`
NUR 4234 FINAL EXAM STUDY GUIDE
1. Age related changes to the liver
Decrease drugs because cannot metabolize well
2. Abdominal Assessment
Inspection, auscultation, light palpation, percussion
Cullen’s sign
o Ecchymosis around umbilicus- intraabdominal bleeding
Most reliable method of assessing return of peristalsis after
abdominal surgery passing flatus within past 8 hours or stool
within past 12-24 hours
Bruit
o Head over aorta usually indicates the presence of an
aneurysm- do not percuss or palpate and notify
physician immediately
Blumberg’s sign
o Rebound tenderness- pain on release
When patient has complains of pain or has trauma in
abdomen still palpate even if injured.
3. Abdominal Aortic Aneurysm
Back Pain is the indication of a rupture
4. Esophageal Trauma
Airway assessment
5. Peptic Ulcer disease
Peptic ulcer- mucosal lesion of the stomach or duodenum
Diseases when defense no longer protect the epithelium from
effects of acid and pepsin
2 types
o Gastric, duodenal, and stress
o Most gastric and duodenal caused by H. Pylori
History
1
,`
o Alcohol intake, tobacco uses, certain foods worsen
symtoms, daily stress, past medical conditions,
medication currently taking including corticosteroids,
chemotherapy, NSAIDS.
Clinical manifestation
o Epigastric tenderness usually located between
umbilicus and xiphoid process
Complication
o Hemorrhage (most serious, perforation, pyloric
obstruction, intractable diseases
With hemorrhaging risk of anemia increases
With massive bleeding of gastric ulcers patient vomits bright
red or coffee ground blood
Perforation- patient has a rigid, board-like abdomen
accompanied by rebound tenderness
Usually caused by H. Pylori and NSAIDS
Screening
o Laboratory assessment
o Imaging- x-ray to look for perforation
o Diagnostic assessment
EDG- most accurate
Nuclear medicine scan to look for GI bleeding
Interventions
o Drug therapy
Proton pump inhibitors drug of choice for treating
patients with acid-related disorders
PPI and two antibiotics (flaggy and tetracycline or
clarithromycin and amoxicillin)
o Nutrition therapy
Exclude foods that cause discomfort
Bland diet
o Complementary and alternative therapy
2
,`
Reduces stress
herbs
o NG tube lavage
6. Perforation
7. Peritonitis
Life threatening
Inflammation and infection of the visceral/parental
peritoneum
Bacterial
o Usually by perforation, external penetrating wound,
bowel obstruction.
Perforation from: appendicitis, diverticulitis,
peptic ulcer disease
Chemical
o Leakage of bile, pancreatic enzymes, and gastric acid
Assessment
o Abdominal pain, fever, movement is guarded,
distention, bowel sounds
o Cardinal signs peritonitis are abdominal pain,
tenderness and distention
o WBC elevation
o Blood culture to determine septicemia
o Abdominal x-rays free air in abdomen
Interventions
o Non-surgical
Hypertonic IV fluid
Broad Spectrum antibiotics
Monitor daily weight and intake and outputs
NGT
NPO
Analgesics
3
, `
o Surgical
May irrigate peritoneum with antibiotic solutions
prior to closure
o Antibiotics and analgesics, stool softeners, avoid lifting
for 6 weeks
8. Appendicitis s/s
Abdominal pain followed by nausea and vomiting can
indicate appendicitis
Pain in RLQ at McBurney’s point (between umbilicus and
anterior iliac crest)
Abdominal pain that increases with cough or movements and
is relieved by bending the right hip or knees suggest
perforation and peritonitis.
Rebound tenderness
9. Gastroenteritis vs appendicitis
Gastroenteritis
o Nausea and vomiting comes first then pain
Appendicitis
o Abdominal pain followed by nausea and vomiting can
indicate appendicitis
10. Perineal care with diarrhea
Keep it clean and dry, cotton underwear, do not use toilet
paper
11. Ileostomy complications
Signs of ischemia and necrosis (dark red, purplish, or black
color; dry)
Unusual bleeding
Mucocutaneous separation (breakdown of the suture line
securing the stoma to the abdominal wall)
12. Hepatitis A
Mild-flu like infection
Often goes unrecognized
4
NUR 4234 FINAL EXAM STUDY GUIDE
1. Age related changes to the liver
Decrease drugs because cannot metabolize well
2. Abdominal Assessment
Inspection, auscultation, light palpation, percussion
Cullen’s sign
o Ecchymosis around umbilicus- intraabdominal bleeding
Most reliable method of assessing return of peristalsis after
abdominal surgery passing flatus within past 8 hours or stool
within past 12-24 hours
Bruit
o Head over aorta usually indicates the presence of an
aneurysm- do not percuss or palpate and notify
physician immediately
Blumberg’s sign
o Rebound tenderness- pain on release
When patient has complains of pain or has trauma in
abdomen still palpate even if injured.
3. Abdominal Aortic Aneurysm
Back Pain is the indication of a rupture
4. Esophageal Trauma
Airway assessment
5. Peptic Ulcer disease
Peptic ulcer- mucosal lesion of the stomach or duodenum
Diseases when defense no longer protect the epithelium from
effects of acid and pepsin
2 types
o Gastric, duodenal, and stress
o Most gastric and duodenal caused by H. Pylori
History
1
,`
o Alcohol intake, tobacco uses, certain foods worsen
symtoms, daily stress, past medical conditions,
medication currently taking including corticosteroids,
chemotherapy, NSAIDS.
Clinical manifestation
o Epigastric tenderness usually located between
umbilicus and xiphoid process
Complication
o Hemorrhage (most serious, perforation, pyloric
obstruction, intractable diseases
With hemorrhaging risk of anemia increases
With massive bleeding of gastric ulcers patient vomits bright
red or coffee ground blood
Perforation- patient has a rigid, board-like abdomen
accompanied by rebound tenderness
Usually caused by H. Pylori and NSAIDS
Screening
o Laboratory assessment
o Imaging- x-ray to look for perforation
o Diagnostic assessment
EDG- most accurate
Nuclear medicine scan to look for GI bleeding
Interventions
o Drug therapy
Proton pump inhibitors drug of choice for treating
patients with acid-related disorders
PPI and two antibiotics (flaggy and tetracycline or
clarithromycin and amoxicillin)
o Nutrition therapy
Exclude foods that cause discomfort
Bland diet
o Complementary and alternative therapy
2
,`
Reduces stress
herbs
o NG tube lavage
6. Perforation
7. Peritonitis
Life threatening
Inflammation and infection of the visceral/parental
peritoneum
Bacterial
o Usually by perforation, external penetrating wound,
bowel obstruction.
Perforation from: appendicitis, diverticulitis,
peptic ulcer disease
Chemical
o Leakage of bile, pancreatic enzymes, and gastric acid
Assessment
o Abdominal pain, fever, movement is guarded,
distention, bowel sounds
o Cardinal signs peritonitis are abdominal pain,
tenderness and distention
o WBC elevation
o Blood culture to determine septicemia
o Abdominal x-rays free air in abdomen
Interventions
o Non-surgical
Hypertonic IV fluid
Broad Spectrum antibiotics
Monitor daily weight and intake and outputs
NGT
NPO
Analgesics
3
, `
o Surgical
May irrigate peritoneum with antibiotic solutions
prior to closure
o Antibiotics and analgesics, stool softeners, avoid lifting
for 6 weeks
8. Appendicitis s/s
Abdominal pain followed by nausea and vomiting can
indicate appendicitis
Pain in RLQ at McBurney’s point (between umbilicus and
anterior iliac crest)
Abdominal pain that increases with cough or movements and
is relieved by bending the right hip or knees suggest
perforation and peritonitis.
Rebound tenderness
9. Gastroenteritis vs appendicitis
Gastroenteritis
o Nausea and vomiting comes first then pain
Appendicitis
o Abdominal pain followed by nausea and vomiting can
indicate appendicitis
10. Perineal care with diarrhea
Keep it clean and dry, cotton underwear, do not use toilet
paper
11. Ileostomy complications
Signs of ischemia and necrosis (dark red, purplish, or black
color; dry)
Unusual bleeding
Mucocutaneous separation (breakdown of the suture line
securing the stoma to the abdominal wall)
12. Hepatitis A
Mild-flu like infection
Often goes unrecognized
4
