NUR 242 Exam 3 Notes
Medical/Surgical Nursing Concepts (Galen
College of Nursing)
100% Guarantee Pass
CONTENTS
Medsurg Exam 3
Anything Highlighted in Yellow = on test
Chapters: 48, 49, 50, 51, 52, 53, 54, 55;
Chapters 24, 25, 26, 27, 28
Prof Milhome
,Chapter48 Assessment of Gi system aka Alimentary canal
Labs to know
ALT= 3-36 units/L
Albumin= 3.5-5.0
Alkaline phosphate 30-120
units/L Ammonia= 10-80
mg/dL
AST= 0-35 units
Bilirubin= 0.3-1.0
Calcium= 9.0-10.5
Cholesterol= less than 200
mg/dL Potassium= 3.5-5.0
Amylase= 30-220
Lipase= 0-160
4 layers of the GI tract= Mucosa, Submucosa,
Muscularis, Serosa Small intestine = absorbs
nutrients
Large intestines = absorbs water
Page 1059 Esophagus- Lower esophageal sphincter (LES) does not
work in GERD Page 1064 Location of Body structures in Abdomen
LRQ=appendix, cecum, right ureter, right ovary , fallopian tube,
right spermatic cord URQ= liver, gallbladder, Duodenum,
hepatic fixture of colon,
ULQ= spleen, stomach, pancreas, splenic ficture of colon
LLQ= small intestine( illeum), sigmoid colon,left ureter, left ovary fallopian tube, left spermic cord
Page 1061 GI changes in older adults
-atrophy of HI mucosa = decreased hydrochloric acid levels (Hypochlorhydria=lower iron and B12 and atrophic
gastritis
-peristalsis decrease = decreased sensation to defecate= constipation and impaction
-decrease lipase- decreased fat and digestion= Steatorrhea fatty stools
-decreased rx metabolism= toxic levels
-dysfunction = obesity, inflammatory disease, reduced immunity
Physical assessment of GI> IAPePa= Inspect, Auscultate, Percuss, Palpate
-Normal Auscultation= high pitched, irregular gurgles frequency of 5-10 per min (not normal BORBORYMUS=
hyperactive bowels/ diarrhea)
-After surgery ask assess return of peristalsis ask patient if they have passed flatus within past 8 hours or stool within 12-
24 hours
-BRUIT OVER ABDOMINAL AORTA= ANEURSYM; if sound is heard DO NOT PERCUS OR PALPATE; Tell HCP ASAP
-light Palpitation-depress abd depth ½ -1 inch;
- Deep palpitations by physicians, physician's assistant, and advance practice nurses
Page 1063 Action alert: PERISTALIC MOVEMENTS ARE RALEY SEEN UNLESS THE PATIENT IS THIN AND HAS INCREASED
PERSISALISIS. IF THESE MOVEMENTS ARE OBSERVED, NOTE THE QUADRANT OF ORGIN AND DIRECTION OF PERSITALIC
FLOW. REPORT THIS FINDING TO HEALTH CARE PROVIDER BECAUSE IT MAY INDICATE AN INSTESTIAL OBSTRUCTION
IF BULGING MASS IS PRESENT DURING ASSESSMENT OF ABDOMEN DO NOT TOUCH Area because patient may have an
ABDOMINAL AORTIC
, ANEURSYM. A life-threatening problem. Notify the health care provider of this finding immediately.
GI labs- H&H, CBC, CMP, ASL, AST, (elevated in liver disorders) Bilirubin, PT, serum level of ammonia (hepatic
function) Urine (amylase= pancreatitis), Guaiac fecal occult
Page 1067 Endoscopy used to evaluate bleeding, ulceration, inflammation, tumors, cancer of esophagus, stomach, biliary
system, bowel
Page 1068 Teaching EGD=avoid anticoagulants, aspirin, NSAIDS before procedure, can take other daily meds, remain
NPO 4/6 or 6-8hrs before, remove dentures, Midazolam, fentylal, proprafol sedative(depress rate and depth of
respirations), gag reflex inactivated (numbing spray; HOB elevated, bite block ; takes 20-30 mins; NEED CONSENT
POST EGD = check VS every 15-30 mins til sedative wears off, side rails up, NPO til gag refex returns, someone must
drive them home, (don’t drive 12-18 hrs after), throat may hurt 12-18 hr after take lozenges
IF RESPIRATION IN BELOW 10 breath PER/MIN OR CO2 IS BELOW 20% USE STERNAL RUB to encourage deep / fast
respiration.
PRIORTY AFTER EGD PREVENT ASPIRATION. DO NOT OFFER DFLUIDS OR FOOD PO UNTIL YOU ARE SURE GAG REFLEX
IS INTACT . MONITOR SIGNS OF PERFORATION SUCH AS PAIN, BLEEDING, FEVER.
Page 1068 Teaching ERCP= removes gallstones; avoid anticoagulants', aspirin, NSAID prior to procedure. NPO 6-8 hours
before, remove dentures, CONTRAST USED; IV needed , deactivate defibrillators;
DURING once cannula is placed patient in prone position; last 30 mins to 1 hour.
POST ERCP= Assess VS every 15-30 mins; check gag reflex,
1
Medical/Surgical Nursing Concepts (Galen
College of Nursing)
100% Guarantee Pass
CONTENTS
Medsurg Exam 3
Anything Highlighted in Yellow = on test
Chapters: 48, 49, 50, 51, 52, 53, 54, 55;
Chapters 24, 25, 26, 27, 28
Prof Milhome
,Chapter48 Assessment of Gi system aka Alimentary canal
Labs to know
ALT= 3-36 units/L
Albumin= 3.5-5.0
Alkaline phosphate 30-120
units/L Ammonia= 10-80
mg/dL
AST= 0-35 units
Bilirubin= 0.3-1.0
Calcium= 9.0-10.5
Cholesterol= less than 200
mg/dL Potassium= 3.5-5.0
Amylase= 30-220
Lipase= 0-160
4 layers of the GI tract= Mucosa, Submucosa,
Muscularis, Serosa Small intestine = absorbs
nutrients
Large intestines = absorbs water
Page 1059 Esophagus- Lower esophageal sphincter (LES) does not
work in GERD Page 1064 Location of Body structures in Abdomen
LRQ=appendix, cecum, right ureter, right ovary , fallopian tube,
right spermatic cord URQ= liver, gallbladder, Duodenum,
hepatic fixture of colon,
ULQ= spleen, stomach, pancreas, splenic ficture of colon
LLQ= small intestine( illeum), sigmoid colon,left ureter, left ovary fallopian tube, left spermic cord
Page 1061 GI changes in older adults
-atrophy of HI mucosa = decreased hydrochloric acid levels (Hypochlorhydria=lower iron and B12 and atrophic
gastritis
-peristalsis decrease = decreased sensation to defecate= constipation and impaction
-decrease lipase- decreased fat and digestion= Steatorrhea fatty stools
-decreased rx metabolism= toxic levels
-dysfunction = obesity, inflammatory disease, reduced immunity
Physical assessment of GI> IAPePa= Inspect, Auscultate, Percuss, Palpate
-Normal Auscultation= high pitched, irregular gurgles frequency of 5-10 per min (not normal BORBORYMUS=
hyperactive bowels/ diarrhea)
-After surgery ask assess return of peristalsis ask patient if they have passed flatus within past 8 hours or stool within 12-
24 hours
-BRUIT OVER ABDOMINAL AORTA= ANEURSYM; if sound is heard DO NOT PERCUS OR PALPATE; Tell HCP ASAP
-light Palpitation-depress abd depth ½ -1 inch;
- Deep palpitations by physicians, physician's assistant, and advance practice nurses
Page 1063 Action alert: PERISTALIC MOVEMENTS ARE RALEY SEEN UNLESS THE PATIENT IS THIN AND HAS INCREASED
PERSISALISIS. IF THESE MOVEMENTS ARE OBSERVED, NOTE THE QUADRANT OF ORGIN AND DIRECTION OF PERSITALIC
FLOW. REPORT THIS FINDING TO HEALTH CARE PROVIDER BECAUSE IT MAY INDICATE AN INSTESTIAL OBSTRUCTION
IF BULGING MASS IS PRESENT DURING ASSESSMENT OF ABDOMEN DO NOT TOUCH Area because patient may have an
ABDOMINAL AORTIC
, ANEURSYM. A life-threatening problem. Notify the health care provider of this finding immediately.
GI labs- H&H, CBC, CMP, ASL, AST, (elevated in liver disorders) Bilirubin, PT, serum level of ammonia (hepatic
function) Urine (amylase= pancreatitis), Guaiac fecal occult
Page 1067 Endoscopy used to evaluate bleeding, ulceration, inflammation, tumors, cancer of esophagus, stomach, biliary
system, bowel
Page 1068 Teaching EGD=avoid anticoagulants, aspirin, NSAIDS before procedure, can take other daily meds, remain
NPO 4/6 or 6-8hrs before, remove dentures, Midazolam, fentylal, proprafol sedative(depress rate and depth of
respirations), gag reflex inactivated (numbing spray; HOB elevated, bite block ; takes 20-30 mins; NEED CONSENT
POST EGD = check VS every 15-30 mins til sedative wears off, side rails up, NPO til gag refex returns, someone must
drive them home, (don’t drive 12-18 hrs after), throat may hurt 12-18 hr after take lozenges
IF RESPIRATION IN BELOW 10 breath PER/MIN OR CO2 IS BELOW 20% USE STERNAL RUB to encourage deep / fast
respiration.
PRIORTY AFTER EGD PREVENT ASPIRATION. DO NOT OFFER DFLUIDS OR FOOD PO UNTIL YOU ARE SURE GAG REFLEX
IS INTACT . MONITOR SIGNS OF PERFORATION SUCH AS PAIN, BLEEDING, FEVER.
Page 1068 Teaching ERCP= removes gallstones; avoid anticoagulants', aspirin, NSAID prior to procedure. NPO 6-8 hours
before, remove dentures, CONTRAST USED; IV needed , deactivate defibrillators;
DURING once cannula is placed patient in prone position; last 30 mins to 1 hour.
POST ERCP= Assess VS every 15-30 mins; check gag reflex,
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