HESI NSG 123: Medical Surgical Nursing Final
1. Ulcerative Colitis: Ulcerative colitis is a chronic ulcerative and inflammatory
disease of the mucosal and submucosal layers of the colon and rectum that is
characterized by unpredictable periods of remission and exacerbation with bouts of
abdominal cramps and bloody or purulent diarrhea. The inflammatory changes
typically begin in the rectum and progress proximally through the colon
2. Crohn's Disease: Crohn's disease is characterized by periods of remission
and exacerbation. It is a subacute and chronic inflammation of the GI tract wall that
extends through all layers (i.e., transmural lesion). Although its characteristic
histopathologic changes can occur anywhere in the GI tract, it most commonly
occurs in the distal ileum and the ascending colon. The onset of symptoms is usually
insidious in Crohn's disease, with prominent right lower quadrant abdominal pain
and diarrhea unrelieved by defecation
3. Crohn's Disease Diet: Oral fluids and a low-residue, high-protein, high-calorie
diet with supplemental vitamin therapy and iron replacement are prescribed to meet
nutritional needs, reduce inflammation, and control pain and diarrhea. Fluid and
electrolyte imbalances from dehydration caused by diarrhea are corrected by IV
therapy as necessary if the patient is hospitalized or by oral fluids if the patient is
managed at home. Any foods that exacerbate diarrhea are avoided. Milk may
contribute to diarrhea in those with lactose intolerance. Cold foods and smoking are
avoided because both increase intestinal motility. Parenteral nutrition may be
indicated.
4. Ulcerative Colitis-Goal: The major goals for the patient include attainment of
normal bowel elimination patterns, relief of abdominal pain and cramping,
prevention of fluid volume deficit, maintenance of optimal nutrition and weight,
avoidance of fatigue, reduction of anxiety, promotion of effective coping, absence
of skin breakdown, increased knowledge about the disease process and self-health
management, and avoidance of complications.
5. Bariatric Surgery Post Op: After surgery, the nurse assesses the patient for
complications from the bariatric surgery, such as hemorrhage, venous
, HESI NSG 123: Medical Surgical Nursing Final
thromboembolism, bile reflux, dumping syndrome, dysphagia, and bowel or gastric
outlet obstruction.
Eat smaller but more frequent meals that contain protein and fiber; each meal size
should not exceed 1 cup.
Eat only foods high in nutrients (e.g., peanut butter, cheese, chicken, fish, beans).
Eat slowly and chew thoroughly
Assume a low Fowler position during mealtime and then remain in that position for
20-30 minutes after mealtime—this delays stomach emptying and decreases the
likelihood of dumping syndrome.
Do not drink fluid with meals; instead, consume fluids up to 30 minutes before a
meal and 30-60 minutes after mealtime.
6. Cholelithiasis- Jaundice: Jaundice occurs in a few patients with gallbladder
disease, usually with obstruction of the common bile duct. The bile, which is no
longer carried to the duodenum, is absorbed by the blood and gives the skin and
mucous membranes a yellow color. This is frequently accompanied by marked
pruritus (itching) of the skin.
7. Gallbladder Risk Factors: The risk of developing such stones is increased in
patients with cirrhosis, hemolysis, and infections of the biliary tract.
Cholesterol stones account for most of the remaining 75% of cases of gallbladder
disease in the United States
Two to three times more women than men develop cholesterol stones and
gallbladder disease
Stone formation is more frequent in people who use oral contraceptives, estrogens,
or clofibrate (Atromid-S); these medications are known to increase biliary
cholesterol saturation. The incidence of stone formation increases with age as a
result of increased hepatic secretion of cholesterol and decreased bile acid
synthesis.
8. Peptic Ulcer Disease Complication: Although vomiting is rare in an
uncomplicated peptic ulcer, it may be a symptom of a complication of an ulcer. It
results from gastric outlet obstruction, caused by either muscular spasm of the
pylorus or mechanical obstruction from scarring or acute swelling of the inflamed
mucous membrane adjacent to the ulcer.
, HESI NSG 123: Medical Surgical Nursing Final
9. Seizure Precautions: Seizure precautions are maintained, including having
available functioning suction equipment with a suction catheter and oral airway. The
bed is placed in a low position with two to three side rails up and padded, if
necessary, to prevent injury to the patient. The patient may be drowsy and may wish
to sleep after the seizure; they may not remember events leading up to the seizure
and for a short time thereafter.
10. Rheumatoid Arthritis S/S: The initial clinical manifestations of RA include
symmetric joint pain and morning joint stiffness lasting longer than 1 hour. Over the
course of the disease, clinical manifestations of RA vary, usually reflecting the stage
and severity of the disease. Symmetric joint pain, swelling, warmth, erythema, and
lack of function are classic symptoms. Palpation of the joints reveals spongy or
boggy tissue. Often, fluid can be aspirated from the inflamed joint.
Characteristically, the pattern of joint involvement begins in the small joints of the
hands, wrists, and feet. In the early stages of disease, even before the presentation
of bony changes, limitation in function can occur when there is active inflammation
in the joints. Joints that are hot, swollen, and painful are not easily moved.
11. SLE Exacerbation: The lesions often worsen during exacerbations (flares) of
the systemic disease and possibly are provoked by sunlight or artificial ultraviolet
light. Oral ulcers, which may accompany skin lesions, may involve the bucca
mucosa or the hard palate, occur in crops, and are often associated with
exacerbations. Other cutaneous manifestations include splinter hemorrhages,
alopecia, and Raynaud's phenomenon
12. Pre-Op Lab: Routine laboratory tests used to detect infection include the white
blood count (WBC) and the urinalysis. Surgery may be postponed in the presence
of infection.
13. Ambulation Post-Op: The patient should be taught that early and frequent
ambulation postoperatively, as tolerated, will help prevent complications.
1. Ulcerative Colitis: Ulcerative colitis is a chronic ulcerative and inflammatory
disease of the mucosal and submucosal layers of the colon and rectum that is
characterized by unpredictable periods of remission and exacerbation with bouts of
abdominal cramps and bloody or purulent diarrhea. The inflammatory changes
typically begin in the rectum and progress proximally through the colon
2. Crohn's Disease: Crohn's disease is characterized by periods of remission
and exacerbation. It is a subacute and chronic inflammation of the GI tract wall that
extends through all layers (i.e., transmural lesion). Although its characteristic
histopathologic changes can occur anywhere in the GI tract, it most commonly
occurs in the distal ileum and the ascending colon. The onset of symptoms is usually
insidious in Crohn's disease, with prominent right lower quadrant abdominal pain
and diarrhea unrelieved by defecation
3. Crohn's Disease Diet: Oral fluids and a low-residue, high-protein, high-calorie
diet with supplemental vitamin therapy and iron replacement are prescribed to meet
nutritional needs, reduce inflammation, and control pain and diarrhea. Fluid and
electrolyte imbalances from dehydration caused by diarrhea are corrected by IV
therapy as necessary if the patient is hospitalized or by oral fluids if the patient is
managed at home. Any foods that exacerbate diarrhea are avoided. Milk may
contribute to diarrhea in those with lactose intolerance. Cold foods and smoking are
avoided because both increase intestinal motility. Parenteral nutrition may be
indicated.
4. Ulcerative Colitis-Goal: The major goals for the patient include attainment of
normal bowel elimination patterns, relief of abdominal pain and cramping,
prevention of fluid volume deficit, maintenance of optimal nutrition and weight,
avoidance of fatigue, reduction of anxiety, promotion of effective coping, absence
of skin breakdown, increased knowledge about the disease process and self-health
management, and avoidance of complications.
5. Bariatric Surgery Post Op: After surgery, the nurse assesses the patient for
complications from the bariatric surgery, such as hemorrhage, venous
, HESI NSG 123: Medical Surgical Nursing Final
thromboembolism, bile reflux, dumping syndrome, dysphagia, and bowel or gastric
outlet obstruction.
Eat smaller but more frequent meals that contain protein and fiber; each meal size
should not exceed 1 cup.
Eat only foods high in nutrients (e.g., peanut butter, cheese, chicken, fish, beans).
Eat slowly and chew thoroughly
Assume a low Fowler position during mealtime and then remain in that position for
20-30 minutes after mealtime—this delays stomach emptying and decreases the
likelihood of dumping syndrome.
Do not drink fluid with meals; instead, consume fluids up to 30 minutes before a
meal and 30-60 minutes after mealtime.
6. Cholelithiasis- Jaundice: Jaundice occurs in a few patients with gallbladder
disease, usually with obstruction of the common bile duct. The bile, which is no
longer carried to the duodenum, is absorbed by the blood and gives the skin and
mucous membranes a yellow color. This is frequently accompanied by marked
pruritus (itching) of the skin.
7. Gallbladder Risk Factors: The risk of developing such stones is increased in
patients with cirrhosis, hemolysis, and infections of the biliary tract.
Cholesterol stones account for most of the remaining 75% of cases of gallbladder
disease in the United States
Two to three times more women than men develop cholesterol stones and
gallbladder disease
Stone formation is more frequent in people who use oral contraceptives, estrogens,
or clofibrate (Atromid-S); these medications are known to increase biliary
cholesterol saturation. The incidence of stone formation increases with age as a
result of increased hepatic secretion of cholesterol and decreased bile acid
synthesis.
8. Peptic Ulcer Disease Complication: Although vomiting is rare in an
uncomplicated peptic ulcer, it may be a symptom of a complication of an ulcer. It
results from gastric outlet obstruction, caused by either muscular spasm of the
pylorus or mechanical obstruction from scarring or acute swelling of the inflamed
mucous membrane adjacent to the ulcer.
, HESI NSG 123: Medical Surgical Nursing Final
9. Seizure Precautions: Seizure precautions are maintained, including having
available functioning suction equipment with a suction catheter and oral airway. The
bed is placed in a low position with two to three side rails up and padded, if
necessary, to prevent injury to the patient. The patient may be drowsy and may wish
to sleep after the seizure; they may not remember events leading up to the seizure
and for a short time thereafter.
10. Rheumatoid Arthritis S/S: The initial clinical manifestations of RA include
symmetric joint pain and morning joint stiffness lasting longer than 1 hour. Over the
course of the disease, clinical manifestations of RA vary, usually reflecting the stage
and severity of the disease. Symmetric joint pain, swelling, warmth, erythema, and
lack of function are classic symptoms. Palpation of the joints reveals spongy or
boggy tissue. Often, fluid can be aspirated from the inflamed joint.
Characteristically, the pattern of joint involvement begins in the small joints of the
hands, wrists, and feet. In the early stages of disease, even before the presentation
of bony changes, limitation in function can occur when there is active inflammation
in the joints. Joints that are hot, swollen, and painful are not easily moved.
11. SLE Exacerbation: The lesions often worsen during exacerbations (flares) of
the systemic disease and possibly are provoked by sunlight or artificial ultraviolet
light. Oral ulcers, which may accompany skin lesions, may involve the bucca
mucosa or the hard palate, occur in crops, and are often associated with
exacerbations. Other cutaneous manifestations include splinter hemorrhages,
alopecia, and Raynaud's phenomenon
12. Pre-Op Lab: Routine laboratory tests used to detect infection include the white
blood count (WBC) and the urinalysis. Surgery may be postponed in the presence
of infection.
13. Ambulation Post-Op: The patient should be taught that early and frequent
ambulation postoperatively, as tolerated, will help prevent complications.
