NUR 242
EXAM 3 STUDY GUIDE
Medical-Surgical Nursing Concepts
Galen College of Nursing
, Exam 3
Care of the client with elimination GI disorders
Gus function
Secretion
HCL acid (food breakdown)
Digestion
Absorption
Motility
Movement through the stomach
Elimination
Feces
Assessment of the GI system and health promotion
Inspection
Auscultation
Percussion
Palpation
Colonoscopy once every 10 years
After the age of 50 a colonoscopy needs to be done once every 10 yrs
Assessment techniques (NUGGET****)
Abdominal examination starting at RUQ
Inspection, auscultation, palpation
Do not palpate if appendicitis or abdominal aneurysm is suspected
Heath care providers, APRNs perform percussion and deep palpation
Small intestine vs large intestine
Small intestine
16-19ft
Movement, mixing absorption
3 different regions
Duodenum
Jejunum
Ileum
Large intestine
5-6ft
Movement absorption and elimination
Absorption of water and electrolytes
Extends to the rectum
Gastroesophageal Reflux disease (GERD)
Backflow of acidic stomach contents into esophagus
Caused by excessive relaxation of lower esophageal sphincter
Risk factors
Weight gain (obesity)
Fatty foods
Caffeinated/carbonated beverages (coffee, tea, soda, alcohol, chocolate)
ETOH/smoking
, Medications (CCD, Nitrates, anticholinergics-mostly allergy, nicotine’s,
progesterone)
Hiatal hernia
Pregnancy
NGT
NUGGET***
Medications: benydral, anticholinergic
NG tube-makes sphincter lazy and stay open
Food w/ tomatoes Sause, citrus
GERD: what are you looking for?
Dyspepsia (indigestion)
Feeling of fullness
Nausea
Burping
Abdominal discomfort
Regurgitation
Metallic taste in mouth
Severe GERD can mimic cardiac pain (atypical chest pain)
Poor dentition
Hypersalivation (water brash)
Symptoms
Most common symptoms is heartburn; worse after eating
Chest pain
Dysphagia-difficulty swallowing
Odynophagia-painful swallowing
Metallic taste in mouth
Regurgitation (into pharynx)
Poor dentition teeth are bad
Cough
Hoarseness
Wheezing
Extraesophageal symptoms- cough, hoarseness, and wheezing
(aspiration) (bad)
Bending over
Laying down too soon after meals
Long term cause cancer in response to acid
Diagnosis
Clinical based on s/s
Esophagogastroduodenoscopy (Barret’s esophagus)
24 hr ph monitoring and manometry (pH less than 4)
Hiatal hernia: upper GI series, CT
Treatment
Lifestyle management
Elevate HOB
, Diet modification: avoid coffee, ETOH, fatty foods, smoking
Weight loss
No tight clothing
Avoid eating 3 hrs before bedtime, esp if pt has night time
symptoms
Sleep left lateral decubitus position: moves stomach contents
away from LES (sleep right side per monica slides)(when you sleep on the left side it relaxes the
sphincter a little more)
Medical
H2 blockers: mild (famotidine, ranitidine)
Proton pump inhibitors: mod to severe (long term bone loss)
(omeprazole, pantoprazole)
Surgical
Nissen
Fundoplication
Gastric portion of the fundus wrapped around the LES
Peptic ulcer disease (PUD)
Ulceration of the mucosal wall in the stomach
Gastric
Duodenal
Esophageal
(don’t take ibuprofen, or aspirin)
Due to focal ulceration of stomach or duodenal tissue
Very common cause of epigastric pain (after eating)
Gastric: during/briefly after eating; a/w weightloss
Duodenal: a few hrs after eating; more common
Physiology
Gastric ulcer
Stomach secretes acid when you eat, irritates ulcer
Ulceration of the mucosal lining that extends to the submucosal layer of
the stomach
Risk factors
Stress
Smoking
NSAIDs OD
Alcohol
H.pylori (bacteria)
Duodenal
Ulcer far off in duodenum; when acid comes into contact w/ duodenum
they get pain; night time pain
Break in the mucosa of the duodenum
Risk factors
H. Pylori
Alcohol intake
EXAM 3 STUDY GUIDE
Medical-Surgical Nursing Concepts
Galen College of Nursing
, Exam 3
Care of the client with elimination GI disorders
Gus function
Secretion
HCL acid (food breakdown)
Digestion
Absorption
Motility
Movement through the stomach
Elimination
Feces
Assessment of the GI system and health promotion
Inspection
Auscultation
Percussion
Palpation
Colonoscopy once every 10 years
After the age of 50 a colonoscopy needs to be done once every 10 yrs
Assessment techniques (NUGGET****)
Abdominal examination starting at RUQ
Inspection, auscultation, palpation
Do not palpate if appendicitis or abdominal aneurysm is suspected
Heath care providers, APRNs perform percussion and deep palpation
Small intestine vs large intestine
Small intestine
16-19ft
Movement, mixing absorption
3 different regions
Duodenum
Jejunum
Ileum
Large intestine
5-6ft
Movement absorption and elimination
Absorption of water and electrolytes
Extends to the rectum
Gastroesophageal Reflux disease (GERD)
Backflow of acidic stomach contents into esophagus
Caused by excessive relaxation of lower esophageal sphincter
Risk factors
Weight gain (obesity)
Fatty foods
Caffeinated/carbonated beverages (coffee, tea, soda, alcohol, chocolate)
ETOH/smoking
, Medications (CCD, Nitrates, anticholinergics-mostly allergy, nicotine’s,
progesterone)
Hiatal hernia
Pregnancy
NGT
NUGGET***
Medications: benydral, anticholinergic
NG tube-makes sphincter lazy and stay open
Food w/ tomatoes Sause, citrus
GERD: what are you looking for?
Dyspepsia (indigestion)
Feeling of fullness
Nausea
Burping
Abdominal discomfort
Regurgitation
Metallic taste in mouth
Severe GERD can mimic cardiac pain (atypical chest pain)
Poor dentition
Hypersalivation (water brash)
Symptoms
Most common symptoms is heartburn; worse after eating
Chest pain
Dysphagia-difficulty swallowing
Odynophagia-painful swallowing
Metallic taste in mouth
Regurgitation (into pharynx)
Poor dentition teeth are bad
Cough
Hoarseness
Wheezing
Extraesophageal symptoms- cough, hoarseness, and wheezing
(aspiration) (bad)
Bending over
Laying down too soon after meals
Long term cause cancer in response to acid
Diagnosis
Clinical based on s/s
Esophagogastroduodenoscopy (Barret’s esophagus)
24 hr ph monitoring and manometry (pH less than 4)
Hiatal hernia: upper GI series, CT
Treatment
Lifestyle management
Elevate HOB
, Diet modification: avoid coffee, ETOH, fatty foods, smoking
Weight loss
No tight clothing
Avoid eating 3 hrs before bedtime, esp if pt has night time
symptoms
Sleep left lateral decubitus position: moves stomach contents
away from LES (sleep right side per monica slides)(when you sleep on the left side it relaxes the
sphincter a little more)
Medical
H2 blockers: mild (famotidine, ranitidine)
Proton pump inhibitors: mod to severe (long term bone loss)
(omeprazole, pantoprazole)
Surgical
Nissen
Fundoplication
Gastric portion of the fundus wrapped around the LES
Peptic ulcer disease (PUD)
Ulceration of the mucosal wall in the stomach
Gastric
Duodenal
Esophageal
(don’t take ibuprofen, or aspirin)
Due to focal ulceration of stomach or duodenal tissue
Very common cause of epigastric pain (after eating)
Gastric: during/briefly after eating; a/w weightloss
Duodenal: a few hrs after eating; more common
Physiology
Gastric ulcer
Stomach secretes acid when you eat, irritates ulcer
Ulceration of the mucosal lining that extends to the submucosal layer of
the stomach
Risk factors
Stress
Smoking
NSAIDs OD
Alcohol
H.pylori (bacteria)
Duodenal
Ulcer far off in duodenum; when acid comes into contact w/ duodenum
they get pain; night time pain
Break in the mucosa of the duodenum
Risk factors
H. Pylori
Alcohol intake
