NURSING 2 TEST GUIDE EXAM 1- Nursing 1 Final Study Guide: Rasmussen College

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Nursing 2 – Exam 1, Study Guide
 Oral ulcers
o Causes:
 Trauma (biting cheek/tongue), burns, spicy/hot food, ETOH, smoking, allergy,
infection
 Cancer patients at HIGH risk for oral ulcers
o Treatment:
 Chlorohexidine mouthwash (relieves sx, reduces healing time)
 Topical steroids (promotes faster healing/resolution)
o Patient education/Prevention:
 Remove the irritant, good oral hygiene
 Avoid spicy/acidic foods, ETOH, stop smoking, remove irritant/allergen from diet
 GERD
o What is it?
 Gastric juices move up into the esophagus due to:
 Weak LES (lower esophageal sphincter)
 Pressure changes after meals, pregnancy, bending down
o Signs/Sx:
 #1 = Pyrosis (heartburn)
 Barrett’s Esophagus = inflammation/damage/ulceration of esophagus due to untreated
GERD. Can lead to adenocarcinoma/esophageal cancers. Upper GI, Barium Swallow or Upper
Endoscopy to R/O.
o “Red Flag” Symptoms:
 Weight loss, dysphagia, anemia, abnormal masses, vomiting or bleeding, continual
epigastric pain, sx unrelieved by PPI’s
o Assessment:
 Does your pain get worse after meals?
 Do you have pain when bending over?
 Any trouble swallowing? Hoarse voice?
 Diagnostics: Endoscopy, pH Monitoring, Symptom History
o Treatment:
1. PPI’s (-prazole)
 Ex: omeprazole, pantoprazole
 Decreases the volume of HCL produced
 Take 30min – 1hour before meals
 #1 line of defense – MOST EFFECTIVE
2. H2 Blockers (-tidine)
 Ex: ranitidine, cimetidine
 Take 1x daily
 Blocks the release of HCL/Histamine
 Treats MILD symptoms. #2 line of defense
3. Antacids (Ca+ Carbonate)
 Ex: Tums, Maalox
 Neutralizes stomach acid
 Monitor for signs of Metabolic Alkalosis
4. Surgery
 “Anti-Reflux Surgery” to tighten LES sphincter
 “Nissen fundoplication” (more invasive surgery)

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 Hiatal Hernia
o Causes:
 Part of the stomach protrudes through the esophageal hiatus/diaphragm.
 Obesity, pregnancy, overeating, age (anything that puts extra pressure on the diaphragm or
that weakens it)
o Signs/Sx:
 GERD symptoms are common, otherwise patient is asymptomatic
 Most common complaint is Pyrosis (heartburn)
o Tests
 Barium Swallow (barium + applesauce are swallowed and then patient is monitored via
fluoroscopy. If hernia is present, the barium will pool in the out-pouching).
 Fluoroscopy: continuous x-ray done to see if aspiration/deviation occurs when
eating or drinking
 Upper Endoscopy (you can visually see the out-pouching with scope inserted into the
esophagus)
o Treatment: Surgery
o Patient Education:
 Avoid eating 2-3 hours before bed/laying down
 Eat small meals (don’t overeat)
 STOP: smoking, ETOH, caffeine, acidic foods
 Peptic Ulcer Disease (PUD)
o What is it?
 Caused by dyspepsia (indigestion) which erodes the mucosal lining of the
stomach/duodenum
 #1 cause = H. pylori
 #2 cause = NSAIDs on empty stomach
o Signs/Sx:
 #1 Symptom = Burning/abdominal pain
 Burning pain is often relieved by eating or antacids
 Pain wakes patient up in the middle of the night
 Bloating, pain in middle of night, weight loss, poor appetite
 Worse if stomach is empty
o Tests: Endoscopy
o Treatment:
 OTC Antacids (risks: hypercalcemia, metabolic alkalosis, diarrhea, constipation, Na+
overload
 PPI’s, H2 Blockers, Metronidazole (Flagyl), Tetracycline (pg. 1359 in book)
 Cryo-protective agent: Sucralfate
 Coats stomach & forms a barrier allowing the ulcer time to heal.
 Take on empty stomach 1-2 hours before meals or 2 hours after meal.
 Risk: makes it harder for your body to absorb other medications due to the coating
on the stomach wall
 GI Cocktail: Maalox with liquid lidocaine
 Surgery:
 Complication of surgery can result in Dumping Syndrome. This happens when
gastric content moves too fast through intestines & causes diarrhea, stomach pain,
N/V. It also can result in late Dumping Syndrome, which causes reactive
hypoglycemia. Diet modifications are needed to manage this (low carb meals, limit
fluid intake during meals, sitting up after meals to delay gastric emptying)
 Bowel Obstruction
o What is it?
 Tumor or blockage in the intestine. Stool/flatus cannot pass through. Most occur in the
small intestine
o Signs/Sx:
 HIGH PITCHED BOWEL SOUNDS