MDC2 Final Exam Study Guide
Med Surge Success book (found in library)= ch 7 # 13-24,37-144, ch 8 # all
questions
*The exam questions are not limited to only what is listed on this guide. Please refer to
your chapter readings, recordings, and module materials. ATI has additional practice
questions for review in Learning Systems RN 3.0.
Ch. 56 – Care of Patients with Noninflammatory Intestinal Disorders
● Nonmechanical (ileus) vs. mechanical obstruction (intussusception, volvulus, etc.)
o Non-mechanical: results from neurological disturbances that affect
the muscles. Can be primary or secondary (often based on
anesthesia medications). Remember to assess the patient's bowel
tones for complications from this!
▪ Paralytic Ileus: the bowel is not impacted by a physical
obstruction, but because of a lack of peristalsis as a result of
neuromuscular disturbance, causing backup of fecal contents
and abdominal distention and potentially leakage of stool
contents into the peritoneum space can occur, causing
inflammation and infection, decreased electrolyte levels and
reduced blood volume.
o Mechanical: from a structural disturbance of the bowel.
▪ Adhesions: scar tissue from surgery that builds up and causes obstruction
▪ Benign or malignant tumors
▪ Appendicitis complications: if the appendix bursts, often the
contents will cause disruptions in fecal matter flow.
▪ Hernia: protrusion of the bowel through an opening that
should not be there, causing pain and blockages.
▪ Fecal impactions: from constipation
▪ Strictures: from crohns or radiation
▪ Intussusception: telescoping of the bowel into itself.
▪ Volvulus: twisting of the bowels, allowing nothing to go through.
o Physical Assessment
▪ Obstipation: severe constipation that may last for days
without any passage of stools. Diarrhea may be present
in partial obstructions
▪ Failure to pass gas
▪ Vomiting that may be foul smelling or coffee ground like.
, ▪ Abdominal Distention: abdominal when assess will be firm,
swollen, and painful
▪ Peristaltic waves: movement of the intestine, then stopping
▪ Borborygmi: high pitch gurgling bowel sounds
o Diagnostics:
▪ Barium Swallow
▪ CT with contrast
▪ Ultrasound
o Nursing Care:
▪ Monitor vitals
▪ Assess abdomen 2 times a day for bowel tones, distention,
and passing for gas
▪ Monitor F/E,I/O, lab values for disturbances- may need to
give IV fluid replacement due to potential loss of electrolytes
such as NS
▪ Manage NG tube- often will be a salem sump tube
▪ Ensure tube patency
▪ Check initial tube placement with XRAY
▪ May need suction and decompression for the obstruction
● Metabolic alkalosis is a concern
▪ Check for tube placement (pH 0-4)
▪ Irrigate tube
▪ NPO status
▪ Perform mouth and nare care
▪ Place patient in a semi fowler's position
▪ Give pain medications
▪ Give alvimopan.
o Surgery
▪ Exploratory laparotomy: will allow the provider to relieve and
locate the obstruction. may be large or small incisions.
▪ The RN should teach the patient about what to expect after
such as NG tube insertion and a clear liquid diet that will
advance as tolerated. Potential N and V.
o Patient Teaching
▪ Patients should eat high fiber foods, like raw fruits and veggies.
▪ Drink lots of water
▪ Do not use routine laxatives as they have a potential to
become abused. and cause damage to the abdominal muscles.
▪ Daily exercise needed to promote gastric motility
▪ Take bulk forming products and a stool softener.
▪ Sit on the toilet or commode rather than the bedpan.
▪ Must report and abdominal pain, distention, N,V,constipation
▪ Teach about incision care
▪ Drug therapy will often include percocet, stool softener.
● Polyps
o Small growths that are attached to the intestinal mucosa that are often
benign but can become malignant.
o Adenomatous: polyps that have the potential to become malignant
▪ Villious
▪ Tubular
o Hyperplastic: little chance to become cancerous polyps
, o Malignant: those polyps that are cancerous when developed
o Familial adenomatous polyposis and hereditary nonpolyposis are
inherited that will eventually progress to colorectal cancer
o Assessment:
▪ Asymptomatic and usually discovered on a routine
colonoscopy screening
▪ May cause bleeding, obstruction or intussusception
o Diagnostics: biopsy and will often be removed at time of finding.
o Patient teaching: follow ups may be needed for complete polyp
removals. Teach about bleeding, abdominal distention and pain and
blood in the stool after the procedure.
● Colorectal cancer labs (CEA), diagnostics
o Fecal occult blood test (FOBT) – positive test indicates bleeding in the GI tract
▪ Patient needs to avoid aspirin, vitamin C, iron and red meat for
48 hours before giving stool specimen
▪ Also, assess whether the patient is taking anti-inflammatory
drugs, need to be discontinued
▪ Negative results do not completely rule out the possibility of CRC
o Carcinoembryonic antigen (CEA) – an oncofetal antigen is
elevated in many people with CRC
▪ Normal value is less than 5 ng/mL
▪ This protein is not specifically associated with the CRC, and it
may be elevated in the presence of other benign or
malignant diseases and in smokers
▪ It is often used to monitor the effectiveness of treatment and
to identify disease recurrence
● Imaging Assessment
○ Sigmoidoscopy – provides visualization of the lower colon
using a fiberoptic scope
○ Colonoscopy – provides better visualization of polyps and
small lesions than does a barium enema alone
● Irritable bowel syndrome health teaching and testing (hydrogen breath test)
o Types
▪ IBS C: constipation
▪ IBS D: diarrhea
▪ IBS M: mixed constipation and diarrhea
▪ IBS A/U: alternating constipation and diarrhea or unknown
o Hydrogen breath test or small-bowel bacterial overgrowth breath
test. When small-intestinal bacterial overgrowth or malabsorption of
nutrients is present, an excess of hydrogen is produced. Some of this
hydrogen is absorbed into the bloodstream and travels to the lungs
where it is exhaled. Patients with IBS often exhale an increased
amount of hydrogen.
, o Teach the patient that he or she will need to be NPO (may have
water) for at least 12 hours before the hydrogen breath test. At the
beginning of the test, the patient blows into a hydrogen analyzer.
Then, small amounts of test sugar are ingested, depending on the
purpose of the test, and additional breath samples are taken every
15 minutes for 1 to 5 hours
● Teaching and nutrition
● Dietary fiber and bulk help produce bulky, soft stools and
establish regular elimination habits.
● The patient should consume 30-40 g of fiber each day
● Eating regular meals, drinking 8-10 glasses of water each
day, and chewing food slowly help promote normal bowel
function.
● Drug therapy depends on main symptoms of IBS
○ Constipation-predominant IBS treated with bulk forming laxatives
○ Diarrhea-predominant treated with antidiarrheals
● Patient with intestinal bacterial overgrowth are
recommended to use probiotic supplements
● Stress management
Ch. 57 – Care of Patients with Inflammatory Intestinal Disorders
● Peritonitis symptoms
○ Peritonitis is a life-threatening, acute inflammation and infection
of the visceral/parietal peritoneum and endothelial lining of the
abdominal cavity.
○ Peritoneal cavity is contaminated by bacteria from peritoneum
perforation from appendicitis, diverticulitis, PUD, penetrating
wounds, gangrene gallbladder, bowel obstruction, tumors, surgery.
○ Inflammation spreads resulting in peritonitis
○ Fluid is shifting into the peritoneal cavity causing a significant
decrease in circulatory volume and hypovolemic shock.
○ Decreased circulatory volume results in insufficient perfusion to
kidneys leading to acute kidney injury and impaired fluid and
electrolyte balance.
○ Peristalsis slows or stops
○ Bacteria can enter the bloodstream causing septicemia
○ Respiratory problems can occur as result of increased abdominal pressure
○ Key Features:
■ Rigid, boardlike abdomen is classic sign
■ Abdominal pain (classic)
■ Distended abdomen
■ Nausea, anorexia, vomiting
■ Diminishing bowel sounds
■ inability to pass flatus or feces
■ rebound tenderness in the abdomen
■ high fever
■ tachycardia
■ dehydration from high fever
■ decreased urine output
Med Surge Success book (found in library)= ch 7 # 13-24,37-144, ch 8 # all
questions
*The exam questions are not limited to only what is listed on this guide. Please refer to
your chapter readings, recordings, and module materials. ATI has additional practice
questions for review in Learning Systems RN 3.0.
Ch. 56 – Care of Patients with Noninflammatory Intestinal Disorders
● Nonmechanical (ileus) vs. mechanical obstruction (intussusception, volvulus, etc.)
o Non-mechanical: results from neurological disturbances that affect
the muscles. Can be primary or secondary (often based on
anesthesia medications). Remember to assess the patient's bowel
tones for complications from this!
▪ Paralytic Ileus: the bowel is not impacted by a physical
obstruction, but because of a lack of peristalsis as a result of
neuromuscular disturbance, causing backup of fecal contents
and abdominal distention and potentially leakage of stool
contents into the peritoneum space can occur, causing
inflammation and infection, decreased electrolyte levels and
reduced blood volume.
o Mechanical: from a structural disturbance of the bowel.
▪ Adhesions: scar tissue from surgery that builds up and causes obstruction
▪ Benign or malignant tumors
▪ Appendicitis complications: if the appendix bursts, often the
contents will cause disruptions in fecal matter flow.
▪ Hernia: protrusion of the bowel through an opening that
should not be there, causing pain and blockages.
▪ Fecal impactions: from constipation
▪ Strictures: from crohns or radiation
▪ Intussusception: telescoping of the bowel into itself.
▪ Volvulus: twisting of the bowels, allowing nothing to go through.
o Physical Assessment
▪ Obstipation: severe constipation that may last for days
without any passage of stools. Diarrhea may be present
in partial obstructions
▪ Failure to pass gas
▪ Vomiting that may be foul smelling or coffee ground like.
, ▪ Abdominal Distention: abdominal when assess will be firm,
swollen, and painful
▪ Peristaltic waves: movement of the intestine, then stopping
▪ Borborygmi: high pitch gurgling bowel sounds
o Diagnostics:
▪ Barium Swallow
▪ CT with contrast
▪ Ultrasound
o Nursing Care:
▪ Monitor vitals
▪ Assess abdomen 2 times a day for bowel tones, distention,
and passing for gas
▪ Monitor F/E,I/O, lab values for disturbances- may need to
give IV fluid replacement due to potential loss of electrolytes
such as NS
▪ Manage NG tube- often will be a salem sump tube
▪ Ensure tube patency
▪ Check initial tube placement with XRAY
▪ May need suction and decompression for the obstruction
● Metabolic alkalosis is a concern
▪ Check for tube placement (pH 0-4)
▪ Irrigate tube
▪ NPO status
▪ Perform mouth and nare care
▪ Place patient in a semi fowler's position
▪ Give pain medications
▪ Give alvimopan.
o Surgery
▪ Exploratory laparotomy: will allow the provider to relieve and
locate the obstruction. may be large or small incisions.
▪ The RN should teach the patient about what to expect after
such as NG tube insertion and a clear liquid diet that will
advance as tolerated. Potential N and V.
o Patient Teaching
▪ Patients should eat high fiber foods, like raw fruits and veggies.
▪ Drink lots of water
▪ Do not use routine laxatives as they have a potential to
become abused. and cause damage to the abdominal muscles.
▪ Daily exercise needed to promote gastric motility
▪ Take bulk forming products and a stool softener.
▪ Sit on the toilet or commode rather than the bedpan.
▪ Must report and abdominal pain, distention, N,V,constipation
▪ Teach about incision care
▪ Drug therapy will often include percocet, stool softener.
● Polyps
o Small growths that are attached to the intestinal mucosa that are often
benign but can become malignant.
o Adenomatous: polyps that have the potential to become malignant
▪ Villious
▪ Tubular
o Hyperplastic: little chance to become cancerous polyps
, o Malignant: those polyps that are cancerous when developed
o Familial adenomatous polyposis and hereditary nonpolyposis are
inherited that will eventually progress to colorectal cancer
o Assessment:
▪ Asymptomatic and usually discovered on a routine
colonoscopy screening
▪ May cause bleeding, obstruction or intussusception
o Diagnostics: biopsy and will often be removed at time of finding.
o Patient teaching: follow ups may be needed for complete polyp
removals. Teach about bleeding, abdominal distention and pain and
blood in the stool after the procedure.
● Colorectal cancer labs (CEA), diagnostics
o Fecal occult blood test (FOBT) – positive test indicates bleeding in the GI tract
▪ Patient needs to avoid aspirin, vitamin C, iron and red meat for
48 hours before giving stool specimen
▪ Also, assess whether the patient is taking anti-inflammatory
drugs, need to be discontinued
▪ Negative results do not completely rule out the possibility of CRC
o Carcinoembryonic antigen (CEA) – an oncofetal antigen is
elevated in many people with CRC
▪ Normal value is less than 5 ng/mL
▪ This protein is not specifically associated with the CRC, and it
may be elevated in the presence of other benign or
malignant diseases and in smokers
▪ It is often used to monitor the effectiveness of treatment and
to identify disease recurrence
● Imaging Assessment
○ Sigmoidoscopy – provides visualization of the lower colon
using a fiberoptic scope
○ Colonoscopy – provides better visualization of polyps and
small lesions than does a barium enema alone
● Irritable bowel syndrome health teaching and testing (hydrogen breath test)
o Types
▪ IBS C: constipation
▪ IBS D: diarrhea
▪ IBS M: mixed constipation and diarrhea
▪ IBS A/U: alternating constipation and diarrhea or unknown
o Hydrogen breath test or small-bowel bacterial overgrowth breath
test. When small-intestinal bacterial overgrowth or malabsorption of
nutrients is present, an excess of hydrogen is produced. Some of this
hydrogen is absorbed into the bloodstream and travels to the lungs
where it is exhaled. Patients with IBS often exhale an increased
amount of hydrogen.
, o Teach the patient that he or she will need to be NPO (may have
water) for at least 12 hours before the hydrogen breath test. At the
beginning of the test, the patient blows into a hydrogen analyzer.
Then, small amounts of test sugar are ingested, depending on the
purpose of the test, and additional breath samples are taken every
15 minutes for 1 to 5 hours
● Teaching and nutrition
● Dietary fiber and bulk help produce bulky, soft stools and
establish regular elimination habits.
● The patient should consume 30-40 g of fiber each day
● Eating regular meals, drinking 8-10 glasses of water each
day, and chewing food slowly help promote normal bowel
function.
● Drug therapy depends on main symptoms of IBS
○ Constipation-predominant IBS treated with bulk forming laxatives
○ Diarrhea-predominant treated with antidiarrheals
● Patient with intestinal bacterial overgrowth are
recommended to use probiotic supplements
● Stress management
Ch. 57 – Care of Patients with Inflammatory Intestinal Disorders
● Peritonitis symptoms
○ Peritonitis is a life-threatening, acute inflammation and infection
of the visceral/parietal peritoneum and endothelial lining of the
abdominal cavity.
○ Peritoneal cavity is contaminated by bacteria from peritoneum
perforation from appendicitis, diverticulitis, PUD, penetrating
wounds, gangrene gallbladder, bowel obstruction, tumors, surgery.
○ Inflammation spreads resulting in peritonitis
○ Fluid is shifting into the peritoneal cavity causing a significant
decrease in circulatory volume and hypovolemic shock.
○ Decreased circulatory volume results in insufficient perfusion to
kidneys leading to acute kidney injury and impaired fluid and
electrolyte balance.
○ Peristalsis slows or stops
○ Bacteria can enter the bloodstream causing septicemia
○ Respiratory problems can occur as result of increased abdominal pressure
○ Key Features:
■ Rigid, boardlike abdomen is classic sign
■ Abdominal pain (classic)
■ Distended abdomen
■ Nausea, anorexia, vomiting
■ Diminishing bowel sounds
■ inability to pass flatus or feces
■ rebound tenderness in the abdomen
■ high fever
■ tachycardia
■ dehydration from high fever
■ decreased urine output
