NSG 331 - Final Exam Study Guide
Module 13 - Gastrointestinal
Assessment Lewis table 38.11,
38.12 o Colonoscopy
Before: Bowel prep, avoid fiber for up to 72 hours prior, then clear
liquid diet for 24 hours before. Split-dose, evening before than 4-6
hours prior to procedure. Stools should be clear or clear yellow
liquid when colon is clean
After: May have abdominal cramps by stimulation of peristalsis. If pain last
longer than 24 hours to notify HCP. Observe for rectal bleeding and
manifestations of perforation (Malaise, abdominal distention, tenesmus)
o Endoscopic Retrograde Cholangiopancreatography
(ERCP) Before: NPO for 8 hours. Consent signed
After: Check vital, assess for perforation. Check return of gag reflex
o Amylase
60-120
Enzyme secreted by pancreas. Important in dx pancreatitis
o Gastrin
25-100
Hormone secreted by cells of antrum of stomach
o Lipase
0-160
Enzyme by pancreas, important in diagnosis
pancreatitis Intestinal obstruction
o Types and causes
Mechanical
PHYSICAL obstruction of intestinal
lumen Small Intestine (Most common)
o Surgical adhesions are the most common
o Hernia, cancer, stricture (Chrons) Intussusceptions
(folding in itself)
Large Intestine
o Colorectal cancer
o Diverticular disease
o Volvulus (Twisted, Emergency)
, NonMechanical
Reduced or absent peristalsis due to altered
neuromuscular transmission
IE: Paralytic ileus (lack of peristalsis and bowel
sounds) Vascular Disorder
o Mesenteric artery occlusion (atherosclerosis and
emboli) o CMs – Lewis table 42.20
Small Intestine
Rapid onset
Sporadic, colicky pain
Vomiting common
Large Intestine
Gradual onset
Persistent cramping
Infrequent vomiting
Abdominal distention
o Interprofessional
management NPO
Provide IV fluids
NG tube, low suction
Encourage ambulation
Colorectal cancer
o Risk factors Lewis table 42.21
Alcohol (>4 drinks/wk)
Cigarette Smoking
Family hx of CRC
Family or personal history of familial adenomatous polyposis
Family or personal hx of hereditary nonpolyposis colorectal
cancer Obesity (Body mass >30)
Personal hx of CRC, IBD, diabetes
Red Meat (>7 servings/wk)
o Interprofessional care Lewis table
42.22 Diagnostic Assessment
H&P
DRE
Testing for stool
occult CBC
Liver Fxn
Barium enema
Sigmoidoscopy/ Colonoscopy
, Management
o Surgery
Right hemicolectomy
Left hemicolectomy
Abdominal-Perineal resection
Laparoscopic Colectomy
o Chemotherapy
o Targeted Therapy
o Radiation Therapy
o Nursing management
Past health History; previous breast or ovarian
cancer Medications that affect bowel (Laxatives,
antidiarrheal) Family hx of CRC
High calorie or high fat diet?
Change in bowel habits, alternating diarrhea and
constipation Health Promotion
Encourage all persons over 45 to have regular CRC screening.
Barriers are lack of accurate information and fear of diagnosis
Bowel cleansing for colonoscopy procedure
o Lewis table 42.27,
42.28 Stoma
Color: Rose to brick
red Edema
Milk to moderate is
normal Bleeding
Small amount is normal as it is highly
vascular Diverticulosis and diverticulitis
o Lewis table 42.30
Diverticulosis:
Pouch like herniatoions in colon wall (large
intest) No symptoms
Diverticulitis
Inflammation of diverticula
Contributing factors
o Advancing age
o Constipation (chronic)
o Diet, low fiber, high fat, red
meat Prevention
o High fiber diet, decrease red meat, increase fluid,
decrease fat
Module 13 - Gastrointestinal
Assessment Lewis table 38.11,
38.12 o Colonoscopy
Before: Bowel prep, avoid fiber for up to 72 hours prior, then clear
liquid diet for 24 hours before. Split-dose, evening before than 4-6
hours prior to procedure. Stools should be clear or clear yellow
liquid when colon is clean
After: May have abdominal cramps by stimulation of peristalsis. If pain last
longer than 24 hours to notify HCP. Observe for rectal bleeding and
manifestations of perforation (Malaise, abdominal distention, tenesmus)
o Endoscopic Retrograde Cholangiopancreatography
(ERCP) Before: NPO for 8 hours. Consent signed
After: Check vital, assess for perforation. Check return of gag reflex
o Amylase
60-120
Enzyme secreted by pancreas. Important in dx pancreatitis
o Gastrin
25-100
Hormone secreted by cells of antrum of stomach
o Lipase
0-160
Enzyme by pancreas, important in diagnosis
pancreatitis Intestinal obstruction
o Types and causes
Mechanical
PHYSICAL obstruction of intestinal
lumen Small Intestine (Most common)
o Surgical adhesions are the most common
o Hernia, cancer, stricture (Chrons) Intussusceptions
(folding in itself)
Large Intestine
o Colorectal cancer
o Diverticular disease
o Volvulus (Twisted, Emergency)
, NonMechanical
Reduced or absent peristalsis due to altered
neuromuscular transmission
IE: Paralytic ileus (lack of peristalsis and bowel
sounds) Vascular Disorder
o Mesenteric artery occlusion (atherosclerosis and
emboli) o CMs – Lewis table 42.20
Small Intestine
Rapid onset
Sporadic, colicky pain
Vomiting common
Large Intestine
Gradual onset
Persistent cramping
Infrequent vomiting
Abdominal distention
o Interprofessional
management NPO
Provide IV fluids
NG tube, low suction
Encourage ambulation
Colorectal cancer
o Risk factors Lewis table 42.21
Alcohol (>4 drinks/wk)
Cigarette Smoking
Family hx of CRC
Family or personal history of familial adenomatous polyposis
Family or personal hx of hereditary nonpolyposis colorectal
cancer Obesity (Body mass >30)
Personal hx of CRC, IBD, diabetes
Red Meat (>7 servings/wk)
o Interprofessional care Lewis table
42.22 Diagnostic Assessment
H&P
DRE
Testing for stool
occult CBC
Liver Fxn
Barium enema
Sigmoidoscopy/ Colonoscopy
, Management
o Surgery
Right hemicolectomy
Left hemicolectomy
Abdominal-Perineal resection
Laparoscopic Colectomy
o Chemotherapy
o Targeted Therapy
o Radiation Therapy
o Nursing management
Past health History; previous breast or ovarian
cancer Medications that affect bowel (Laxatives,
antidiarrheal) Family hx of CRC
High calorie or high fat diet?
Change in bowel habits, alternating diarrhea and
constipation Health Promotion
Encourage all persons over 45 to have regular CRC screening.
Barriers are lack of accurate information and fear of diagnosis
Bowel cleansing for colonoscopy procedure
o Lewis table 42.27,
42.28 Stoma
Color: Rose to brick
red Edema
Milk to moderate is
normal Bleeding
Small amount is normal as it is highly
vascular Diverticulosis and diverticulitis
o Lewis table 42.30
Diverticulosis:
Pouch like herniatoions in colon wall (large
intest) No symptoms
Diverticulitis
Inflammation of diverticula
Contributing factors
o Advancing age
o Constipation (chronic)
o Diet, low fiber, high fat, red
meat Prevention
o High fiber diet, decrease red meat, increase fluid,
decrease fat
