Download NUR 198 STUDY GUIDE QUESTIONS WITH VERIFIED SOLUTIONS | 2026 UPDATE and more Exams Nursing in PDF only on Docsity!
NUR 198 STUDY GUIDE QUESTIONS WITH
VERIFIED SOLUTIONS | 2026 UPDATE
Barrett's Esophagus: Risk factors
- GERD
- White men aged 50 years or older Barrett's Esophagus: Patho
- The lining of the esophageal mucosa is altered
- Tissue changes to the esophageal lining •Leads to esophageal cancer Barrett's Esophagus: Manifestations
- Symptoms of GERD
- Notably frequent heartburn.
- Symptoms related to peptic ulcers or esophageal stricture, or both.
- Causes esophageal cancer Barrett's Esophagus: Diagnosis •EGD
- Initial diagnostic tool shows that esophageal lining that is pink rather than pale white
- Repeat frequency depends upon grade of cellular changes (3 months to every 3-5 yrs) Barrett's Esophagus: Interventions
Educate on importance of follow up care Barrett's Esophagus: Treatment •Treatment of GERD •Surveillance EGD •Esophageal resection Barrett's Esophagus: Education Can lead to esophageal cancer Clostridium difficile-related diarrhea (C.diff): Risk factors Hospitalized patients Gastric acid suppression IV antibiotics Clostridium difficile-related diarrhea: Patho Can result after antibiotic use alters normal intestinal flora and promotes the abnormal growth of this potentially dangerous microbe; VERY CONTAGIOUS C. difficile colitis occurs most commonly in patients who are hospitalized Colorectal cancer: Risk factors Older age Family history (especially if history of Lynch syndrome) or polyps (especially if history of
Colorectal cancer: Manifestations
- Change in bowel habits.
- The passage of blood in or on the stools is the second most common symptom.
- Unexplained anemia
- pain
- Anorexia
- Weight loss
- Fatigue
- bloating - Jaundice Colorectal cancer: Diagnosis
- Screening colonoscopies (polyups)
- EGD Colorectal cancer: Interventions Preparing the patient for surgery Emotional support Providing postoperative care Maintaining optimal nutrition
Providing wound care Monitoring and managing complications Removing and applying the colostomy appliance Irrigating the colostomy Supporting a positive body image Discussing sexuality issues Promoting home and community-based care Monitor for bleeding after EGD/colonoscopy Access for pain after EGD/colonoscopy Colorectal cancer: Treatment •Surgery:
- Bowel resection with anastomosis
- Bowel resection with creation of an ostomy •Chemotherapy •Radiation therapy Colorectal cancer: Complications •Complete large bowel obstruction •GI bleeding
•I & O- include fecal discharge •Expect 200 and 600 mL of daily output •Monitor Laboratory values •Administer electrolyte replacements •IV fluids Colostomy: Gerontologic Considerations •Vision, impaired hearing , and difficulty with fine motor coordination •Skin irritation •Arteriosclerosis: decrease blood flow to stoma/wound •Decreased peristalsis: delayed emptying after irrigation •May need more time to get comfortable with ostomy care (6 months) Colonoscopy Polyethylene glycol Check w provider about current meds before prepping Constipation Fewer than three bowel movements weekly or bowel movements that are hard, dry, small, or difficult to pass Can indicate an underlying disease or motility disorder of the GI tract. Constipation: Manifestations
- Fewer than three bowel movements per week
- Abdominal distention
- Abdominal pain and bloating
- A sensation of incomplete evacuation
- Straining at stool
- The elimination of small-volume, lumpy, hard, dry stools.
- May report tenesmus (i.e., ineffective and sometimes painful straining and urge to eliminate feces) or low back pain Constipation: Treatment Education Exercise Bowel habit training Increased fiber and fluid intake Judicious use of laxatives. Discontinuing laxative use or replacing medications that could cause or exacerbate constipation with other nonconstipating medications Do not use laxatives regularly. Be hydrated Report excessive diarrhea Crohn's Disease: Risk factors
Anorexia Steatorrhea (fat in stools) Fistula Crohn's Disease: Diagnosis
- CBC : increased WBC due to inflammation, but also may cause anal abscesses or fistulas which can be infected
- ESR/CRP : increased due to inflammation
- Folate and vit B12 deficiency due to malabsorption, resulting in megaloblastic anemia.
- EGD and colonoscopy are used to diagnose condition, also swallowing a camera capsule can show the small intestine Crohn's Disease: Interventions •Weekly weights to monitor for weight loss due to malabsorption of nutrients •Small meals but frequently can help with nutrient absorption and prevent obstructions •Vitamin supplements and iron therapy are often needed Monitor for: •Small bowel obstructions
- Peritonitis •Fistulas to other organs resulting in drainage of stool •Formation of abscesses from the fistulas, especially around the anus
•Bleeding can occur, not as much as in UC •Fluid and electrolyte losses due to diarrhea Crohn's Disease: Treatment •Medications: very similar to UC medications Surgery: •Repair of fistulas to other organs •Surgical excision of severely diseased segments of bowel (can lead to short gut syndrome) •Dilation of narrowed strictures within the GI tract •Drainage of anal abscesses: anal fissures are a tear in the anal canal mucosa, that may require medications or surgery Crohn's Disease: Education •A much smaller risk of colon cancer than UC, increased if it involves the large intestine •Clients often need a high calorie, high protein diet, but low fiber foods •Bowel obstructions are common with Crohn disease due to edema and full thickness Dental caries tooth decay Dental caries: Risk factors
- Nutrition
- Soft drink consumption
•Fever/chills *Diverticulitis: Diagnosis WBC: Elevated CT scan: confirms inflamed/infected diverticula *Colonoscopy contraindicated during acute illness because it will perforate pouches, cause bleeds, spread infx Diverticulitis: Interventions
- Educate about self care at home and antibiotics
- promote normal bowel function and consistency (avoid laxatives and enemas) Diverticulitis: Treatment •Oral or IV antibiotics are used depending on the severity of the diverticulitis •Antibiotics that are used to treat diverticulitis:
- Ciprofloxacin: risk of tendon rupture, avoid if less than 18 years, photosensitivity
- Metronidazole : avoid all alcohol consumption due to disulphiram reaction, gastrointestinal side effects are common, darkens urine color (harmless) •All can cause c. difficile, oral thrush or vaginal yeast infection •During the infection, the diet is fluids and low fiber/residue, then gradually increased to solid food and increased fiber intake
- Trimethoprim-sulfamethoxazole : drink fluids to avoid crystals in urine, photosensitive rashes, severe SJS (Steven Johnson Syndrome) rashes Diverticulitis: Education
- Consume a clear liquid diet until manifestations subside
- Progress to a low-fiber diet once solid foods are tolerated w/o other manifestations
- Avoid seeds or indigestible material Diverticulitis: Complications
- Bowel obstruction from severe inflammation, will usually need surgical repair to remove diseased area
- Perforation of diverticulitis can result in peritonitis , and abscess formation from the pus leaking out of the diverticula into the peritoneal cavity
- Gastrointestinal bleeding presenting as rectal bleeding Dumping Syndrome: Risk factors surgical resection following gastric or bariatric surgery Dumping Syndrome: Patho Unpleasant set of vasomotor and GI symptoms that commonly occur in patients who have had bariatric surgery. A shift of fluid to the abdomen is triggered by rapid gastric emptying. Bypasses gi track and directly into small intestine or high-carbohydrate indigestion.
1.5 to 3 hrs after eating due to excessive insulin release: Sweating Tachycardia Somnolence Unconsciousness/hypoglycemia symptoms Tremors Irritability Dizziness Anxiety Confusion Dumping Syndrome: Diagnosis Clinical, oral glucose tolerance test Dumping Syndrome: Interventions Assist/instruct the client to lie down when vasomotor symtpoms occurs Administer meds Malnutrition and fluid electrolyte imbalances can occur due to altered absorption. Monitor I&O, labs Dumping Syndrome: Treatment increase fat and protein, small frequent meals, lie down after meal to decrease peristalsis.
Low fiber meals Wait 1 hr after meals to drink Education on laxative use
- bulk forming need to be given with plenty of fluid--> can produce esophogeal and/or intestinal obstruction
- ASSESS: last BM and characteristics, abdominal pain, fever, obstruction
- ASSESS: dietary and fluid intake
- encourage fluids, fiber and exercise Short term Gastric outlet obstruction (GOO): Causes
- Severe acute gastritis with deep tissue inflammation extending into the stomach muscle Gastric outlet obstruction (GOO): Manifestations Delayed gastric emptying Vomiting Feel fuller quicker Wt loss Gastric outlet obstruction (GOO): Interventions
- Monitor fluid and electrolytes due to continuous vomiting results in loss of chloride (metabolic alk) and severe fluid and electrolyte depletion
- Provide fluid and electrolyte replacement. Monitor I&O
•Disruption of mucosal barrier that normally protects stomach tissue from digestive juices •The impaired mucosal barrier allows corrosive acid, pepsin, and other irritating agents (e.g., alcohol, NSAIDs, H. pylori ) to meet the gastric mucosa, resulting in inflammation Gastritis: Manifestations •Anorexia, nausea, vomiting •Indigestion: irritated by spicy foods, alcohol, smoking, NSAIDS , and caffeine/coffee •Upper abdominal pain •Hematemesis •Melena Gastritis: Diagnosis CBC for anemia EGD for confirmation of gastritis (can also be used for biopsies) Stools for H. pylori antigen or urea breath test Gastritis: Interventions •Promoting nutrition •Reducing pain •Promoting fluid balance •Client education
- Monitor electroylytes
- Monitor stool characteristics Monthly injection of Vitamin B12 to treat anemia Gastritis: Treatment H2 blockers : (famotidine), well tolerated, occasional GI symptoms Proton-pump inhibitors (PPIs): such as pantoprazole, omeprazole (c.diff, osteoporosis) Aluminum/Magnesium antacids : (mixture to prevent diarrhea or constipation) Prostaglandins : increases mucosal lining of stomach so protects it from acid (misoprostol), never take with pregnancy and causes abdo.cramps/diarrhea Mucosal barriers (sucralfate): coats the stomach with a paste-like material If H. pylori positive: Same antibiotics as peptic ulcer disease can be used (clarithromycin, amoxicillin, tetracycline or metronidazole), usually a combination of 2 of them, plus PPI Gastritis: Education Identify irritants, including foods, medications, alcohol Eat smaller meals, more frequently Eat slowly to help digest Reduce stress in life Report black stools or vomiting of blood Gastritis: Complications
