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NSG 331 Final Exam Study Guide Latest 2021
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NSG 331Final Exam Study Guide
NSG 331 Final Exam
Study Guide
If we’re asking for what would you DO make sure it’s an INTERVENTION
If we’re asking for what would you CHECK make sure it’s an
ASSESSMENT
The final exam is considered comprehensive in concepts that overarch the different disorders covered in this
course. The following is a list of the modules and specific topics included in this 75-question exam. Please refer to
previous study guides from exam 1, 2, 3, and 4. New content on the exam covers the GI module. Plus four (4) math
questions.
Module 13 - Gastrointestinal
• Assessment Lewis table 38.11, 38.12
o
o
• Intestinal obstruction
o Types and causes
▪ Mechanical – Physical obstruction mostly in Small intestine
• Small intestine
,o Adhesions (Most Common Cause)
, Interprofessional Care
Treatment of a bowel obstruction depends on the cause. If a
strangulated obstruction or perforation is present, the patient will
need emergency surgery to relieve the obstruction and survive. In
some, especially those due to surgical adhesions, an obstruction may NSG 331
resolve without surgery. Final Exam Study e
Surgery may involve simply resecting the obstructed segment of Guid
bowel and anastomosing the remaining healthy bowel back together.
o Hernia
Partial or total colectomy, colostomy, or ileostomy may be done when
o Cancer
extensive obstruction or necrosis is present. Sometimes, an obstruction
can be removed nonsurgically. o Stricture
Colonoscopy offers a means to remove
polyps, dilate strictures, and o remove and destroy tumors with a laser.
Intussusception
The initial treatment includes placing the patient on NPO status,
providing IV ▪fluid therapy
Large with either normal saline or lactated
intestine
Ringer’s solution, and giving
• ColorectalIV antiemetics. If needed,
cancer (Most Common Cause)insert an NG
tube for decompression and give ordered electrolyte replacement.
• Diverticular disease
Obtain blood cultures and start IV antibiotic therapy. Some patients
• Volvulus
need PN to allow bowel rest and improve nutritional status before
surgery. ▪ Nonmechanical - Reduce or absent peristalsis cause by altered neuromuscular
The treatment goal for a patientparasympathetic
transmission of the innervation
with a malignant to the bowel(Paralytic
obstruction is to Ileus)
• Vascular Disorder
regain patency and resolve the obstruction. Stents can be placed via
endoscopic or fluoroscopic oprocedures.
Mesenteric They
artery are
occlusion
used for palliative
purposes
o CMsor as “a bridge
– Lewis to surgery,” allowing a patient to avoid
table 42.20
emergency surgery.19 This gives the interprofessional team time to
correct fluid volume problems and treat other problems, thus
improving surgical outcomes. Corticosteroids with antiemetic
properties that decrease edema and inflammation may be used with
stent placement.
Obstipation = severe or complete constipation
▪ The 4 hallmark clinical manifestations of an obstruction are (colicky pain first
symptoms of SBO)
• Abdominal pain
• nausea and vomiting
• distention
• constipation.
o Interprofessional management
▪ NPO
▪ Nasogastric tube (NG) to low intermittent suction
▪ IV fluids and Electrolyte replacement
▪ Encourage ambulation
▪ Prepare for possible surgery
, NSG 331
Final Exam Study Guide
Nursing Assessment drying
Intestinal obstruction is a potentially life-threatening condition.
Major concerns are preventing fluid and electrolyte deficiencies and
early recognition of deterioration in the patient’s condition (e.g.,
• hypovolemic shock, sepsis, bowel strangulation). Nursing assessment
begins with a detailed patient history and physical examination.
Determine the location, duration, intensity, and frequency of
abdominal pain.
Record the onset, frequency, color, odor, and amount of vomitus.
Assess bowel function, including the passage of flatus. Auscultate for
bowel sounds and document their character and location. Inspect the
abdomen for scars, visible masses, and distention. Assess whether
abdominal tenderness or rigidity is present. Measure the abdominal
girth. Check for signs of peritoneal irritation (e.g., muscle guarding,
rebound pain). If the HCP decides to wait to see if the obstruction
resolves on its own, assess the patient regularly. Notify the HCP of
changes in vital signs, changes in bowel sounds, decreased urine
output, increased abdominal distention, and pain.
Maintain a strict intake and output record, including emesis and
tube drainage. A urinary catheter allows for hourly monitoring of
urine output. Report if the urine output is less than 0.5 mL/kg of body
weight per hour. This indicates inadequate vascular volume and the
potential for acute kidney injury. Rising serum creatinine and BUN
levels are other indicators of acute kidney injury.
Nursing Diagnoses
Nursing diagnoses for the patient with intestinal obstructions include:
• Acute pain
• Fluid imbalance
Planning
The overall goals are that the patient with an intestinal obstruction
will have (1) relief of the obstruction and return to normal bowel
function, (2) minimal to no discomfort, and (3) normal fluid and
electrolyte and acid-base status.
Nursing Implementation
Monitor the patient closely for signs of dehydration and electrolyte
imbalances. Give IV fluids as ordered. Assess for signs and symptoms
of fluid imbalance. Some patients, especially older adults, may not
tolerate rapid fluid replacement. Monitor serum electrolyte levels
closely. A patient with a high intestinal obstruction is more likely to
have metabolic alkalosis. A patient with a low obstruction is at
greater risk for metabolic acidosis. The patient is often restless and
constantly changes position to relieve the pain. Provide comfort
measures and promote a restful environment. Nursing care of the
patient after surgery for an intestinal obstruction is similar to care of
the patient after a laparotomy (see p. 935).
With an NG tube in place, oral care is extremely important.
Vomiting leaves an unpleasant taste in the patient’s mouth, and fecal
odor may be present. The patient breathes through the mouth,
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