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Chamberlain College of Nursing NR142 Exam 1 Study Guide
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Chamberlain College of NursingNR142 Exam 1 Study Guide
Instructions: The contents on this guide are intended to help you organize your preparation for the
Subject for the NR142 exam 1. This is NOT intended to serve as a direct reflection of the exact
questions which will be presented in the exam. As you review the topics listed below, be sure that you
can
1. Understand the Pathophysiology
2. Identify the appropriate assessment skills
3. Interpret the appropriate lab or other diagnostic findings
4. Develop a safe and competent plan of care with rationale
5. Associate the nursing implications with the appropriate medications or other treatments
6. Teach the RATIONALE for all the above.
7. Prioritize especially r/t interventions and use of the nursing process keeping in mind scope of
practice and responsibilities related to practicing as a R.N.
Medication calculations
Review: All oral and injectable; IV fluids, IV medications (continuous/intermittent; with meds; not
weight based); Reconstitution
Gastrointestinal Alterations
Esophagus (Meg)
Esophageal Cancer – Occurs 3x more often in men than in women. Seen more frequently in African
Americans than in Caucasians. Occurs most often in 5th or 6th decade of life. Is seen more in China and
Northern Iran than in other parts of the world.
Pathophysiology – Consists of 2 cell types – Adenocarcinoma and Squamous cell carcinoma. Normally
not found till disease is advanced and then there is a very poor prognosis
1. Adenocarcinoma is primarily found in the distal esophagus and gastroesophageal junction.
Risk factors – chronic esophageal irritation as with tobacco and alcohol use, people with GERD
and Barrett’s esophagus (chronic irritation of the mucous membranes due to reflux)
2. Squamous Cell Carcinoma
Risk factors – chronic ingestion of hot liquids or foods, nutritional deficiencies, poor oral
hygiene, exposure to nitrosamines in the environment or food, cigarette smoking or chronic
alcohol use and some esophageal medical conditions such as caustic injury
Tumor cells of both types may spread beneath the esophageal mucosa or directly into, through and
beyond the muscle layer into the lymph nodes. In later stages patients can have obstruction of the
esophagus and possible perforation into the mediastinum and erosion into the vessels.
Assessment – Diagnosis confirmed by biopsy
S/S – lesions in the throat, dysphasia, with solid foods first and then liquids, sensation of a mass in the
throat, painful swallowing, substernal pain or fullness, regurgitation of undigested foods with bad
breathe and hiccups.
Rationale – Pain and trouble swallowing can indicate a blockage or mass in the throat. A mass in the
throat can cause gastroesophageal reflux, and damage or irritation to the nerves. Both of these things can
1
, cause consistent hiccupping. Reflux or respiratory issues denying oxygen into the blood, to the heart and
other muscles, can cause substernal pain
Treatment:
Surgery to remove tumor or surgical resection of the esophagus
Esophagectomy – partial or full removal of the esophagus
Radiation
Chemo
Combination
Palliative treatments – dilation of the esophagus, laser therapy, placement of a stint
Radical neck dissection is how they perform surgery on the esophagus
Tumors in the cervical or upper thoracic area of the esophagus may be maintained by a free jejunal graft
in which the tumor is removed and the area is replaced with a portion of the jejunum. (Esojejunostomy)
Complications:
Surgery or surgical resection – high mortality rate due to infection, pulmonary complications,
leakage through the anastomosis
Radiation & Chemo – Infection, hair loss, N/V, fatigue
Education for surgical patients:
To talking or eating
Keep pt in semi-fowlers position
Support head
Ask about preferred form of communication since will not be able to talk (ie…communication
board, writing)
Nutrition
Parental feeding for 24-48 hours after, enteral feeding after until cleared by speech therapist
evaluation and ability to swallow returns
Esophageal Varices – extremely dilated (tortured) sub-mucosal veins in the lower third of the esophagus
– Usually develop in patients with cirrhosis. Caused by portal hypertension, cirrhosis and alcoholism
Pathophysiology – almost always develops from portal hypertension, which results from obstruction of
the portal venous circulation within the damaged liver. Due to obstruction, blood from the intestinal
tract and spleen increases pressure in the vessels of the lower esophagus and upper part of the stomach.
Life threatening and can result in hemorrhagic shock. Chart on page 1129
Bulimia is second greatest cause after portal hypertension due to constant vomiting
Assessment: S/S hematemesis, melena, general deterioration in mental and physical status, alcohol
abuse, vomiting, blood in stool, black tarry stool, anemia, thrombocytopenia, ascites (fluid collection in
peritoneum), low WBC, hypovolemia
Rationale: melena is black tarry stool and is a symptom of upper gastrointestinal bleeding, Hematemesis
or vomiting blood can indicate esophageal bleeding, ascites from decrease in protein due to liver
disease, confusion from build up of waste products because the liver cannot filter, anemia and
2
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