GERD:
Management (What makes GERD better?): Don’t eat before bed, sleep with HOB elevated, treat with
PPIs, H2s 30 min before meals, antacids after meals, eat SMALL meals throughout the day, don’t
SMOKE! Lose weight! Don’t lay down after meals. No caffeine.
What makes GERD worse? (the opposite of above)
Gastric Ulcer vs. Duodenal Ulcer s/s
Gastric: 1-2 hours after eating, epigastric pain – burning, food aggravates pain
Duodenal: 2-5 hours after eating, epigastric pain – burning, cramping, back pain – food sometimes
relieves pain
Risk factors for Gastritis? (NSAIDS) so when someone is on NSAIDs you are always worried about
bleeding
When somebody’s condition changes, what is the FIRST thing you do? (Always check v/s)
ALWAYS ASSESS BEFORE INTERVENTION… these questions come up in a million different ways. ADPIE.
If someone has bright red NG drainage after surgery/intervention… what should you do? Bright red is
bad. Active bleed….
Okay, prioritizing: ABCs come first. Next, Altered LOC (signifies worsening condition). So if
somebody is difficult to arouse and they used to be A&Ox4, this is a priority.
Don’t forget your delegation questions-- only nurses can assess, give meds, teach, etc.
What’s your primary concern with nausea/vomiting patients? (Dehydration!) So how do you
intervene…?
I thought GI Prioritization questions were tricky. If someone is bleeding, what is the WORST
sign? So melena sucks but if v/s are OK, no big deal, psychological stuff sucks (upset patients), but a
super low BP like 90/40 REALLY REALLY SUCKS-- it means they’re probably in hypovolemic shock
because of a bleed. Or, if someone is vomiting blood, the first thing you want to check is BP and pulse.
Signs of hypovolemic shock are low BP, tachycardia, altered LOC… bad bad bad.
If a patient has upper GI bleed, coffee grounds are expected in NG tube residual.
If a patient is receiving IV boluses (lots of fluid)... watch out for fluid overload. What’s a bad sign?
Crackles maybe? Hello pulmonary edema!
When someone has abdominal pain, that’s common to like every disease you’ve learned. So,
what do you ask pt first? DESCRIBE YOUR PAIN! Then you can narrow down.
IBS: psychosocial concerns are big. If someone is newly diagnosed, make sure you provide
emotional support and encourage questions from the pt… this is the priority. Then later on, once
they’ve accepted their chronic disease you can educate them about specific interventions and stuff.
Crohn’s: same (psychosocial) but worry about FISTULA FORMATION
Small bowel obstruction: What happens if you can’t eliminate (poop)? Alkalosis or Acidosis?
Metabolic or Respiratory? ;)
What should a healthy STOMA look like?
Post-op care for hernial repair? (don’t cough, strain, but DO support the scrotum to reduce
swelling… anything else?)
What’s the priority if someone has an infection?
How do PPIs work? H2s?
,Know Crohn’s vs. Colitis (differences and SHARED characteristics)
Do you need to know Hemoglobin/Hematocrit values?
Know the difference between open angle (not painful) and closed angle glaucoma! (major
pain!) IOP values?
UV-- cataracts. Pressure-- glaucoma.
Glaucoma associated with decreased peripheral vision-- which is not a normal part of vision
changes with aging.
Where do you apply eye medications? How? (same for ears)
https://quizlet.com/146182105/chapter-21-lewis-med-surg-flash-cards/ (sensory)
End of chapter review questions
https://quizlet.com/106222459/med-surg-1-lewis-ch-42-flash-cards/ (this is a crazy good quizlet… I
know there were questions from our exam on here)
MCA-I Exam #3 Study Guide
GI Problems / Arthritis / Pain / CAM
** Remember many of the questions will ask you to apply or synthesize the knowledge, not just ‘state’
or know it. As you read and study think how the ‘facts’ or ‘knowledge’ you are reading about will be
applied.
** This is a general study guide. There is no guarantee that every question is reflected on this study
guide; however, this study guide covers the most important aspects from the assigned readings and
lecture that will be on the exam.
Topic / Chapter Number of questions
General GI 5-8
Upper GI 5-8
Lower GI 5-8
Inflammatory Bowel Disease 5-8
Other GI Problems 5-8
Osteoarthritis 3-6
Rheumatoid Arthritis, Lupus, Scleroderma 6-10
Gout, Raynauds 3-6
Lymes, Fibromyalgia 3-6
Pain 3-6
CAM (complementary and Alternative Medicine) 3-6
, There will be between 50 questions on the exam. You will have 75 minutes.
IN GENERAL ALL GI PTs ARE NPO
General GI Problems
A. Nausea & Vomiting Tables 41.1, 41.2
a. Description
i. Forceful ejection of partially digested particles
b. Patho
i. Vomiting center in the brainstem
ii. Chemoreceptor Trigger Zone
c. Clinical Manifestations!
i. Amount, frequency, description – projectile, regurgitation
d. Nursing Management
i. IV fluids
ii. NG tube management and care
iii. I & O!!
iv. Signs and symptoms of dehydration!!!
1. HR, orthostatic blood pressure, hypotension, skin turgor, I & O (urine
output)
v. Oral care – brush teeth, rinse mouth..
vi. Cool washcloth or towel
B. Diarrhea 42.1,42.2,42.3
a. Description
i. At least 3 loose stools in one 24hr period
b. Patho
i. Bacteria, viruses
ii. Broad spectrum abx
1. C. difficile
c. Clinical Manifestations
i. Diarrhea, fever, abd discomfort
d. Diagnostics
i. Blood, mucus, WBC, cultures
e. Collaborative Care
i. Anti-diarrheal meds – use with caution (can delay healing of infection)
ii. FLUID AND ELECTROLYTE imbalances!
f. Nursing Management
i. Infection control
Management (What makes GERD better?): Don’t eat before bed, sleep with HOB elevated, treat with
PPIs, H2s 30 min before meals, antacids after meals, eat SMALL meals throughout the day, don’t
SMOKE! Lose weight! Don’t lay down after meals. No caffeine.
What makes GERD worse? (the opposite of above)
Gastric Ulcer vs. Duodenal Ulcer s/s
Gastric: 1-2 hours after eating, epigastric pain – burning, food aggravates pain
Duodenal: 2-5 hours after eating, epigastric pain – burning, cramping, back pain – food sometimes
relieves pain
Risk factors for Gastritis? (NSAIDS) so when someone is on NSAIDs you are always worried about
bleeding
When somebody’s condition changes, what is the FIRST thing you do? (Always check v/s)
ALWAYS ASSESS BEFORE INTERVENTION… these questions come up in a million different ways. ADPIE.
If someone has bright red NG drainage after surgery/intervention… what should you do? Bright red is
bad. Active bleed….
Okay, prioritizing: ABCs come first. Next, Altered LOC (signifies worsening condition). So if
somebody is difficult to arouse and they used to be A&Ox4, this is a priority.
Don’t forget your delegation questions-- only nurses can assess, give meds, teach, etc.
What’s your primary concern with nausea/vomiting patients? (Dehydration!) So how do you
intervene…?
I thought GI Prioritization questions were tricky. If someone is bleeding, what is the WORST
sign? So melena sucks but if v/s are OK, no big deal, psychological stuff sucks (upset patients), but a
super low BP like 90/40 REALLY REALLY SUCKS-- it means they’re probably in hypovolemic shock
because of a bleed. Or, if someone is vomiting blood, the first thing you want to check is BP and pulse.
Signs of hypovolemic shock are low BP, tachycardia, altered LOC… bad bad bad.
If a patient has upper GI bleed, coffee grounds are expected in NG tube residual.
If a patient is receiving IV boluses (lots of fluid)... watch out for fluid overload. What’s a bad sign?
Crackles maybe? Hello pulmonary edema!
When someone has abdominal pain, that’s common to like every disease you’ve learned. So,
what do you ask pt first? DESCRIBE YOUR PAIN! Then you can narrow down.
IBS: psychosocial concerns are big. If someone is newly diagnosed, make sure you provide
emotional support and encourage questions from the pt… this is the priority. Then later on, once
they’ve accepted their chronic disease you can educate them about specific interventions and stuff.
Crohn’s: same (psychosocial) but worry about FISTULA FORMATION
Small bowel obstruction: What happens if you can’t eliminate (poop)? Alkalosis or Acidosis?
Metabolic or Respiratory? ;)
What should a healthy STOMA look like?
Post-op care for hernial repair? (don’t cough, strain, but DO support the scrotum to reduce
swelling… anything else?)
What’s the priority if someone has an infection?
How do PPIs work? H2s?
,Know Crohn’s vs. Colitis (differences and SHARED characteristics)
Do you need to know Hemoglobin/Hematocrit values?
Know the difference between open angle (not painful) and closed angle glaucoma! (major
pain!) IOP values?
UV-- cataracts. Pressure-- glaucoma.
Glaucoma associated with decreased peripheral vision-- which is not a normal part of vision
changes with aging.
Where do you apply eye medications? How? (same for ears)
https://quizlet.com/146182105/chapter-21-lewis-med-surg-flash-cards/ (sensory)
End of chapter review questions
https://quizlet.com/106222459/med-surg-1-lewis-ch-42-flash-cards/ (this is a crazy good quizlet… I
know there were questions from our exam on here)
MCA-I Exam #3 Study Guide
GI Problems / Arthritis / Pain / CAM
** Remember many of the questions will ask you to apply or synthesize the knowledge, not just ‘state’
or know it. As you read and study think how the ‘facts’ or ‘knowledge’ you are reading about will be
applied.
** This is a general study guide. There is no guarantee that every question is reflected on this study
guide; however, this study guide covers the most important aspects from the assigned readings and
lecture that will be on the exam.
Topic / Chapter Number of questions
General GI 5-8
Upper GI 5-8
Lower GI 5-8
Inflammatory Bowel Disease 5-8
Other GI Problems 5-8
Osteoarthritis 3-6
Rheumatoid Arthritis, Lupus, Scleroderma 6-10
Gout, Raynauds 3-6
Lymes, Fibromyalgia 3-6
Pain 3-6
CAM (complementary and Alternative Medicine) 3-6
, There will be between 50 questions on the exam. You will have 75 minutes.
IN GENERAL ALL GI PTs ARE NPO
General GI Problems
A. Nausea & Vomiting Tables 41.1, 41.2
a. Description
i. Forceful ejection of partially digested particles
b. Patho
i. Vomiting center in the brainstem
ii. Chemoreceptor Trigger Zone
c. Clinical Manifestations!
i. Amount, frequency, description – projectile, regurgitation
d. Nursing Management
i. IV fluids
ii. NG tube management and care
iii. I & O!!
iv. Signs and symptoms of dehydration!!!
1. HR, orthostatic blood pressure, hypotension, skin turgor, I & O (urine
output)
v. Oral care – brush teeth, rinse mouth..
vi. Cool washcloth or towel
B. Diarrhea 42.1,42.2,42.3
a. Description
i. At least 3 loose stools in one 24hr period
b. Patho
i. Bacteria, viruses
ii. Broad spectrum abx
1. C. difficile
c. Clinical Manifestations
i. Diarrhea, fever, abd discomfort
d. Diagnostics
i. Blood, mucus, WBC, cultures
e. Collaborative Care
i. Anti-diarrheal meds – use with caution (can delay healing of infection)
ii. FLUID AND ELECTROLYTE imbalances!
f. Nursing Management
i. Infection control
