NUR170 / NUR 170 Exam 4 (Latest 2024 / 2025 Update): Concepts of Medical-Surgical Nursing, Exams of Nursing

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NUR170 / NUR 170 Exam 4 (Latest 2024 / 2025 Update):

Concepts of Medical-Surgical Nursing

What are the symptoms for GERD or a Hiatal Hernia? - ans ---Heartburn

• Indigestion
• Pain
• N&V What are ways to manage the symptoms of GERD or a Hiatal Hernia? - ans --- Lifestyle changes (diet=Low residue or bland)
• Nutrition
• Medications Which patients are at risk for GERD? - ans ---Obese
• Older adults
• Pregnant women
• Tight clothing Patients with GERD are at risk for what? - ans --Aspiration Can a patient have GERD and not have a hernia? - ans --Yes Can a patient have a hernia and not have GERD? - ans --No If a patient has GERD, how should they lay in bed? - ans --On their right side or with the head of the bed at 30 degree angle What are common causes of peptic ulcer disease? - ans --- H. Pylori
• NSAIDS
• Stress How is the patient with an upper GI bleed managed? - ans ----- 2 - 4L of oxygen nasal canula
• Two large bore IV's
• Isotonic solution
• N/G tube
• EGD with cauterization

What is a sign of peritonitis? - ans --Boardlike abdomen What are the vital signs for a patient with an active bleed? - ans --Low BP, High pulse What part of the body does Crohns disease affect? - ans --"Gum to Bum"= Mouth all the way through the digestive tract is inflammed What part of the body does Ulcerative Colitis affect? - ans --Rectum/ Sigmoid colon Which disease is highly genetic? --Ulcerative Colitis -- Crohns - ans --Ulverative Colitis Which disease is more immune? --Ulcerative Colitis -- Crohns - ans --Crohns Describe the diarrhea in a patient with Ulcerative Colitis - ans --- Bloody/ Mucus stools

• 10 - 20 stools a day
• Urgent sensation to defecate Describe the diarrhea in a patient with Crohns disease - ans ---Steatorrhea (fatty and floating)
• 5 - 6 stool a day
• Rarely any bloody stools Which patient has strictures and Fistulas? - ans --Crohns disease What is the surgical intervention for Ulcerative Colitis? - ans --Removal of the colon resulting in a ileostomy What is the surgical intervention for Crohns? - ans --There is none. Only surgery is performed if something is wrong (perforations, strictures, or fistulas) Describe the stool of an illeostomy? - ans --Watery. Located on the right side of body Describe the stool of a colostomy? - ans --Formed. Located on the left side of the body If a colostomy is not draining, what should be done? - ans --- Moist warm towels on abdomen
• Hot tea
• Flexing knees to abdomen
• DO NOT ADD FIBER

How should an ostomy site (stoma) look? - ans --Reddish, pink, moist, soft

• Should not be deep red, blue, black, dry, or firm What are the symptoms of IBS? - ans --- Diarrhea or Constipation
• Soft, watery stool
• Nausea when eating or defecating
• Abnormal pain or bloating
• ***Normal weight & nutrition
• ***Normal labs What are some treatment options for IBS? - ans --- Probiotics
• Fiber 30 - 40g per day
• Immodium
• Metamucil What is Diverticulosis? - ans --Pouching of the colon What is Diverticulitis? - ans --Inflammation of the pouch in the stomach What are the lab signs for diverticulitis? - ans --Increased WBC and decreased H&H Low or High fiber for Diverticulitis? - ans --Low (think litis= little) Low or High fiber for Diverticulosis? - ans --High What is the treatment for diverticulosis? - ans ---No laxatives or enemas
• Avoid strenuous activities
• Avoid seeds and nuts
• Meds: Flagyl, Bactrim, Cipro What is the difference between a small and large bowel obstruction? - ans --Has to do with the small and large intestine Give examples of a mechanical bowel obstruction - ans --- Tumors
• Scar tissue
• Feces
• Intussusception (when bowel pushes together)
• Volvulus (twisting of the bowel) Give examples of a non-mechanical bowel obstruction - ans --Typically post op: paralytic illeus (section of the intestine where its not moving) Symptoms of a small bowel obstruction - ans ---Upper abdominal distention
• Nausea and vomitting (possibly containing fecal material)
• Obstipation (Severe or complete constipation)

• Severe fluid and electrolyte imbalance Symptoms of a large bowel obstruction - ans ---Lower abdominal cramping
• Lower abdominal distention
• Ribbon like stools or obstipation Treatment (non-surgical) for a bowel obstruction - ans --- N/G tubes to decompress
• Enemas and laxatives
• IV fluids
• Reposition the patient What medications are used to increase peristalsis? - ans --Reglan/Metoclopramide Who is at risk for Cholecystitis/Cholelithiasis? - ans --The "4 F's"
  • Forties
  • Fat
  • Female
  • Fertile What is cholecystitis? - ans --Inflammation of the gallbladder What is cholelithitis? - ans --Gallstones What is biliary colic? - ans --A stuck stone What are the symptoms of a biliary colic? - ans ---Tachycardia
• Pallor
• Diaphoresis (sweating)
• Severe pain in the upper right quadrant
• Call Rapid Response Team What are symptoms of cholecystitis? - ans ---N/V
• Abdominal pain
• Indigestion
• Flatulence What treatments (nonsurgical) are used for Cholelithitis/ Cholecystitis? - ans ---Meds: Toradol and Opioids
• Avoid fatty food if at home
• NPO at hospital What is Hepatitis? - ans --inflammation of the liver Describe Hepatitis A - ans --"ANAL"
  • Oral-Fecal route
  • Ingestion of contaminated food/water

• 15 - 50 days for incubation
• Standard precautions
• Disinfect with bleach to clean surfaces Describe Hepatitis B - ans --'BLOOD'
• Transmitted through semen, mucus, saliva, open sores
• 25 - 180 days for incubaton
• Standard precautions
• After infection immunity is developed Describe Hepatitis C - ans --"BLOOD TO BLOOD"
• Multiple sexual partners
• Unsterile tattoos
• Once diagnosed no sharing: needles, toothbrushes
• Incubation period of 7 weeks
• Most are asymptomatic
• Standard precautions Describe Hepatitis D - ans --- Must have B to get D
• Exclusively in IV drug users
• Vaccinations for B protect from D
• Standard precautions What are the symptoms for hepatitis? - ans --N/V, fever, fatigue, dark urine, light stool, joint pain How should hepatitis be managed? - ans --- Treat the symptoms
• Rest
• Nutrition
• Prevent further damage
• Do not give medications metabolized by the liver (narcotics, Tylenol, or alcohol) Standard precautions - ans --Gloves Contact precautions - ans --Gloves and gown Patient is in private room (respiratory infections, wound infections, skin infections) Droplet precautions - ans --Standard precautions + Mask Patient is in private room (flu, sepsis, rubella) Airborne precautions - ans --Put on before entering room: Negative air pressure room, N95 mask

(shingles, TB, measles, chickenpox) How to prevent a pressure ulcer - ans --- In a chair, turn the pt every hour

• In bed, turn the pt every 2 hours
• Float the heals
• Pad bony prominence
• Use skin barrier cream How to stage a pressure ulcer - ans --Stage 1: Just a sore, blanching Stage 2: Skin breaks open Stage 3: Extends into the tissue beneath skin Stage 4: Reaches to muscle and bone How do you assess for skin cancer? - ans --ABCDE
  • Asymmetry of shape
  • Boarder irregularity
  • Color variation within lesion
  • Diameter greater than 6mm
  • Evolving or changing When do you do a skin assessment on a patient? - ans --When you are doing a head to toe assessment How do you assess a wound? - ans --The wound bed and surrounding tissue What are signs of a suspected wound infection? - ans --Red, Temperature, Drainage What is the normal range for WBC's? - ans -- 5 - 10 thousand What is the normal range for Albumin? - ans --3.5- 5 What is the normal range for Total Protein? - ans --6.4-8. If a patient has a low albumin and low protein, what are they at an increased risk for? - ans --Infection What should be done if a patient has a low albumin and low protein? - ans --Call dietary How often should a wet to dry dressing be changed? - ans --Every 8 hours at least What is the ending of a medication for an enzymatic agent? - ans --"ase" What is pediculosis? - ans --Lice

What are the precautions for pediculosis? - ans --Contact. They are put in isolation What are scabies and what are their precautions? - ans --Skin mites. Contact precautions and isolation. Wash with warm water.. What are bedbugs and what are their precautions? - ans --Bugs found in mattresses. Contact precautions What is another name for shingles? - ans --Decimated Herpes Zoster What are the precautions for shingles? - ans --Airborne How are shingles treated? - ans --Antiviral medications What is uticaria? - ans --Hives What is pruritis? - ans --Itching What is the drug of choice if a patient is having an allergic skin reaction? - ans --Epi What are signs of an allergic skin reaction? - ans ---Uticaria (hives)

• Pruritus (itching)
• Wheezing/SOB What is psoriasis? - ans --An overgrowth of skin cells Is psoriasis contagious? - ans --No. They are on standard precautions What is psoriasis caused by? - ans --Its an autoimmune disorder. Stress can cause a flareup. What are common triggers for psoriasis? - ans --Stress Cold weather Infections Smoking What are the key features of psoriasis? - ans --Scaley, dry, red patches that may itch and burn What is the treatment for psoriasis? - ans ---Topical corticosterioids
• UV light and sun (10- 15 minutes at most)
• Immunosuppressants What are the signs and symptoms of a UTI? - ans ---Frequency
• Urgency
• Pain

• Nocturia
• Incontinence
• Burning
• Fever and Chills (rare) What are abnormalities in a urinalysis? - ans ---Odor
• Cloudy
• Protein
• RBC
• WBC
• Bacteria
• Leukoesterase (E. Coli) (WWW or fistula) What is the normal pH of the urine? - ans -- 5 - 7 What is the normal specific gravity of the urine? - ans --1.005-1. What does it indicate if the specific gravity is high? - ans --The patient is dehydrated How do you perform a clean-catch mid stream (CCMS urinalysis? - ans ---Wipe with an antimicrobial wipe
• Urinate tiny amount
• Catch middle of the stream
• Finish urinating the rest in the toilet What medications are used to treat a UTI? - ans ---Antibiotics
• Bladder Analgesics
• Antispasmodics What is the drug of choice for a UTI? - ans --Cipro What are ways to prevent a UTI? - ans ---- 2 - 3L of fluid a day
• Empty bladder before and after intercourse
• Empty as soon as you feel the urge
• No baths/ bubble baths
• Empty bladder at least every 4 hours
• Cranberry juice and Vitamin C What is urolithiasis? - ans --Formation of stones in the bladder or urinary tract What does the ending, "Lithiasis" mean? - ans --Stones What are reasons that stones can form? - ans ---Slow urine flow
• High urine acidity/alkalinity
• Hypercalciuria

What is a way to prevent stones? - ans --Drinking plenty of water What are the symptoms of renal calculi? - ans ---Severe pain

• N/V
• Pallor
• Diaphoresis
• Frequency and urgency when in the bladder What urine output is considered anuria? - ans --<100ml What urine output is considered oliguria? - ans -- 100 - 400ml If the patient has a kidney stone, what should be done? - ans ---Ambulate often
• Increase fluid intake to 2 - 3L per day
• Low protein diet
• Low Sodium diet When should you not give Toradol? - ans --If the creatnine level is >1. What is lithotripsy (ESWL)? - ans --Shock therapy used to break up stones Describe the nursing considerations for lithotripsy. - ans ---Moderate sedation
• Bed rest for 2 - 3 hours after the procedure
• Bruising may occur over the site for several weeks
• Continuous monitoring by ECG
• Hematuria up to one week
• Make sure they strain the urine What are symptoms of Benign Prostatic Hyperplasia? - ans ---Residual urine
• Chronic Retention
• Leaks/dribbling
• Nocturia
• Urgency
• Trouble starting stream How is BPH diagnosed? - ans ---Digital rectal exam
• PSA levels
• Cystoscopy (scope inside bladder) What medication is used to treat BPH? - ans --Proscar (Finasteride) What is a common side effect of Proscar? - ans --Orthostatic Hypotension. Teach the patient to stand up slowly, Dangle on the side of the bed and then get up. What is the typical surgery for BPH? - ans --TURP

What should you teach the patient with BPH? - ans ---Avoid alcohol, diuretics, and caffeine

• No OTC herbs or vitamins
• How to do kegel exercises What is the typical post-op routine for a patient that just received the TURP? - ans --- 24 Fr. foley (anchored to abdomen)
• CBI with normal saline to prevent clots (adjust as needed)
• Clean foley with mild soap and water 2x per day At home:
• No baths
• Change foley bag once a week
• No lifting more than 15 lbs What is pyelonephritis? - ans --Bacterial infection in kidney and renal pelvis What are the symptoms of pyelonephritis? - ans --Same as UTI plus these
• Tachycardia
• Fever/Chills
• Fatigue
• Abdominal discomfort What is glomerulonephritis? - ans --An infection of the glomerus What are the signs and symptoms of glomerulonephritis? - ans ---Fluid overload
• SOB/Crackles
• Blood and protein in urine
• Fatigue
• Anorexia
• N/V
• Elevated BUN and specific gravity With acute glomerulonephritis, what is treated first? - ans --The underlying infection and then treat the symptoms With chronic glomerulonephritis what does the patient end up on? - ans --Dialysis