Med Surge

Front 1

Intervention for patient diagnosed with aphthous stomatitis (canker sore)

Back 1

apply topical tetracycline several times a day (shortens healing time)

Front 2

Intervention for patient with gastritis

Back 2

monitor for bloody diarrhea

Front 3

Primary cause of peptic ulcers

Back 3

bacterial infection

Front 4

purpose of H2 antagonists

Back 4

inhibit secretion of gastric acid
tagament, zantac, pepcid, axid

Front 5

purpose of proton pump inhibitors

Back 5

block gastric acid secretion
prilosec, prevacid, aciphex

Front 6

action of antacids

Back 6

strengthens gastric mucosal barrier; reduces pepsin activity
mylanta, tums

Front 7

priority nursing intervention for vomiting patient who has recently returned from surgery

Back 7

place on side

Front 8

foods to avoid with dumping syndrome

Back 8

coffee and glazed doughnut

Front 9

teaching regarding laxatives

Back 9

regular laxative use can be harmful

Front 10

interventions following appendectomy to prevent respiratory complications

Back 10

pain control
early ambulation
coughing, deep breathing,
turning in bed
incentive spirmometer

Front 11

food to avoid with ulcerative colitis

Back 11

fresh fruits

Front 12

post-op care to prevent respiratory complications following hernia repair

Back 12

deep breathe every house while awake

Front 13

monitor during intermittent suction

Back 13

I & O
pain
pulse rate
temperature

Front 14

melena

Back 14

black, tarry stool

Front 15

concern following colostomy

Back 15

dusky color

Front 16

low vitamin k

Back 16

increased risk for bleeding

Front 17

elevated in chronic pancreatitis

Back 17

serum amylase

Front 18

highest priority patient outcome in newly admitted acute pancreatitis

Back 18

satisfied with pain control

Front 19

bile duct obstruction S&S

Back 19

dark, amber colored urine

Front 20

interventions for patient following open cholecystectomy to maintain effective breathing pattern

Back 20

provide analgesia for pain relief
encourage coughing and deep breathing
assist with splinting during coughing

Front 21

expected location of pain in appendicitis

Back 21

right lower quadrant

Front 22

function of the liver

Back 22

synthesis of plasma proteins
lipid/carb/amino acid metabolism
detoxification
formation of billirubin

Front 23

normal rate of bowel sounds

Back 23

irregular every 5-15 seconds

Front 24

palpation

Back 24

lightly depress abdomen 1/2 to 1 inch

Front 25

intervention following upper or lower GI series

Back 25

encourage liquids to flush out barium

Front 26

functions of sump pump

Back 26

decompression, irrigation, lavage

Front 27

confirm placement of feeding tube

Back 27

x-ray

Front 28

acute pancreatitis - trypsin

Back 28

o Trypsin destroys pancreatic tissue and causes vasodilation. Fluid is lost, shock occurs. (p. 733)

Front 29

acute pancreatitis - location of pain

Back 29

o Abdominal pain in pancreatitis is generally located in the midline just below the sternum with radiation to the spine, back, and flank. (p. 733)

Front 30

acute pancreatitis
turner's sign
cullen's sign

Back 30

o Purplish discoloration of the flanks (Turner’s sign) or purplish discoloration around the umbilicus (cullen’s sign) may occur with extensive hemorrhagic destruction of the pancreas. (p. 733)

Front 31

acute pancreatitis pain meds

Back 31

o In pancreatitis, the physician usually orders Demerol (meperidine hydrochloride) for pain because some experts believe morphine can cause spasm of the sphincter of Oddi and increase pain. (p. 734)

Front 32

how to tell if pancreatic enzymes are working

Back 32

o Pancreatic enzymes must be replaced in pancreatitis; enzymes are working if stools are normal (p. 738)

Front 33

hital hernia
most common
worse symtoms
notify physician if

Back 33

o A sliding hiatal hernia is the most common type of hernia. (p. 672)
o In a sliding hiatal hernia symptoms worsen when lying down (pain, heartburn, feeling of fullness, reflux)
o If dysphagia, gagging, hiccups occurs following surgery for a hiatal hernia, physician must be called. (p. 673)

Front 34

post-op care for nissen fundiplication

Back 34

o If dysphagia, gagging, hiccups occurs following surgery for a hiatal hernia, physician must be called. (p. 673)
o Stomach is wrapped around esophagus

Front 35

color of stools in chronic liver failure

Back 35

o Chronic liver failure = clay colored stools (p. 726)

Front 36

GI bleeding
types
hemmorage

Back 36

o Blood loss can be hidden (occult), observable vomited blood (hematoemeis, blood in the stool, or black tarry stools (melena.) If on iron stools may be black and tarry as well. (p. 678)
o Severe blood loss (more than 1L in 24 hours) may result in hypovolemic shock, with sigsn and symptoms such as hypotension, a weak/thread pulse, chills, palpitations, and diaphoresis. (p. 687) – indicated hemorrage

Front 37

when tpn

Back 37

o If NPO therapy is prolonged or the patient is malnourished, TPN may be needed. (p. 734)

Front 38

mallory weiss tear

Back 38

o Mallory-Weiss tears result from prolonged force due to coughing, vomiting, seizures, prolapse of the stomach into the esophagus, or CPR. Symptoms include bright red blood emesis or bloody or tarry stools. (p. 674)

Front 39

dumping syndrome

Back 39

dizzyness, tachycardia, fainting, sweating, N/V, hypoglycemia
o The treatment for dumping syndrome is teaching the patient to eat small, frequent meals that are high in protein and fat and low in carbs, especially refined sugars. (p. 684)
o Rapid entry of food into jejunum without mixing with gastric juices results in pulling fluid into bowel – shift causes problems.

Front 40

vitamin deficiency in gastric surgery

Back 40

o In chronic gastritis type A, there is a difficulty absorbing vitamin B12, which leads to pernicious anemia. (p. 675)
o Gastric surgery requires lifelong administration of vitamin B12. (p. 683)

Front 41

• Diet after gastric bypass/restrictive or malapsorption surgery

Back 41

o Clear liquid diet to full liquids to pureed to regular foods
o Must eat healthy and exercise

Front 42

• Barrett’s esophagus

Back 42

o Complications of GERD a result in esophagitis due to acid reflux. Over time this may lead to Barrett’s esophagus. (p. 673)

Front 43

small bowel obstruction

Back 43

o As the intestinal obstruction becomes more extreme, peristaltic waves reverse, propelling the intestinal contents toward the mouth, eventually leading to fecal vomiting. (p. 705)

Front 44

bowel obstruction care and treatment

Back 44

o In most cases of intestinal obstruction, the patient is kept NPO, and the bowel is decompressed using nasogastric tubes, which relieves symptoms and may resolve the obstruction. (p. 705)

Front 45

appendicits
mcburney's point
cares
rupture considerations
complications

Back 45

o In appendicitis, pain usually occurs at McBurney’s point, which is midway between the umbilicus and right iliac crest. (p. 692)
o If appendicitis is suspected, keep patient NPO, watch WBC count.
o If appendix ruptures, IV fluids ad antibiotic therapy are started and surgery may be delayed for 8 hours or more. (p. 692)
o Perforation, abscess of the appendix, peritonitis are major complications of appendicitis. (p. 693) Perforation may be indicated by elevated temperature.
o The most common cause of peritonitis is a ruptured appendix. (p. 693)

Front 46

• Diverticulosis/Diverticulitis

Back 46

o Diverticulitis is inflammation and infection resulting from food and bacteria trapped in a diverticulum. (p. 693)
o Chronic constipation usually precedes the development of diverticulosis by many years, increased pressure within the bowel causes the development of diverticula. (p. 693)
o Diverticulosis is managed by preventing constipation. (p. 694)
o Fiber should be increase slowly in the diet to prevent excess gas and cramping with diverticulosis. (p. 694)

Front 47

ileostomy/colostomy

Back 47

o An ostomy is a surgically created opening that diverts stool or urine to the outside of the body through an opening in the abdomen called a stoma. (p. 710)
o An ileostomy is an end stoma formed by bringing the terminal ileum out to the abdominal wall following a total protocolectomy. (p. 710)

Front 48

crohn's disease
vs. ulcerative colitis
meds

Back 48

o Crohns’s disease occurs in the small and large intestine. (p. 695) vs. ulcerative colitis which is generally in the large colon and rectum. (p. 698)
o Budesonide (Enterocort EC) is used to reduce local inflammation caused by Crohn’s disease because there are fewer systemic side effects. (p. 697)
o Flagyl and Cipro are two antibiotics commonly used in Crohn’s disease. (p. 697)

Front 49

esophogeal varices treatment

Back 49

o Bleeding varices are treated with vasoconstrictors such as vasopressin

Front 50

considerations for esophageal varices

Back 50

o The blood-filled, thin-walled varices may tear easily from sudden excessive pressure, such as intrabdominal pressure that results from coughing, lifting, or straining, causing severe bleeding (p. 725)

Front 51

• Gallstones- Composition, tests, pain/assessment findings

Back 51

o Cholelithiasis is characterized by the formation of gallstones in the gallbladder that are usually composed primarily of cholesterol. (p. 741)
o S&S of cholecystitis include a positive Murphy’s sign, which is the inability to take a deep breathe when the examiners fingers are pressed into the abdomen. (p. 741)
o The patient with a traditional cholecsytectomy incision pain that creates difficulty with coughing and deep breathing postoperatively because deep breathing causes the diaphragm to press on the operative site.

Front 52

What causes jaundice in Gall Bladder Disease?

Back 52

o Jaundice is more commonly present with acute choledocholithiases because the common bile ducts is blocked or inflamed. (p. 742)

Front 53

lab findings in liver disease

Back 53

o Marked elevation in clotting time is an ominous sign in acute liver failure (p. 723)
o elevated

Front 54

abnormal pancreatitis labs

Back 54

o Elevated serum amylase and lipase

Front 55

hepatic encephalopathy

Back 55

o Hepatic encephalopathy signs and symptoms include progressive confusion, asterxis, or flapping tremors in the hands caused by toxins at peripheral nerves (put hands out to test for), and fetor hepaticus, or foul breath. (p. 725)

Front 56

nausea

Back 56

subjective feeling of the urge to vomit

Front 57

Coffee grounds appearing emesis

Back 57

may indicate bleeding from the stomach.

Front 58

S&S of metabolic alkalosis

Back 58

hypokalemia, hypocalcemia

Front 59

protoniks

Back 59

Do not crush protonics or open up capsule and place on food. (GERD)

Front 60

complications of peptic ulcers

Back 60

Major complications in peptic ulcer disease can result from bleeding, perforation, and obstruction. Bleeding can occur in varying degrees from occult blood in stool and emesis to massive bright red bleeding. Treatment includes stopping the bleeding, replacing fluid and electrolytes, and possibly administering vasopressin to stop bleeding. (p. 678)

Front 61

billroth I & II

Back 61

Billroth 1 is removal of distal portion of stomach, with the rest of the stomach attached to the duodenum. The Billroth II is bypasses the duodenum. (p. 681)

Front 62

ostipation

Back 62

prolonged constipation

Front 63

S&S of sprue

Back 63

frequent loose, bulky, foul stools that are gray in color and have an increased fat content (steatorrhea) (p. 703) absorption disorder

Front 64

volvus
interssusception

Back 64

A volvus occurs when the bowel twists, occluding the lumen of the intestine. Intussusception occurs when peristalsis causes the intestine to telescope onto itself. (p. 704)

Front 65

Common causative organisms of anorectal abscess

Back 65

E. coli, proteus spp., staph, or step.

Front 66

treatment for elevated ammonia in hepatitis

Back 66

Elevated ammonia, give lactolose to excrete ammonia in stools

Front 67

hepatitis

Back 67

Hepatitis is an infection of the liver, resulting from an infection by viral agents or exposure to drugs toxic to the liver or occasionally from bacterial infection. (p. 720)

Front 68

structures connected by ileocecal valve

Back 68

colon to small intestine

Front 69

mechanic digestion completed by

Back 69

smooth muscle layers

Front 70

gastric juice helps to digest

Back 70

proteins

Front 71

enzymes in small intestine help digest

Back 71

disachharides

Front 72

diagnostic procedure that does not require patient to be NPO

Back 72

flat plate of abdomen

Front 73

nursing diagnosis following barium swallow

Back 73

risk for constipation

Front 74

stool color following barium swallow

Back 74

white

Front 75

side effect of tagament

Back 75

confusion

Front 76

S&S of chornic gastritis type B

Back 76

anorexia
heartburn after eating
belching
N/V
(type A asyptomatic)

Front 77

S&S of severe gastric bleeding

Back 77

diaphoresis
hypotension

Front 78

esophageal cancer - palliative therapy

Back 78

esophogeal dilation

Front 79

lab studies to monitor ulcerative colitis

Back 79

CBC
electrolytes

Front 80

nursing diagnosis for patient with symptoms of bowel obstruction

Back 80

risk for fluid volume deficit related to N/V

Front 81

loop ostomy

Back 81

put back after bowel heals

Front 82

teaching point for patient with ileostomy

Back 82

drink lots of fluids to prevent dehydration

Front 83

teaching point regarding ileostomy odor

Back 83

plastic pouch is odorproof

Front 84

fulminant liver failure most often caused by

Back 84

hep B

Front 85

medication for biliary colic

Back 85

probantheline (Pro-Banthine)

Front 86

acute pancreatitis pain

Back 86

dull, boring beginning at mid epigastrium and radiating to back