ABSN N300
Exam 3 Study Guide
63 Questions
PART 1 GI
12 Questions GI (topics include C. Diff, GI bleed, general GI post-op care, ng-tube
care, tube feeding nursing care, Ulcerative Colitis, bowel obstruction, Stoma care
(especially post-op), general care for N & V, GERD, PUD, obesity education)
● C. Diff
○ A species that causes watery diarrhea, fever, anorexia, and abdominal pain
○ Most antibiotics have been associated with the development of C. diff
○ Isolation for pts (gram positive bacteria causes diarrhea)
○ PPE: gowns and gloves
○ Mild to moderately infected patients typically improve with oral administration of
metronidazole or vanco
○ Severely ill patients may need infusions of vanco directly into the gastrointestinal
○ Nursing considerations
■ Contact precautions
■ Stool samples
■ Skin integrity
■ Treat with flagyl
○ You can put two patients with c.diff in the same room together
● GI Bleed
○ Vital signs that indicate bleeding
■ Hypotension, tachycardia, altered level of consciousness
■ Assess hematemesis, black tarry stools
■ Trend H/H
● General Post Op Care
○ Patients often experience considerable pain, difficulty moving, n/v, and changes
in nutritional status and fluid balance
○ Risk of infection from surgical wound and indwelling catheters
○ High risk: MI, atelectasis, stroke, delirium, bleeding, clotting, adverse reactions to
medications, peptic ulceration, and depression
○ Interventions: Turn cough deep breath, IS, SCDs, ambulation, may need to wear
an abdominal binder
■ SCD: sequential compression device (reduce edema or prevent formation
of blood clots in an extremity)
■ IS: an incentive spirometer
○ Check for bowel sounds, passing gas**
○ Diet: allows them to eat what they like but wont exacerbate their illness
● NG Tube Care
○ Flush tube with at least 30 cc of water every 4 hours and before/after medications
or with residual checks
○ To prevent aspiration
■ Confirm placement with x ray
■ Keep HOB elevated at all times
■ Turn feedings off when repositioning
■ Routinely assess lung sounds, bowel sounds
, ○ Assess nares and mucosa for inflammation and bleeding every shift (skin
checks)
○ Assess for placement and patency every shift
○ Secure with safety pin to gown
○ Provide oral/nasal care every shift
○ Flush with tap water per physician order (free flow water with bolus possibly?)
○ Aspirate and record residuals as ordered
○ If connected to suction, assess
○ How do you reposition the NG tube?
■ Push in air or do another flush
● Tube Feeding Nursing Care
○ Aspiration Prevention (as stated above)
○ Look for diarrhea, alert MD (rate is too fast or formula is contaminated)
○ Check for hyperglycemia
○ Check for placement
■ Check pH of aspirated gastric secretion
■ Measure residuals (return to stomach)
○ Flush tube with 30 cc water 4 hours, with meds, with residual checks
○ Record all administered volumes and residuals on I/o record
○ Slow down or stop the rate of flow (standing orders)
● Ulcerative Colitis
○ Chronic inflammation of mucosa and submucosa in the colon and rectum
■ Inflammation develops into abscesses that penetrate mucosa and spread
laterally
■ Begins in rectum and usually limited to sigmoid colon and rectum
○ Periods of exacerbation and remission
○ Cause:
■ Unknown
■ Related to stress, genetics, infection, dietary factors (low fiber), or
antibody formation
○ Manifestations:
■ Diarrhea (10-20 liquid stools a day often containing blood and mucus)
■ Fatigue from blood loss and fluid imbalance and lack of sleep
○ Complications:
■ Hemorrhage, abscess, toxic megacolon, fluid and electrolyte imbalance,
malabsorption, bowel obstruction, bowel perf, risk of colon cancer
○ Diagnostic
■ Sigmoidoscopy that shows friable mucosa with granular appearance
■ CBC to identify anemia
○ Treatment
■ Surgical treatment
● Ileostomy
■ Medications
● Steroids during exacerbations (prednisone)
● Salicylate compounds to decrease prostaglandin formation in
bowel (reducing inflammation)
■ May need low residue diet (limit raw fruits and veg, whole grains, seeds
and nuts, popcorn, and highly spiced or flavorful foods)
, ■ Avoid stress
■ Exercise
● Bowel Obstruction
○ Failure of bowel contents to move forward
■ Can be complete or partial
■ Peristalsis increases in the intestine above blockage leading to increased
secretion, edema, and increased capillary permeability = fluid and
electrolyte imbalances and hypovolemia
○ Types:
■ Mechanical
● r/o forces outside intestine (tumors, hernias, adhesions)
● Blockage in lumen itself (fecal impaction, edema, tumor, strictures,
intussusceptions, twisting of intestine)
■ Non mechanical/Paralytic ileus
● Impairment of muscle tone or nervous system innervation
preventing forward movement
● Anesthesia, abdominal surgery, spinal cord injury, peritonitis,
vascular insufficiency
■ Most often occurs in ileum - where intestinal diameter is smallest
○ Manifestations
■ Early: bowel sounds are high pitched and tinkling proximal to obstruction
and silent distal
■ Late: bowel sounds silent
■ Abdominal pain can be colicky and may increase as progresses
■ Vomiting is common, may have fecal odor and/or brown or green color
■ Abdominal distention is common
■ Vital signs normal early, but progress to signs of shock
● Tachycardia, fever, tachypnea, hypotension
○ Nursing Care
■ Prepare for possible surgery
■ Prepare for NG insertion
■ Maintain NPO
■ Frequent position changes
■ Monitor vital signs, pain levels, electrolytes, and I/Os
● Stoma Care (especially post-op)
○ Make sure beefy red
■ If blue or purplish: blood flow is inadequate, need to alert surgeon
○ Blood may be seen in bag after surgery, normal
○ Bleeding should be monitored closely, if increases or continues for several days,
something is wrong
● General Care for N/V
○ Antiemetic medicines administered orally, rectally, intramuscularly, or
intravenously
○ IV fluid and electrolytes may be needed to replace losses due to continued
vomiting
○ r/t esophageal obstruction, gastric distention, PUD, cholecystitis, cholelithiasis,
pancreatitis, intestinal obstruction, ileus
○ May need to be on NPO, need to be cautious with medication
, ○ Give medication for n/v before other medications such as pain medications
● GERD
○ Backward movement of stomach contents or even bile into the esophagus
without vomiting
■ The gastric contents are irritating to esophagus and causes breakdown of
the mucosal barrier leading to inflammation and erosion
■ Healing of erosion causes substitution of normal squamous epithelial
tissue for columnar epithelial tissue (Barrett’s which resists acid but is
pre-malignant)
○ Causes:
■ Relaxation of lower esophageal sphincter
■ Decreased tone of LES
■ Increased intra abdominal pressure
■ Increased gastric volume
○ Manifestations:
■ Most common: heartburn or substernal burning pain
■ Regurgitation without nausea or vomiting
■ Bad or sour taste upon awakening
■ Coughing, hoarseness, wheezing at night
○ Diagnosis:
■ Most accurately diagnosed with 24 hour pH monitoring
○ Nursing Care
■ Avoid foods or medications that reduce LES tone
■ Don’t eat 2 hours before bedtime
■ Don’t bend over after eating or lie down
■ Lose weight
■ Avoid restrictive clothing
■ Avoid large meals
■ Elevate head of bed for sleeping
■ Stop smoking
■ H2 receptor antagonists (long term relief but take a while to start working)
or PPIs (good for long term use)
● PUD
○ Generic term for ulcers or breaks in the mucosal lining in the GI tract that come in
contact with gastric juices
○ Can occur in stomach, duodenum, lower esophagus
○ Major Causes:
■ H. pylori (up to 90-95%)
■ Chronic NSAID use (aspirin is the worst)
■ Cigarette smoking
■ Family history
■ Blood group O
■ Alcohol use
○ Manifestations:
■ Pain: gnawing, burning, aching, hunger like
● Duodenal ulcers: pain may be relieved by eating
● Gastric ulcers: pain exacerbated by food
○ Diagnosis:
Exam 3 Study Guide
63 Questions
PART 1 GI
12 Questions GI (topics include C. Diff, GI bleed, general GI post-op care, ng-tube
care, tube feeding nursing care, Ulcerative Colitis, bowel obstruction, Stoma care
(especially post-op), general care for N & V, GERD, PUD, obesity education)
● C. Diff
○ A species that causes watery diarrhea, fever, anorexia, and abdominal pain
○ Most antibiotics have been associated with the development of C. diff
○ Isolation for pts (gram positive bacteria causes diarrhea)
○ PPE: gowns and gloves
○ Mild to moderately infected patients typically improve with oral administration of
metronidazole or vanco
○ Severely ill patients may need infusions of vanco directly into the gastrointestinal
○ Nursing considerations
■ Contact precautions
■ Stool samples
■ Skin integrity
■ Treat with flagyl
○ You can put two patients with c.diff in the same room together
● GI Bleed
○ Vital signs that indicate bleeding
■ Hypotension, tachycardia, altered level of consciousness
■ Assess hematemesis, black tarry stools
■ Trend H/H
● General Post Op Care
○ Patients often experience considerable pain, difficulty moving, n/v, and changes
in nutritional status and fluid balance
○ Risk of infection from surgical wound and indwelling catheters
○ High risk: MI, atelectasis, stroke, delirium, bleeding, clotting, adverse reactions to
medications, peptic ulceration, and depression
○ Interventions: Turn cough deep breath, IS, SCDs, ambulation, may need to wear
an abdominal binder
■ SCD: sequential compression device (reduce edema or prevent formation
of blood clots in an extremity)
■ IS: an incentive spirometer
○ Check for bowel sounds, passing gas**
○ Diet: allows them to eat what they like but wont exacerbate their illness
● NG Tube Care
○ Flush tube with at least 30 cc of water every 4 hours and before/after medications
or with residual checks
○ To prevent aspiration
■ Confirm placement with x ray
■ Keep HOB elevated at all times
■ Turn feedings off when repositioning
■ Routinely assess lung sounds, bowel sounds
, ○ Assess nares and mucosa for inflammation and bleeding every shift (skin
checks)
○ Assess for placement and patency every shift
○ Secure with safety pin to gown
○ Provide oral/nasal care every shift
○ Flush with tap water per physician order (free flow water with bolus possibly?)
○ Aspirate and record residuals as ordered
○ If connected to suction, assess
○ How do you reposition the NG tube?
■ Push in air or do another flush
● Tube Feeding Nursing Care
○ Aspiration Prevention (as stated above)
○ Look for diarrhea, alert MD (rate is too fast or formula is contaminated)
○ Check for hyperglycemia
○ Check for placement
■ Check pH of aspirated gastric secretion
■ Measure residuals (return to stomach)
○ Flush tube with 30 cc water 4 hours, with meds, with residual checks
○ Record all administered volumes and residuals on I/o record
○ Slow down or stop the rate of flow (standing orders)
● Ulcerative Colitis
○ Chronic inflammation of mucosa and submucosa in the colon and rectum
■ Inflammation develops into abscesses that penetrate mucosa and spread
laterally
■ Begins in rectum and usually limited to sigmoid colon and rectum
○ Periods of exacerbation and remission
○ Cause:
■ Unknown
■ Related to stress, genetics, infection, dietary factors (low fiber), or
antibody formation
○ Manifestations:
■ Diarrhea (10-20 liquid stools a day often containing blood and mucus)
■ Fatigue from blood loss and fluid imbalance and lack of sleep
○ Complications:
■ Hemorrhage, abscess, toxic megacolon, fluid and electrolyte imbalance,
malabsorption, bowel obstruction, bowel perf, risk of colon cancer
○ Diagnostic
■ Sigmoidoscopy that shows friable mucosa with granular appearance
■ CBC to identify anemia
○ Treatment
■ Surgical treatment
● Ileostomy
■ Medications
● Steroids during exacerbations (prednisone)
● Salicylate compounds to decrease prostaglandin formation in
bowel (reducing inflammation)
■ May need low residue diet (limit raw fruits and veg, whole grains, seeds
and nuts, popcorn, and highly spiced or flavorful foods)
, ■ Avoid stress
■ Exercise
● Bowel Obstruction
○ Failure of bowel contents to move forward
■ Can be complete or partial
■ Peristalsis increases in the intestine above blockage leading to increased
secretion, edema, and increased capillary permeability = fluid and
electrolyte imbalances and hypovolemia
○ Types:
■ Mechanical
● r/o forces outside intestine (tumors, hernias, adhesions)
● Blockage in lumen itself (fecal impaction, edema, tumor, strictures,
intussusceptions, twisting of intestine)
■ Non mechanical/Paralytic ileus
● Impairment of muscle tone or nervous system innervation
preventing forward movement
● Anesthesia, abdominal surgery, spinal cord injury, peritonitis,
vascular insufficiency
■ Most often occurs in ileum - where intestinal diameter is smallest
○ Manifestations
■ Early: bowel sounds are high pitched and tinkling proximal to obstruction
and silent distal
■ Late: bowel sounds silent
■ Abdominal pain can be colicky and may increase as progresses
■ Vomiting is common, may have fecal odor and/or brown or green color
■ Abdominal distention is common
■ Vital signs normal early, but progress to signs of shock
● Tachycardia, fever, tachypnea, hypotension
○ Nursing Care
■ Prepare for possible surgery
■ Prepare for NG insertion
■ Maintain NPO
■ Frequent position changes
■ Monitor vital signs, pain levels, electrolytes, and I/Os
● Stoma Care (especially post-op)
○ Make sure beefy red
■ If blue or purplish: blood flow is inadequate, need to alert surgeon
○ Blood may be seen in bag after surgery, normal
○ Bleeding should be monitored closely, if increases or continues for several days,
something is wrong
● General Care for N/V
○ Antiemetic medicines administered orally, rectally, intramuscularly, or
intravenously
○ IV fluid and electrolytes may be needed to replace losses due to continued
vomiting
○ r/t esophageal obstruction, gastric distention, PUD, cholecystitis, cholelithiasis,
pancreatitis, intestinal obstruction, ileus
○ May need to be on NPO, need to be cautious with medication
, ○ Give medication for n/v before other medications such as pain medications
● GERD
○ Backward movement of stomach contents or even bile into the esophagus
without vomiting
■ The gastric contents are irritating to esophagus and causes breakdown of
the mucosal barrier leading to inflammation and erosion
■ Healing of erosion causes substitution of normal squamous epithelial
tissue for columnar epithelial tissue (Barrett’s which resists acid but is
pre-malignant)
○ Causes:
■ Relaxation of lower esophageal sphincter
■ Decreased tone of LES
■ Increased intra abdominal pressure
■ Increased gastric volume
○ Manifestations:
■ Most common: heartburn or substernal burning pain
■ Regurgitation without nausea or vomiting
■ Bad or sour taste upon awakening
■ Coughing, hoarseness, wheezing at night
○ Diagnosis:
■ Most accurately diagnosed with 24 hour pH monitoring
○ Nursing Care
■ Avoid foods or medications that reduce LES tone
■ Don’t eat 2 hours before bedtime
■ Don’t bend over after eating or lie down
■ Lose weight
■ Avoid restrictive clothing
■ Avoid large meals
■ Elevate head of bed for sleeping
■ Stop smoking
■ H2 receptor antagonists (long term relief but take a while to start working)
or PPIs (good for long term use)
● PUD
○ Generic term for ulcers or breaks in the mucosal lining in the GI tract that come in
contact with gastric juices
○ Can occur in stomach, duodenum, lower esophagus
○ Major Causes:
■ H. pylori (up to 90-95%)
■ Chronic NSAID use (aspirin is the worst)
■ Cigarette smoking
■ Family history
■ Blood group O
■ Alcohol use
○ Manifestations:
■ Pain: gnawing, burning, aching, hunger like
● Duodenal ulcers: pain may be relieved by eating
● Gastric ulcers: pain exacerbated by food
○ Diagnosis:
