Med-Surg II HESI Study Guide (Second Semester RN)
Unit 1: Acute Neurological Disorders
1. Ischemic Stroke
What it is: Blocked blood flow to brain tissue causing ischemia/infarction.
Causes: Thrombotic, embolic, atrial fibrillation, carotid stenosis, HTN, diabetes, smoking,
hyperlipidemia.
Key Signs: Sudden unilateral weakness, facial droop, slurred speech, aphasia, confusion, vision
changes, dysphagia, one-sided neglect.
HESI Priorities: Last known well time, noncontrast CT first, NIH Stroke Scale, glucose first,
swallow screen before PO.
Treatment: tPA if eligible, mechanical thrombectomy, aspirin, later anticoagulants if embolic.
Nursing: ABCs, neuro checks, aspiration precautions, fall precautions, HOB 30°, oxygenation, BP
management, NPO until swallow cleared.
HESI Traps: No PO before swallow eval, do not lower BP aggressively, CT before thrombolytics,
hypoglycemia mimics stroke.
2. Hemorrhagic Stroke
What it is: Bleeding into brain tissue or subarachnoid space.
Causes: HTN, aneurysm rupture, AV malformation, trauma, anticoagulants.
Key Signs: Sudden severe headache, N/V, decreased LOC, seizures, neuro deficits, nuchal
rigidity.
HESI Priorities: CT confirms bleed, no tPA, control BP, prevent rebleeding, watch ICP.
Treatment: BP control, surgery, seizure precautions, ICP management.
Nursing: Neuro checks, monitor increased ICP, seizure precautions, avoid straining, HOB 30°.
HESI Traps: No anticoagulants, no thrombolytics, sudden headache = hemorrhage until proven
otherwise.
Unit 2: GI Disorders Part 1
, 3. Hepatitis
Types: A/E fecal-oral, B/C blood/body fluids, D needs Hep B.
Signs: Fatigue, N/V, RUQ pain, jaundice, dark urine, clay stools, elevated AST/ALT.
HESI Priorities: Monitor liver function, avoid alcohol, avoid acetaminophen, rest, nutrition.
Nursing: Standard precautions, watch bleeding, monitor ammonia/LOC, teach transmission
prevention.
HESI Traps: Hep A/E fecal-oral, Hep B/C blood, dark urine + clay stool = obstructed bile flow.
4. Acute Pancreatitis
What it is: Acute pancreatic inflammation; pancreas digests itself.
Causes: Gallstones, alcohol, high triglycerides.
Signs: Severe LUQ/epigastric pain radiating to back, N/V, fever, tachycardia, distention,
decreased bowel sounds.
Labs: Elevated amylase, elevated lipase (most specific), low calcium, high glucose.
HESI Priorities: NPO, IV fluids, pain control, NG if severe, watch for shock.
Nursing: Assess Cullen’s sign, Grey Turner’s sign, strict I&O, monitor calcium, respiratory status.
HESI Traps: Lipase most specific, NPO priority, pain better leaning forward.
5. Chronic Pancreatitis
What it is: Long-term pancreatic damage.
Signs: Chronic pain, steatorrhea, weight loss, malabsorption, diabetes.
Nursing: Pancreatic enzymes, low-fat diet, no alcohol, pain control, monitor glucose.
HESI Trap: Chronic = malabsorption + diabetes.
6. Cirrhosis
What it is: Chronic liver scarring leading to liver failure.
Causes: Alcohol, hepatitis, fatty liver disease.
Signs: Jaundice, ascites, edema, varices, bruising, confusion, asterixis.
Labs: Elevated bilirubin, elevated PT/INR, low albumin, elevated ammonia.
Unit 1: Acute Neurological Disorders
1. Ischemic Stroke
What it is: Blocked blood flow to brain tissue causing ischemia/infarction.
Causes: Thrombotic, embolic, atrial fibrillation, carotid stenosis, HTN, diabetes, smoking,
hyperlipidemia.
Key Signs: Sudden unilateral weakness, facial droop, slurred speech, aphasia, confusion, vision
changes, dysphagia, one-sided neglect.
HESI Priorities: Last known well time, noncontrast CT first, NIH Stroke Scale, glucose first,
swallow screen before PO.
Treatment: tPA if eligible, mechanical thrombectomy, aspirin, later anticoagulants if embolic.
Nursing: ABCs, neuro checks, aspiration precautions, fall precautions, HOB 30°, oxygenation, BP
management, NPO until swallow cleared.
HESI Traps: No PO before swallow eval, do not lower BP aggressively, CT before thrombolytics,
hypoglycemia mimics stroke.
2. Hemorrhagic Stroke
What it is: Bleeding into brain tissue or subarachnoid space.
Causes: HTN, aneurysm rupture, AV malformation, trauma, anticoagulants.
Key Signs: Sudden severe headache, N/V, decreased LOC, seizures, neuro deficits, nuchal
rigidity.
HESI Priorities: CT confirms bleed, no tPA, control BP, prevent rebleeding, watch ICP.
Treatment: BP control, surgery, seizure precautions, ICP management.
Nursing: Neuro checks, monitor increased ICP, seizure precautions, avoid straining, HOB 30°.
HESI Traps: No anticoagulants, no thrombolytics, sudden headache = hemorrhage until proven
otherwise.
Unit 2: GI Disorders Part 1
, 3. Hepatitis
Types: A/E fecal-oral, B/C blood/body fluids, D needs Hep B.
Signs: Fatigue, N/V, RUQ pain, jaundice, dark urine, clay stools, elevated AST/ALT.
HESI Priorities: Monitor liver function, avoid alcohol, avoid acetaminophen, rest, nutrition.
Nursing: Standard precautions, watch bleeding, monitor ammonia/LOC, teach transmission
prevention.
HESI Traps: Hep A/E fecal-oral, Hep B/C blood, dark urine + clay stool = obstructed bile flow.
4. Acute Pancreatitis
What it is: Acute pancreatic inflammation; pancreas digests itself.
Causes: Gallstones, alcohol, high triglycerides.
Signs: Severe LUQ/epigastric pain radiating to back, N/V, fever, tachycardia, distention,
decreased bowel sounds.
Labs: Elevated amylase, elevated lipase (most specific), low calcium, high glucose.
HESI Priorities: NPO, IV fluids, pain control, NG if severe, watch for shock.
Nursing: Assess Cullen’s sign, Grey Turner’s sign, strict I&O, monitor calcium, respiratory status.
HESI Traps: Lipase most specific, NPO priority, pain better leaning forward.
5. Chronic Pancreatitis
What it is: Long-term pancreatic damage.
Signs: Chronic pain, steatorrhea, weight loss, malabsorption, diabetes.
Nursing: Pancreatic enzymes, low-fat diet, no alcohol, pain control, monitor glucose.
HESI Trap: Chronic = malabsorption + diabetes.
6. Cirrhosis
What it is: Chronic liver scarring leading to liver failure.
Causes: Alcohol, hepatitis, fatty liver disease.
Signs: Jaundice, ascites, edema, varices, bruising, confusion, asterixis.
Labs: Elevated bilirubin, elevated PT/INR, low albumin, elevated ammonia.
