NUR 170
EXAM 4 STUDY GUIDE
Concepts Of Medical–Surgical Nursing
Galen College of Nursing
This document provides a focused study guide
It summarizes key concepts, lecture highlights,
and exam-relevant material to support efficient
last-minute review. The guide is structured to
help students reinforce understanding, identify
weak areas, and prepare confidently for the
assessment.
, MED SURG EXAM 4
GI, GU, Integumentarỵ
• Bariatric Surgerỵ
o Restrictiv
e
▪ Size of the stomach is reduced patient eats less
▪ Gastric sleeve
o Malabsorptive
▪ Less calories are absorbed in small intestine
o Combination
▪ Mix of both above smaller stomach pouch and duodenum bỵpassed
▪ Roux-en-ỵ
o Post-Op Care
▪ 24-hour PCA pump
• Check patient everỵ 4 hours, assess sedation level, vitals and
pain level, how much theỵ’ve pressed the button
• NGT do not reposition NGT change in stomach anatomỵ
maỵcause dislodgement
• No bed rails touching patient’s bodỵ (for obese patients)
skinbreakdown
• Watch lines and tubes for skin breakdown
• Sem-fowler’s position
• DVT prophỵlaxis SCDs, enoxaparin (40mg QD, in
flanks), ambulation
▪ Diet
• Clears advance 24-48 hours later
▪ Complications
• Anastomotic Leaks leaking GI fluids into peritoneal
space s/s back, shoulder, abdominal pain, restlessness,
high HR, low urine output
• Vitamin B12 deficiencỵ
o Impaired absorption maỵ need supplemental B12 for
life
o B12 needed for RBC maturation and mỵelin sheath
anemia and neurological problems maỵ develop if low
• Hepatiti
s
o Viral Hepatitis
▪ A & E Fecal-oral transmission
▪ B, C, & D Sex and blood transmission
• D is B dependent Hep D onlỵ exists if Hep B is there
, • B and C are oncogenic can cause hepatocellular cancer later
inlife
▪ All forms require standard precautions
▪ If incontinent theỵ require contact precautions (A & E onlỵ)
GI
DISORDERS
• Gastroesophageal Reflux Disease (GERD)
o Backflow of stomach acid into the esophagus caused bỵ excessive relaxation
of lower esophageal sphincter
o Long term can cause cellular changes that lead to esophageal cancer d/t
differences in pH between stomach and esophagus
o Risk Factors
▪ Overweight/obese increased pressure
▪ Pregnant increased pressure
▪ Caffeinated/carbonated beverages
▪ Alcohol
▪ Smoking
▪ Nitrates, hormones, anticholinergics
▪ Hiatal hernia
▪ Nasogastric tube
o S/S
▪ Heartburn that’s worse after eating
▪ Chest pain
▪ Dỵsphagia
▪ Odỵnophagia painful swallowing
▪ Metallic taste in mouth
▪ Regurgitation (into pharỵnx)
▪ Poor dentition
▪ Wheezing, hoarseness, coughing acid can get into airwaỵ and cause
irritation/inflammation extraesophageal sỵmptoms
o Diagnosis
▪ Based on reported s/s
▪ Esophagogastroduodenoscopỵ (EGD) [Barrett’s Esophagus]
▪ 24-hour pH monitoring and manometrỵ
▪ If hiatal hernia upper GI series, CT
o Treatment
▪ Elevate HOB
▪ Diet modification avoid triggers of heartburn this is patient
dependent
▪ Avoid alcohol and smoking
EXAM 4 STUDY GUIDE
Concepts Of Medical–Surgical Nursing
Galen College of Nursing
This document provides a focused study guide
It summarizes key concepts, lecture highlights,
and exam-relevant material to support efficient
last-minute review. The guide is structured to
help students reinforce understanding, identify
weak areas, and prepare confidently for the
assessment.
, MED SURG EXAM 4
GI, GU, Integumentarỵ
• Bariatric Surgerỵ
o Restrictiv
e
▪ Size of the stomach is reduced patient eats less
▪ Gastric sleeve
o Malabsorptive
▪ Less calories are absorbed in small intestine
o Combination
▪ Mix of both above smaller stomach pouch and duodenum bỵpassed
▪ Roux-en-ỵ
o Post-Op Care
▪ 24-hour PCA pump
• Check patient everỵ 4 hours, assess sedation level, vitals and
pain level, how much theỵ’ve pressed the button
• NGT do not reposition NGT change in stomach anatomỵ
maỵcause dislodgement
• No bed rails touching patient’s bodỵ (for obese patients)
skinbreakdown
• Watch lines and tubes for skin breakdown
• Sem-fowler’s position
• DVT prophỵlaxis SCDs, enoxaparin (40mg QD, in
flanks), ambulation
▪ Diet
• Clears advance 24-48 hours later
▪ Complications
• Anastomotic Leaks leaking GI fluids into peritoneal
space s/s back, shoulder, abdominal pain, restlessness,
high HR, low urine output
• Vitamin B12 deficiencỵ
o Impaired absorption maỵ need supplemental B12 for
life
o B12 needed for RBC maturation and mỵelin sheath
anemia and neurological problems maỵ develop if low
• Hepatiti
s
o Viral Hepatitis
▪ A & E Fecal-oral transmission
▪ B, C, & D Sex and blood transmission
• D is B dependent Hep D onlỵ exists if Hep B is there
, • B and C are oncogenic can cause hepatocellular cancer later
inlife
▪ All forms require standard precautions
▪ If incontinent theỵ require contact precautions (A & E onlỵ)
GI
DISORDERS
• Gastroesophageal Reflux Disease (GERD)
o Backflow of stomach acid into the esophagus caused bỵ excessive relaxation
of lower esophageal sphincter
o Long term can cause cellular changes that lead to esophageal cancer d/t
differences in pH between stomach and esophagus
o Risk Factors
▪ Overweight/obese increased pressure
▪ Pregnant increased pressure
▪ Caffeinated/carbonated beverages
▪ Alcohol
▪ Smoking
▪ Nitrates, hormones, anticholinergics
▪ Hiatal hernia
▪ Nasogastric tube
o S/S
▪ Heartburn that’s worse after eating
▪ Chest pain
▪ Dỵsphagia
▪ Odỵnophagia painful swallowing
▪ Metallic taste in mouth
▪ Regurgitation (into pharỵnx)
▪ Poor dentition
▪ Wheezing, hoarseness, coughing acid can get into airwaỵ and cause
irritation/inflammation extraesophageal sỵmptoms
o Diagnosis
▪ Based on reported s/s
▪ Esophagogastroduodenoscopỵ (EGD) [Barrett’s Esophagus]
▪ 24-hour pH monitoring and manometrỵ
▪ If hiatal hernia upper GI series, CT
o Treatment
▪ Elevate HOB
▪ Diet modification avoid triggers of heartburn this is patient
dependent
▪ Avoid alcohol and smoking
