Individual Performance in the Major Content Areas

# Individual Individual Score (% Correct)
Sub-Scale Items Score

Health Promotion and 1 100.0%

Maintenance
Basic Care and Comfort 5 20.0%
Pharmacological and 4 100.0%
Parenteral Therapies
Reduction of Risk 6 83.3%
Potential
Physiological Adaptation 14 64.3%

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 Topics To Review Go to your Improve tab to access your Focused Review Experience

Basic Care and Comfort (4 items)

Elimination (1 item)
Inflammatory Bowel Disease: Pharmacological Interventions for Gastroenteritis(Active Learning Template: System
Disorder)
Nutrition and Oral Hydration (3 items)
Gastrointestinal Disorders: Evaluating a Client's Understanding of Dietary Teaching for Celiac Disease(Active Learning
Template: System Disorder)
Pancreatitis: Evaluating Client Understanding About Dietary Management(Active Learning Template: System Disorder)
Peptic Ulcer Disease: Teaching About Dietary Management to Prevent Dumping Syndrome(Active Learning Template:
System Disorder)
Reduction of Risk Potential (1 item)
Potential for Complications from Surgical Procedures and Health Alterations (1 item)
Gastrointestinal Therapeutic Procedures: Assessing for Abdominal Distension Following a Gastrectomy(Active Learning
Template: System Disorder)
Physiological Adaptation (5 items)
Illness Management (2 items)
Cancer Disorders: Responding to a Client's Questions About a Carcinoembryonic Antigen Test(Active Learning Template:
Diagnostic Procedure)
Gastrointestinal Therapeutic Procedures: Findings to Report Following an Ileostomy(Active Learning Template:
Therapeutic Procedure)
Pathophysiology (3 items)
Hepatitis and Cirrhosis: Expected Findings of Acute Hepatitis B(Active Learning Template: System Disorder)
Inflammatory Bowel Disease: Expected Findings of Peritonitis(Active Learning Template: System Disorder)
Peptic Ulcer Disease: Expected Findings for a Client Who Has a Duodenal Ulcer(Active Learning Template: System
Disorder)

Outcomes

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 No of Individual
Nursing Process Items Score Description

RN Assessment 6 50.0% The assessment step of the nursing process involves application of
nursing knowledge to the collection, organization, validation and
documentation of data about a client’s health status. The nurse
focuses on the client’s response to a specific health problem
including the client’s health beliefs and practices. The nurse thinks
critically to perform a comprehensive assessment of subjective and
objective information. Nurses must have excellent communication
and assessment skills in order to plan client care.
RN Analysis/Diagnosis 6 66.7% The analysis step of the nursing process involves the nurse’s ability
to analyze assessment data to identify health problems/risks and a
client’s needs for health intervention. The nurse identifies patterns
or trends, compares the data with expected standards or reference
ranges and draws conclusions to direct nursing care. The nurse
then frames nursing diagnoses in order to direct client care.
RN Planning 3 100.0% The planning step of the nursing process involves the nurse’s ability
to make decisions and problem solve. The nurse uses a client’s
assessment data and nursing diagnoses to develop measureable
client goals/outcomes and identify nursing interventions. The nurse
uses evidenced based practice to set client goals, establish
priorities of care, and identify nursing interventions to assist the
client to achieve his goals.
RN Implementation/Therapeutic 8 62.5% The implementation step of the nursing process involves the nurse’s
Nursing Intervention ability to apply nursing knowledge to implement interventions to
assist a client to promote, maintain, or restore his health. The nurse
uses problem-solving skills, clinical judgment, and critical thinking
when using interpersonal and technical skills to provide client care.
During this step the nurse will also delegate and supervise care and
document the care and the client’s response.
RN Evaluation 7 71.4% The evaluation step of the nursing process involves the nurse’s
ability to evaluate a client’s response to nursing interventions and to
reach a nursing judgment regarding the extent to which the client
has met the goals and outcomes. During this step the nurse will
also assess client/staff understanding of instruction, the
effectiveness of interventions, and identify the need for further
intervention or the need to alter the plan.

No of Individual
Priority Setting Items Score Description

2 100.0% Ability to demonstrate nursing judgment in making decisions about

priority responses to a client problem. Also includes establishing
priorities regarding the sequence of care to be provided to multiple
clients.

No of Individual
Thinking Skills Items Score Description

Foundational Thinking in Nursing 8 62.5% Ability to recall and comprehend information and concepts
foundational to quality nursing practice.

Clinical Judgment/Critical Thinking in 22 68.2% Ability to use critical thinking skills (interpretation, analysis,
Nursing evaluation, inference, and explanation) to make a clinical judgment
regarding a posed clinical problem. Includes cognitive abilities of
application and analysis.

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 No of Individual
NCLEX® Items Score Description

RN Health Promotion and 1 100.0% The nurse directs nursing care to promote prevention and detection
Maintenance of illness and support optimal health.

RN Basic Care and Comfort 5 20.0% The nurse provides nursing care to promote comfort and assist
client to perform activities of daily living.
RN Pharmacological and Parenteral 4 100.0% The nurse administers, monitors and evaluates pharmacological
Therapies and parenteral therapy.

RN Reduction of Risk Potential 6 83.3% The nurse directs nursing care to decrease clients’ risk of
developing complications from existing health disorders, treatments
or procedures.
RN Physiological Adaptation 14 64.3% The nurse manages and provides nursing care for clients with an
acute, chronic or life threatening illness.

No of Individual
QSEN Items Score Description

Safety 2 100.0% The minimization of risk factors that could cause injury or harm
while promoting quality care and maintaining a secure environment
for clients, self, and others.
Patient-Centered Care 9 66.7% The provision of caring and compassionate, culturally sensitive care
that is based on a patient’s physiological, psychological,
sociological, spiritual, and cultural needs, preferences, and values.
Evidence Based Practice 18 61.1% The use of current knowledge from research and other credible
sources to make clinical judgments and provide client-centered
care.
Teamwork and Collaboration 1 100.0% The delivery of client care in partnership with multidisciplinary
members of the health care team, to achieve continuity of care and
positive client outcomes.

No of Individual
NLN Competency Items Score Description

Human Flourishing 10 70.0% Human flourishing is reflected in patient care that demonstrates
respect for diversity, approaches patients in a holistic and patient-
centered manner, and uses advocacy to enhance their health and
well-being.
Nursing Judgment 11 72.7% Nursing judgment involves the use of critical thinking and decision
making skills when making clinical judgments that promote safe,
quality patient care.
Spirit of Inquiry 9 55.6% A spirit of inquiry is exhibited by nurses who provide evidence based
clinical nursing practice and use evidence to promote change and
excellence.

No of Individual
BSN Essentials Items Score Description

Basic Organization and Systems 3 100.0% The need for nurses to be able to understand power relationships
Leadership for Quality Care and and use decision-making and leadership skills to promote safe
Patient Safety practice and quality improvement within health care systems.

Scholarship for Evidence-Based 15 60.0% The need for nurses to be able to understand the research process
Practice and base practice and clinical judgments upon fact-based evidence
to enhance patient outcomes.
Clinical Prevention and Population 12 66.7% The need for nurses to be able to identify health related risk factors
Health and facilitate behaviors that support health promotion, and disease
and injury prevention, while providing population-focused care that
is based on principles of epidemiology and promotes social justice.
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 Page 5 of 5

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 Score Explanation and Interpretation
Individual Performance Profile
INDIVIDUAL SCORE TOPICS TO REVIEW
The individual score is the number of questions answered Based on the questions missed on this assessment, a
correctly divided by the number of questions on the listing of content areas and topics to review is provided.
assessment. It is on a scale of 0% to 100%. A variety of learning resources may be used in the review
process, including content, images, animations, and
videos in ATI’s Content Mastery Series® Review Modules,
online practice assessments, and a focused review that is
individualized to the questions missed.

Exp_Ind_Non_Proctored

www.atitesting.com © Assessment Technologies Institute®, Inc.

 Eunice Aguilar
STUDENT NAME 47
Findings to report following ileostomy
PROCEDURE NAME REVIEW MODULE CHAPTER

Description of Procedure
An ostomy is a surgical opening from the inside of the body to the outside and can be located in various areas of the body. Ostomies can be permanent or temporary.
● A stoma is the artificial opening created during the
ostomy surgery.
● Main types of ostomies performed in the abdominal area
⃝ Ileostomy: A surgical opening into the ileum to drain stool, which is typically frequent and liquid because large intestine is bypassed

CONSIDERATIONS
Indications
Ileostomy: when the entire colon must be removed due to disease
(Crohn’s disease, ulcerative colitis).
Nursing Interventions (pre, intra, post)
Determine the client’s readiness for the procedure. Assess visual acuity, manual dexterity, cognitive
status, cultural influences, and support systems. Initiate a referral to the wound ostomy care nurse
(WOCN) for ostomy placement marking and client teaching. Work collaboratively with the WOCN to
begin teaching the client and support person about ostomy care and management.
Assess the type and fit of the ostomy appliance. Monitor for leakage (risk to skin integrity). Fit the
ostomy appliance based on the following. Type and location of the ostomy, Visual acuity and manual
dexterity of the client, Assess peristomal skin integrity and appearance of the stoma. The stoma
should appear pink and moist. Apply skin barriers and creams (adhesive paste) to peristomal skin and
allow to dry before applying a
new appliance.

Outcomes/Evaluation
Intestinal obstruction can occur for a variety of reasons. Client Education
NURSING ACTIONS
● Monitor and record output from the stoma. Follow instructions regarding dietary changes, and use ostomy appliances that
● Assess for manifestations of obstruction, including can help manage flatus and odor. Foods that can cause odor include fish, eggs,
abdominal pain, hypoactive or absent bowel sounds, distention, nausea, and vomiting. asparagus, garlic, beans, and dark green leafy vegetables. Buttermilk,
CLIENT EDUCATION: Note indications of an intestinal obstruction following discharge. cranberry juice, parsley, and yogurt help to decrease odor.

Potential Complications Nursing Interventions

Stomal appearance should normally be pink or red and moist. ● Manifestations of Obtain vital signs, oxygen saturation, and current laboratory results.
stomal ischemia are a pale pink or CLIENT EDUCATION: Watch for indications of stomal ischemia/necrosis.
bluish purple color and dry appearance.
● If the stoma appears black or purple in color, this indicates a serious impairment of
blood flow and
requires immediate intervention.

ACTIVE LEARNING TEMPLATES THERAPEUTIC PROCEDURE A13