Test 3 Med-Surg
Unit 7 - 7 Questions
Elimination (GI)
Cholelithiasis
1. [ in class review] gall stones RUQ pain, right shoulder, mid epigastric or back = acts
differently; Clinical manifestations: typically RUQ pain; vomiting bile; bloating; pain a couple
hours after eating fatty foods; relief of pain = standing and walking only; “cannot find a
position of comfort”, prefer to be standing; narcotics only relieve pain;
2. Management: narcotic; diet: low fat; medications [unless they’re bile gallstones, it only
works on fat]; laporoscopic; open = cholecystectomy (many complications, last resort) =
major abdominal surgery + monitoring bile drained; post-op teaching: splint if open;
TCDB/early ambulation; monitor incision sites; low fat diet again! Avoid foods that cause
gas [eggs, cabbage, beans, nuts, corn];
Diagnostic Tests, Prep/patient education:
3. EGD: NPO 6-8 hours; should not be painful; moderate sedation; pain = call physician;
4. ERCP: NPO 6-8 hours
5. Colonoscopy: prep = golitely; no red/orange liquids; no steak before you start prepping;
strict liquids for evening meal, then NPO; “prep is worse than the procedure”; 5 years if
polyps >50 or earlier if reason; 10 years if normal >50;
6. Clinical manifestations [textbook]
a. s/s usually occur 2-3 hours after a meal, esp. large meal/high in fat
b. Severe, steady pain in the upper right abdomen that, if left untreated, may last several
hours or days and gets worse with a deep breath
c. Pain that radiates from abdomen to right shoulder or back
d. Tenderness over abdomen when it's touched
e. Nausea/Vomiting
f. Loss of appetite
g. Fever
h. Chills
i. Abdominal bloating
j. Sweating
7. Management
a. Medical Management
i. Pain medication
ii. IV fluids if acute attack
iii. Cholesterol dissolving agents
1. ursodeoxycholic acid (Urdox tablets)
iv. Extracorporeal Shock Wave Lithotripsy
v. Low-fat diet
8. Surgical Management
a. Laparoscopic cholecystectomy
b. Open cholecystectomy
i. Insert a T tube or penrose into the common bile
duct Diagnostic Tests, Prep/patient education:
1) EGD (Esophagogastroduodenoscopy)
A visual examination of the esophagus, stomach, and duodenum, during which a physician can inject a
sclerotherapy agent into an affected area to stop bleeding.
Page 1 of 21
, Test 3 Med-Surg
a) Prep
Page 2 of 21
, Test 3 Med-Surg
– NPO 6 – 8 hrs
– Avoid NSAIDS, anticoagulants or aspirin several days before the test
– Mild Sedation
– Local anesthetic will suppress the gag reflex making it harder to swallow
b) After
– Vitals checked every 30 minutes until sedation wears off
– NPO until gag reflex returns (Usually 1 – 2 hours}
– Pt should not drive for at least 12 hrs after procedure
– Sore throat may persist for several day
2) ERCP (Endoscopic Retrograde Cholangiopancreatography)
Includes visual and radiographic examination of the liver, gallbladder, bile ducts, and pancreas to
identify the cause and location of obstruction.
a) Prep
– NPO 6 – 8 hrs
– Avoid NSAIDS, anticoagulants or aspirin several days before the test
– Mild Sedation
– Local anesthetic will suppress the gag reflex making it harder to swallow
– Ask about prior x-ray contrast exposure and allergies/sensitivities
– Ask about implanted devices such as pacemaker. Electrocautery cannot be used if present.
b) After
– Check vitals every 15 minutes until patient is stable
– NPO until gag reflex returns
c) Teach
– Monitor at home for gallbalder inflammation, bleeding, perforation, sepsis, and pancreatitis.
(sever pain if any complications occur)(Fever occurs with sepsis)
– Problems might not develop several hours to a couple days after surgery
– Report abdominal pain, fever, nausea, or vomiting that fails to resolve after returning home.
3) Colonoscopy (1st one at age 50, then q10 years if normal or q5 years if polyps found)
An endoscopic examination of the entire large bowel, during which tissue biopsy specimens or polyps
may be removed through the colonoscope.
a) Prep
– Clear liquid diet day before
– NPO 4 – 6 hrs prior
– Avoid aspirin, anticoagulants and antiplatelet’s several days before
– Drink prep liquid(GoLYTELY) night before procedure
o Avoid with elderly
o Water diarrhea usually begins 1 after drinking
b) After
– Check vital signs every 15 minutes until stable
– NPO
– Monitor for signs of perforation(causes severe pain) and hemorrhage(rapid drop in BP)
– Fluids are permitted after patient passes gas indicating peristalsis has returned
– If polypectomy or tissue biopsy is performed 1st stool may have small amounts of blood
Malnutrition
Promoting eating in the patient:
Page 3 of 21
Unit 7 - 7 Questions
Elimination (GI)
Cholelithiasis
1. [ in class review] gall stones RUQ pain, right shoulder, mid epigastric or back = acts
differently; Clinical manifestations: typically RUQ pain; vomiting bile; bloating; pain a couple
hours after eating fatty foods; relief of pain = standing and walking only; “cannot find a
position of comfort”, prefer to be standing; narcotics only relieve pain;
2. Management: narcotic; diet: low fat; medications [unless they’re bile gallstones, it only
works on fat]; laporoscopic; open = cholecystectomy (many complications, last resort) =
major abdominal surgery + monitoring bile drained; post-op teaching: splint if open;
TCDB/early ambulation; monitor incision sites; low fat diet again! Avoid foods that cause
gas [eggs, cabbage, beans, nuts, corn];
Diagnostic Tests, Prep/patient education:
3. EGD: NPO 6-8 hours; should not be painful; moderate sedation; pain = call physician;
4. ERCP: NPO 6-8 hours
5. Colonoscopy: prep = golitely; no red/orange liquids; no steak before you start prepping;
strict liquids for evening meal, then NPO; “prep is worse than the procedure”; 5 years if
polyps >50 or earlier if reason; 10 years if normal >50;
6. Clinical manifestations [textbook]
a. s/s usually occur 2-3 hours after a meal, esp. large meal/high in fat
b. Severe, steady pain in the upper right abdomen that, if left untreated, may last several
hours or days and gets worse with a deep breath
c. Pain that radiates from abdomen to right shoulder or back
d. Tenderness over abdomen when it's touched
e. Nausea/Vomiting
f. Loss of appetite
g. Fever
h. Chills
i. Abdominal bloating
j. Sweating
7. Management
a. Medical Management
i. Pain medication
ii. IV fluids if acute attack
iii. Cholesterol dissolving agents
1. ursodeoxycholic acid (Urdox tablets)
iv. Extracorporeal Shock Wave Lithotripsy
v. Low-fat diet
8. Surgical Management
a. Laparoscopic cholecystectomy
b. Open cholecystectomy
i. Insert a T tube or penrose into the common bile
duct Diagnostic Tests, Prep/patient education:
1) EGD (Esophagogastroduodenoscopy)
A visual examination of the esophagus, stomach, and duodenum, during which a physician can inject a
sclerotherapy agent into an affected area to stop bleeding.
Page 1 of 21
, Test 3 Med-Surg
a) Prep
Page 2 of 21
, Test 3 Med-Surg
– NPO 6 – 8 hrs
– Avoid NSAIDS, anticoagulants or aspirin several days before the test
– Mild Sedation
– Local anesthetic will suppress the gag reflex making it harder to swallow
b) After
– Vitals checked every 30 minutes until sedation wears off
– NPO until gag reflex returns (Usually 1 – 2 hours}
– Pt should not drive for at least 12 hrs after procedure
– Sore throat may persist for several day
2) ERCP (Endoscopic Retrograde Cholangiopancreatography)
Includes visual and radiographic examination of the liver, gallbladder, bile ducts, and pancreas to
identify the cause and location of obstruction.
a) Prep
– NPO 6 – 8 hrs
– Avoid NSAIDS, anticoagulants or aspirin several days before the test
– Mild Sedation
– Local anesthetic will suppress the gag reflex making it harder to swallow
– Ask about prior x-ray contrast exposure and allergies/sensitivities
– Ask about implanted devices such as pacemaker. Electrocautery cannot be used if present.
b) After
– Check vitals every 15 minutes until patient is stable
– NPO until gag reflex returns
c) Teach
– Monitor at home for gallbalder inflammation, bleeding, perforation, sepsis, and pancreatitis.
(sever pain if any complications occur)(Fever occurs with sepsis)
– Problems might not develop several hours to a couple days after surgery
– Report abdominal pain, fever, nausea, or vomiting that fails to resolve after returning home.
3) Colonoscopy (1st one at age 50, then q10 years if normal or q5 years if polyps found)
An endoscopic examination of the entire large bowel, during which tissue biopsy specimens or polyps
may be removed through the colonoscope.
a) Prep
– Clear liquid diet day before
– NPO 4 – 6 hrs prior
– Avoid aspirin, anticoagulants and antiplatelet’s several days before
– Drink prep liquid(GoLYTELY) night before procedure
o Avoid with elderly
o Water diarrhea usually begins 1 after drinking
b) After
– Check vital signs every 15 minutes until stable
– NPO
– Monitor for signs of perforation(causes severe pain) and hemorrhage(rapid drop in BP)
– Fluids are permitted after patient passes gas indicating peristalsis has returned
– If polypectomy or tissue biopsy is performed 1st stool may have small amounts of blood
Malnutrition
Promoting eating in the patient:
Page 3 of 21
