MED SURG (NURS 242 ) TEST 3 RECAP FOR EXAM
3 (all information you need for exam 3) GALEN
COLLEGE OF NURSING
,NUR 242 Unit 7 & 8 Test 2 Outline
Appendicitis: inflammation of appendix
Common causes: infection (most common), trauma/injury
S/S: pain originating around “belly area”, then localizes in RLQ; Pain increases w/movement, coughing,
bending knees; constipation, N/V, WBC count elevated; low grade temp
Assessment: rebound tenderness is positive in RLQ
Treatment: surgery; pain management, NPO = no peristalsis r/t appendix rupture; begin antibiotics,
surgery prep
Nursing measures: pain management, IV hydration; if NG tube, then suction it/functioning & properly
secured; all post-op nursing care management is r/t whether they had a laparoscopic appendectomy or
an open appendectomy and whether it was ruptured; if ruptured, intensive post-op care of open,
infected wound with drains; pt & family teaching r/t wound & drain care
Complications: peritonitis = if abdominal pain is alleviated, then returns = “red flag for peritonitis”;
distended abdomen then becomes rigid/board-like; pain is relieved when pt pulls knees toward
abdomen/fetal position; progressing signs of shock: tachypnea, tachycardia, drop in BP and O2 sats
GERD: reflux of gastric content into esophagus *usually after a large meal; risk factors: overweight, or
hiatal hernia (anything that effects movement of food); pt positioning becomes “very very” important in
GERD management; looks like severe heartburn; may complain of lump in throat (especially w/hiatal
hernia); may have dry cough, hoarse voice; wakes up at night coughing w/acrid taste in mouth/throat;
higher risk for aspiration = assess for crackles!
Assessment: listen to lungs for crackles (aspiration during sleep)
Lifestyle modifications and diet changes = “bland diet”; restrict fatty spicy foods; sitting upright when
eating & remain for 30 minutes post meal; don’t eat late at night before bed; no restrictive clothing; lose
weight; avoid vigorous exercise/strain; medications
Nursing measures around teaching; prevent attacks of GERD
Complications: esophageal cancer r/t persistent irritation by gastric juices
PUD/peptic ulcer disease: gastric ulcer or duodenal ulcers; gastric ulcer = lower curvature of stomach;
duodenal in duodenum
Causes: H. Pylori infection; mucosal barrier/stomach lining @ duodenum is eroded away by acid;
S/S: duodenal = occurs on an empty stomach, gets gnawing pain and eats/drinks milk and pain subsides
= “nighttime ulcer”; gastric ulcer = “daytime ulcer”, pain upon eating (vs. empty stomach w/duodenal);
gnawing, burning pain in the pit of the stomach when we eat r/t gastric acid secretion & stimulation;
Treatment: treated the same = reduce hostile factors, protect stomach lining while it repairs r/t diet,
minimize Hcl acid production; antacids for coating; antibiotics for H. Pylori, limit production of Hcl acid =
PPI’s and H2 receptor antagonists; may result in surgery with strictures, damage too great/perforations
in stomach or duodenum; vagotomy or partial/total gastrectomy
1
, NUR 242 Unit 7 & 8 Test 2 Outline
Teaching: Lifestyle changes = limit stress, alcohol/caffeine consumption, stop smoking, diet; prevent
formation/exacerbation of PUD;
complications: gastric ulcer = chronic gastritis, high risk for stomach cancer (if add PUD & bad diet r/t
nitrates, pickled foods, smoked/charred foods & meats; smoking (stop smoking! It aggravates ulcerative
condition); possibly peritonitis;
Partial or total gastrectomy surgery can lead to dumping syndrome: post-op complication of partial/total
gastrectomy; self-limiting, pt needs to wait it out and will resolve itself just needs to rest until is subsides.
No other treatment.
S/S: pt feels like they’re having a Heart attack = tachycardia, N/V/D, diaphoresis, chest pain, palpitations,
abdominal cramping, clammy, generalized weakness, vertigo/dizziness; pt can’t do anything when it is
happening. Just rest/lie down and wait it out; 15-20 minutes after eating, lasts 20-30 minutes r/t SNS
response
Treatment: controlled through diet = avoid large intakes of simple carbs (white flour, sugar, rice, pasta,
bread, tortillas, fruits w/out pulp especially, juices, regular soft drinks; diet drinks okay but sorbitol will
cause diarrhea; no fluids/don’t drink anything before or with meal; fat content of meals delays
absorption of carbs into intestines so fats/proteins will help episode;
Procedures to review:
Esophagogastroduodenoscopy: EGD visual inspection of stomach, esophagus and duodenum; done
under moderate sedation = recovery post-procedure; medication/anesthetics knock out gag reflex, so
monitor for gag reflex post-op, will be NPO for approx. 6-8 hours post procedure, even though gag reflex
will return within 1-2 hours. Meds will be completely out of system after 6-8 hours, so can drink fluids
(NPO status lifted after 6-8 hrs).
Pre-procedure: No aspirin/NSAIDs, no anticoagulants 5-7 days prior; NPO pre-op overnight or at least 8
hours;
Endoscopic Retrograde Cholangiopancreatography: ERCP = visual & radiographic exam of liver,
gallbladder, pancreas, and bile ducts; used preventionally to open narrowed/closed sphincter, removing
stones, placing stints = all these mean a higher risk for bleeding; “electrocaudery”; moderate sedation
Pre-op prep: is same as EGD, but includes verifying/assessing if pt has implanted devices that interfere
w/ERCP; ex: if pt has pacemaker, can’t perform r/t “electrocaudery” interference
Post-op Recovery: same as EGD plus (monitor for) increased risk for bleeding post-op r/t type of
procedures performed
Colonoscopy: “everyone looks forward to at aged 50”; earlier if risk factors present = like inflammatory
bowel disease (which is chronic); look at everything, rule out & look for cancer, pre-cancerous polyps;
suspect if GI bleeding (find cause); diverticulosis is typically diagnosed w/colonoscopy; [moderate
sedation]
Prep: cleaning out bowel = don’t eat anything Red, orange or gray before the day; are to be on clear
liquids; at least 4-6 hours NPO, typically overnight NPO; will be moderate sedation
2
3 (all information you need for exam 3) GALEN
COLLEGE OF NURSING
,NUR 242 Unit 7 & 8 Test 2 Outline
Appendicitis: inflammation of appendix
Common causes: infection (most common), trauma/injury
S/S: pain originating around “belly area”, then localizes in RLQ; Pain increases w/movement, coughing,
bending knees; constipation, N/V, WBC count elevated; low grade temp
Assessment: rebound tenderness is positive in RLQ
Treatment: surgery; pain management, NPO = no peristalsis r/t appendix rupture; begin antibiotics,
surgery prep
Nursing measures: pain management, IV hydration; if NG tube, then suction it/functioning & properly
secured; all post-op nursing care management is r/t whether they had a laparoscopic appendectomy or
an open appendectomy and whether it was ruptured; if ruptured, intensive post-op care of open,
infected wound with drains; pt & family teaching r/t wound & drain care
Complications: peritonitis = if abdominal pain is alleviated, then returns = “red flag for peritonitis”;
distended abdomen then becomes rigid/board-like; pain is relieved when pt pulls knees toward
abdomen/fetal position; progressing signs of shock: tachypnea, tachycardia, drop in BP and O2 sats
GERD: reflux of gastric content into esophagus *usually after a large meal; risk factors: overweight, or
hiatal hernia (anything that effects movement of food); pt positioning becomes “very very” important in
GERD management; looks like severe heartburn; may complain of lump in throat (especially w/hiatal
hernia); may have dry cough, hoarse voice; wakes up at night coughing w/acrid taste in mouth/throat;
higher risk for aspiration = assess for crackles!
Assessment: listen to lungs for crackles (aspiration during sleep)
Lifestyle modifications and diet changes = “bland diet”; restrict fatty spicy foods; sitting upright when
eating & remain for 30 minutes post meal; don’t eat late at night before bed; no restrictive clothing; lose
weight; avoid vigorous exercise/strain; medications
Nursing measures around teaching; prevent attacks of GERD
Complications: esophageal cancer r/t persistent irritation by gastric juices
PUD/peptic ulcer disease: gastric ulcer or duodenal ulcers; gastric ulcer = lower curvature of stomach;
duodenal in duodenum
Causes: H. Pylori infection; mucosal barrier/stomach lining @ duodenum is eroded away by acid;
S/S: duodenal = occurs on an empty stomach, gets gnawing pain and eats/drinks milk and pain subsides
= “nighttime ulcer”; gastric ulcer = “daytime ulcer”, pain upon eating (vs. empty stomach w/duodenal);
gnawing, burning pain in the pit of the stomach when we eat r/t gastric acid secretion & stimulation;
Treatment: treated the same = reduce hostile factors, protect stomach lining while it repairs r/t diet,
minimize Hcl acid production; antacids for coating; antibiotics for H. Pylori, limit production of Hcl acid =
PPI’s and H2 receptor antagonists; may result in surgery with strictures, damage too great/perforations
in stomach or duodenum; vagotomy or partial/total gastrectomy
1
, NUR 242 Unit 7 & 8 Test 2 Outline
Teaching: Lifestyle changes = limit stress, alcohol/caffeine consumption, stop smoking, diet; prevent
formation/exacerbation of PUD;
complications: gastric ulcer = chronic gastritis, high risk for stomach cancer (if add PUD & bad diet r/t
nitrates, pickled foods, smoked/charred foods & meats; smoking (stop smoking! It aggravates ulcerative
condition); possibly peritonitis;
Partial or total gastrectomy surgery can lead to dumping syndrome: post-op complication of partial/total
gastrectomy; self-limiting, pt needs to wait it out and will resolve itself just needs to rest until is subsides.
No other treatment.
S/S: pt feels like they’re having a Heart attack = tachycardia, N/V/D, diaphoresis, chest pain, palpitations,
abdominal cramping, clammy, generalized weakness, vertigo/dizziness; pt can’t do anything when it is
happening. Just rest/lie down and wait it out; 15-20 minutes after eating, lasts 20-30 minutes r/t SNS
response
Treatment: controlled through diet = avoid large intakes of simple carbs (white flour, sugar, rice, pasta,
bread, tortillas, fruits w/out pulp especially, juices, regular soft drinks; diet drinks okay but sorbitol will
cause diarrhea; no fluids/don’t drink anything before or with meal; fat content of meals delays
absorption of carbs into intestines so fats/proteins will help episode;
Procedures to review:
Esophagogastroduodenoscopy: EGD visual inspection of stomach, esophagus and duodenum; done
under moderate sedation = recovery post-procedure; medication/anesthetics knock out gag reflex, so
monitor for gag reflex post-op, will be NPO for approx. 6-8 hours post procedure, even though gag reflex
will return within 1-2 hours. Meds will be completely out of system after 6-8 hours, so can drink fluids
(NPO status lifted after 6-8 hrs).
Pre-procedure: No aspirin/NSAIDs, no anticoagulants 5-7 days prior; NPO pre-op overnight or at least 8
hours;
Endoscopic Retrograde Cholangiopancreatography: ERCP = visual & radiographic exam of liver,
gallbladder, pancreas, and bile ducts; used preventionally to open narrowed/closed sphincter, removing
stones, placing stints = all these mean a higher risk for bleeding; “electrocaudery”; moderate sedation
Pre-op prep: is same as EGD, but includes verifying/assessing if pt has implanted devices that interfere
w/ERCP; ex: if pt has pacemaker, can’t perform r/t “electrocaudery” interference
Post-op Recovery: same as EGD plus (monitor for) increased risk for bleeding post-op r/t type of
procedures performed
Colonoscopy: “everyone looks forward to at aged 50”; earlier if risk factors present = like inflammatory
bowel disease (which is chronic); look at everything, rule out & look for cancer, pre-cancerous polyps;
suspect if GI bleeding (find cause); diverticulosis is typically diagnosed w/colonoscopy; [moderate
sedation]
Prep: cleaning out bowel = don’t eat anything Red, orange or gray before the day; are to be on clear
liquids; at least 4-6 hours NPO, typically overnight NPO; will be moderate sedation
2
