8/30/24, 3:22 AM
HESI NSG 123: Medical Surgical Nursing Final
Jeremiah
Terms in this set (93)
Ulcerative colitis is a chronic ulcerative and inflammatory disease of the mucosal and
submucosal layers of the colon and rectum that is characterized by unpredictable
Ulcerative Colitis periods of remission and exacerbation with bouts of abdominal cramps and bloody or
purulent diarrhea. The inflammatory changes typically begin in the rectum and progress
proximally through the colon
Crohn's disease is characterized by periods of remission and exacerbation. It is a
subacute and chronic inflammation of the GI tract wall that extends through all layers
(i.e., transmural lesion). Although its characteristic histopathologic changes can occur
Crohn's Disease
anywhere in the GI tract, it most commonly occurs in the distal ileum and the ascending
colon. The onset of symptoms is usually insidious in Crohn's disease, with prominent
right lower quadrant abdominal pain and diarrhea unrelieved by defecation
Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin
therapy and iron replacement are prescribed to meet nutritional needs, reduce
inflammation, and control pain and diarrhea. Fluid and electrolyte imbalances from
dehydration caused by diarrhea are corrected by IV therapy as necessary if the patient
Crohn's Disease Diet
is hospitalized or by oral fluids if the patient is managed at home. Any foods that
exacerbate diarrhea are avoided. Milk may contribute to diarrhea in those with lactose
intolerance. Cold foods and smoking are avoided because both increase intestinal
motility. Parenteral nutrition may be indicated.
The major goals for the patient include attainment of normal bowel elimination
patterns, relief of abdominal pain and cramping, prevention of fluid volume deficit,
maintenance of optimal nutrition and weight, avoidance of fatigue, reduction of anxiety,
Ulcerative Colitis-Goal
promotion of effective coping, absence of skin breakdown, increased knowledge
about the disease process and self-health management, and avoidance of
complications.
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After surgery, the nurse assesses the patient for complications from the bariatric
surgery, such as hemorrhage, venous thromboembolism, bile reflux, dumping
syndrome, dysphagia, and bowel or gastric outlet obstruction.
Eat smaller but more frequent meals that contain protein and fiber; each meal size
should not exceed 1 cup.
Eat only foods high in nutrients (e.g., peanut butter, cheese, chicken, fish, beans).
Bariatric Surgery Post Op
Eat slowly and chew thoroughly
Assume a low Fowler position during mealtime and then remain in that position for 20-
30 minutes after mealtime—this delays stomach emptying and decreases the likelihood
of dumping syndrome.
Do not drink fluid with meals; instead, consume fluids up to 30 minutes before a meal
and 30-60 minutes after mealtime.
Jaundice occurs in a few patients with gallbladder disease, usually with obstruction of
the common bile duct. The bile, which is no longer carried to the duodenum, is
Cholelithiasis- Jaundice
absorbed by the blood and gives the skin and mucous membranes a yellow color. This
is frequently accompanied by marked pruritus (itching) of the skin.
The risk of developing such stones is increased in patients with cirrhosis, hemolysis, and
infections of the biliary tract.
Cholesterol stones account for most of the remaining 75% of cases of gallbladder
disease in the United States
Two to three times more women than men develop cholesterol stones and gallbladder
Gallbladder Risk Factors
disease
Stone formation is more frequent in people who use oral contraceptives, estrogens, or
clofibrate (Atromid-S); these medications are known to increase biliary cholesterol
saturation. The incidence of stone formation increases with age as a result of increased
hepatic secretion of cholesterol and decreased bile acid synthesis.
Although vomiting is rare in an uncomplicated peptic ulcer, it may be a symptom of a
complication of an ulcer. It results from gastric outlet obstruction, caused by either
Peptic Ulcer Disease Complication
muscular spasm of the pylorus or mechanical obstruction from scarring or acute
swelling of the inflamed mucous membrane adjacent to the ulcer.
Seizure precautions are maintained, including having available functioning suction
equipment with a suction catheter and oral airway. The bed is placed in a low position
Seizure Precautions with two to three side rails up and padded, if necessary, to prevent injury to the patient.
The patient may be drowsy and may wish to sleep after the seizure; they may not
remember events leading up to the seizure and for a short time thereafter.
The initial clinical manifestations of RA include symmetric joint pain and morning joint
stiffness lasting longer than 1 hour. Over the course of the disease, clinical
manifestations of RA vary, usually reflecting the stage and severity of the disease.
Symmetric joint pain, swelling, warmth, erythema, and lack of function are classic
symptoms. Palpation of the joints reveals spongy or boggy tissue. Often, fluid can be
Rheumatoid Arthritis S/S
aspirated from the inflamed joint. Characteristically, the pattern of joint involvement
begins in the small joints of the hands, wrists, and feet. In the early stages of disease,
even before the presentation of bony changes, limitation in function can occur when
there is active inflammation in the joints. Joints that are hot, swollen, and painful are not
easily moved.
The lesions often worsen during exacerbations (flares) of the systemic disease and
possibly are provoked by sunlight or artificial ultraviolet light. Oral ulcers, which may
SLE Exacerbation accompany skin lesions, may involve the buccal mucosa or the hard palate, occur in
crops, and are often associated with exacerbations. Other cutaneous manifestations
include splinter hemorrhages, alopecia, and Raynaud's phenomenon
Routine laboratory tests used to detect infection include the white blood count (WBC)
Pre-Op Lab
and the urinalysis. Surgery may be postponed in the presence of infection.
HESI NSG 123: Medical Surgical Nursing Final
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