NURA 3810 Medical Surgical Nursing I
Unit 1
Reading guides are tools that can and should be used when reading and completed BEFORE coming to
class. Read and fill in the questions so class will be a time of review and to clarify things that you did not
understand. The chapters refer to your Harding et al. Lewis’s medical surgical nursing: Assessment and
management of clinical problems textbook. In this course, you must be able to access the Evolve e-book.
When completed, this reading guide can be used as a study guide for the test, HESI, and NCLEX.
Concepts to Review from Foundations/Pharmacology/Assessment:
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Everything . You may need the textbooks from these courses for this course.
Delegation- What are the key words?
The Nursing Process (What do you do first?)
Maslow’s Hierarchy
Labs and lab values
Medications related to disorder (special considerations, etc.)
A few testing tips:
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Prioritize (what does that mean? Who dies first? What will kill them?); ABC’s.
Consider what the question is asking. Does the answer have anything to do with the question? If
there is more than one correct answer, which is the most correct for this question?
Pay close attention to words like assessment, intervention, diagnosis. The answer should be
related to what is being asked. If asked what is the priority assessment, do not choose an
intervention.
Make sure you have the information needed to “proceed”. The answer might be to call the
physician, but do you have the information you need to call? You might need to assess first, so
you will know what to tell the physician. Remember, you will never be tested on how well you
can dial a phone, so if there is a RN/lifesaving intervention, think about what the best answer
would be in that scenario.
Pay attention to questions that ask what you would NOT do, or some version of that. Which
order would you clarify from the doctor? Look for the “wrong” answer. The words can be subtle
and can be missed.
Make sure to differentiate between “understands education because they state” and “needs
further education because they state”.
Know what you can delegate. Who can assess? Who can perform invasive procedures? Who can
teach? Who can give medications or change a plan of care?
Be careful that you do not confuse “NP” (nurse practitioner) with “PN” (practical nurse, aka LPN
or LVN). This wording is used in the HESI and NCLEX.
Practice multiple answer (select all that apply) questions when you are studying.
When do you call the physician? You call the physician if you need an order, to report an
abnormal finding that needs an order, or for complications that requires a physician at the
bedside. Do not call about an expected finding or for something that is not pertinent to the
situation.
Keep in mind Bloom’s Taxonomy to make sure you are studying at the appropriate level.
NURA 3810 Medical Surgical Nursing I
Chapter
Topic
Ch. 39
Malnutrition:
What is the basic pathology of malnutrition?
What role does albumin play? The liver? The Na/K pump?
What are the symptoms of low albumin? What is the treatment?
Which patients are at a higher risk of malnutrition?
What is the nursing role in nutrition?
Know BMI’s and their relationship to malnutrition.
What assessment findings are anticipated with someone with malnutrition?
What age and cultural considerations need to be made when teaching a patient about
how to improve nutrition?
What nursing actions can be taken for a patient struggling to eat all of their meal?
When is enteral nutrition indicated? What is required for a patient to “qualify”?
What are the benefits of enteral nutrition? What are the disadvantages?
What are some ways to troubleshoot tube feeding problems?
What are safety considerations with tube feedings (potential complications)? and how is
it safely given?
What can a nurse delegate, related to tube feedings?
What is parenteral nutrition? What is it indicated for?
Anorexia Nervosa:
What are the signs and symptoms of AN?
What are potential changes to laboratory results (Why?)
What are priority concerns (nursing diagnosis)? Long term?
What needs to be the focus of treatment for AN?
Bulimia Nervosa:
What are assessment findings for a patient with BN?
Why is it sometimes difficult to diagnose?
What is Russell sign? (what causes it?)
What is the initial treatment? What is continuing treatment?
Obesity:
What are the secondary causes for obesity? Are they more common or less common than
primary causes?
What are the health risks of obesity? What assessment data increases a patient’s health
risks with obesity (male vs. female).
What are the goals of nursing interventions?
What are the surgery options? Which is the gold standard?
What are the post-op considerations? (Education?) (Remember their stomach is SMALL)
What are some potential post op complications?
What needs to be considered with severe pain post op GBP?
Who is a candidate for bariatric surgery?
What is metabolic syndrome? What are the symptoms (data that is needed to confirm
diagnosis)?
What should be the focus for a patient with metabolic syndrome?
Gastroesophageal Reflux Disease:
What is GERD? Gastroesophageal Reflux Disease
Caused by reflux of gastric contents into lower esophagus
What are risk factors for GERD?
Study
tables
39.3,
39.5,
39.6,
39.7,
39.12
Ch. 40
Study figs.
40.5, 40.6
Study
tables
40.5,
40.10
Ch. 41
NURA 3810 Medical Surgical Nursing I
Study
table
41.10
and
fig. 41.4
Study
table
41.19
Incompetent LES (lower esophageal sphincter)- Primary- can be due to certain foods
(caffeine, chocolate) and drugs (anticholinergics), Obesity, Smoking
Hiatal Hernia and Delayed gastric emptying
What are the symptoms? Which is most common?
Heartburn (pyrosis, chest pain)- M/c, burning, intermittent tight sensation beneath
sternum,
Dyspepsia- upper abdominal pain
Regurgitation- hot, bitter, or sour liquids coming from mouth, hyper salivation
Respiratory symptoms- wheezing, coughing, dyspnea
What do you do if a patient states they have chest pain that is GERD?
**Patient education: elevation of head of bed 30 degrees, no lying down 2-3 hrs after
eating, avoid late night eating/milk, evaluating effectiveness of meds, drink between
meals, avoid smoking, alcohol, caffeine, high fat foods, acidic food, peppermint,
stress reduction techniques, weight reduction, avoid tight clothing, small/frequent meals
What can happen with chronic GERD or if it is untreated?
GERD can destroy LES
Surgical therapy- fundoplication
How is the majority of GERD treated?
What are the different GERD medications, and how do they work?
Proton pump inhibitors (PPIs)- ex. Nexium- decreases stomach acid and production
Histamine-2 receptor (H2R) blockers,
Prokinetic Drugs,
Antacids
**look what drug was pulled bc it caused stomach cancer
How does diet affect GERD? What are food considerations as well as how much and
when to eat?
What is the nursing specific treatment/management of GERD?
What is a Nissen fundoplication? How does it help GERD? What is the recurrence rate?
What is the nursing post-op care for a Nissen?
Maintain fluid/electrolyte imbalance, when peristalsis returns- clear liquids only and
solids added gradually
Recurrence rate may range from 10-30% over a 20-year period following surgery
Gastritis:
What is gastritis?
Inflammation of gastric mucosa
How prevalent is gastritis?
What are the symptoms of acute gastritis? Chronic?
What are some risk factors for gastritis?
Drugs- NSAIDs, aspirin, corticosteroids
Diet- alcohol, spicy food
Microorganisms- H.pylori
Environmental- radiation, smoking
Pathophysiologic- burns., renal, failure, sepsis
What is intrinsic factor? What is cobalamin? What is their relationship to gastritis?
Loss of intrinsic factor can occur when acid-secreting cells are loss or nonfunctioning
Cobalamin- Vit. B12,
NURA 3810 Medical Surgical Nursing I
They will need b12 inj bc stomach cant digest
Which type of gastritis causes a deficiency of cobalamin?
How is gastritis usually diagnosed? How is it specifically diagnosed?
Endospic exam- biopsy
What is the major focus of care for gastritis?
What are some additional care considerations?
No alc, abstinence from drugs, H.pylori education aB, supportive care for nausea/vomNPO, IV fluids, rest
What is pernicious anemia?
Study
tables
41.12,
41.13,
41.16,
41.18
Study
tables
41.20,
41.21
Ch. 42
Study
tables
42.15,
42.16,
Peptic Ulcer Disease:
What are the two main types of ulcers?
What are the differences?
Which of the two occurs more often?
Which has a higher risk for complications?
What are the risk factors for PUD?
What are the symptoms for duodenal ulcers? Gastric?
What is the nursing management?
What drugs are used?
What are the potential complications of PUD?
What are the symptoms and treatment of a hemorrhage, perforation, and gastric outlet
obstruction? Think emergent!
What are the surgical options for gastric outlet obstruction?
What is the post op care?
When can a patient begin clear liquids? When can the progress their diet further?
What are potential complications post-op?
What is dumping syndrome and how is it related to PUD? What symptoms might a
patient have after meals related to dumping syndrome? What interventions should the
nurse encourage?
Upper GI bleeding:
Know the signs and symptoms.
Know the interventions. What is the priority intervention?
What are the different types of bleeds? What do they tell us about the bleed?
What is “coffee-ground” emesis? What is the difference between vomiting that and
bright red blood? What diagnosis test is used for coffee-ground emesis?
What drugs do you give for each type of bleed?
Are the interventions different depending where the bleed is?
Irritable Bowel Syndrome:
How is IBS diagnosed?
What are the criteria for diagnosis of IBS?
What are dietary considerations for a patient with IBS?
How do physiological factors play into diagnosis and treatment of IBS?
How would the nurse assess for IBS?
Inflammatory Bowel Disease:
What are the two classifications of IBD?
Differentiate between the two the clinical manifestations.
What are the patterns of inflammation for UC and Crohn’s?
NURA 3810 Medical Surgical Nursing I
42.18,
42.27
and
Fig. 42.3
What are the complications for UC? Crohn’s?
What is the initial treatment for a patient with IBD?
What is the goal of treatment?
What is the medication therapy?
What nutritional support needs to be considered?
and
Which disease does surgery cure?
Nursing
Do Crohn’s patients’ have surgery? Why or why not?
Care plans What are the post-op considerations and care?
in Ch. 42 What is an ostomy? How should an ostomy look? What are psychosocial considerations
on
for an ostomy?
website
What is short bowel syndrome? How is it treated?
What are anticipated nursing diagnoses for a patient with IBD?
Study
Intestinal obstruction:
table
What are the two classifications of obstructions? What are common causes of each?
42.20
Know the differences between a small intestine and large intestine obstruction and signs
and symptoms.
and
What are the complications of an obstruction? What will happen if the obstruction is not
resolved?
Figs.
What does bowel rest mean? Why is it done?
42.10,
What are indications for surgery for a bowel obstruction?
42.5
What is post op care post small bowel resection?
Why might a patient get an ostomy after an obstruction of the intestine?
Appendicitis:
What causes appendicitis?
What are the symptoms? Early signs and late signs?
What is McBurney’s point?
What is rebound tenderness and muscle rigidity?
What is referred pain? Where is it usually in appendicitis?
What are the potential complications of appendicitis?
What is the immediate symptom of a perforated appendix?
What is the initial treatment for peritonitis? What is the ultimate treatment?
What is post-op care?
Diverticulosis/Diverticulitis
What is diverticulosis vs. diverticulitis?
What are risk factors?
What are the signs and symptoms?
What is the initial treatment for a patient with acute diverticulitis?
Ch. 45
Urinary tract infections:
What are the types of urinary incontinence and what are the interventions associated
with each?
Study
What are the main causes of UTI’s?
tables
What are the symptoms (upper vs. lower)?
45.16,
Know the terms for each type (for example, pyelonephritis).
45.17,
What are the diagnostic tests for UTI’s?
45.20
What is the treatment for a UTI?
How is a clean catch performed?
What is asymptomatic bacteremia? What should be done about it?
What is the teaching for antibiotics? Pyridium?
NURA 3810 Medical Surgical Nursing I
Study
table 45.8
Study
tables
45.10,
45.12
Ch. 48
Study fig.
48.5 (and
the info it
What nursing teaching should be done to prevent future UTI’s?
What is the best way to prevent a HAI of the urinary tract?
What is complicated vs. uncomplicated UTI?
Pyelonephritis:
What is pyelonephritis?
What does it usually start as?
What can happen if not treated aggressively?
What are the symptoms of pyelonephritis (or an upper urinary tract infection)?
What are different studies done than for a lower urinary tract UTI? Why?
What is treatment? What is important about treatment?
What is the nursing care? What are the signs and symptoms you would be concerned
about?
Glomerulonephritis:
What is glomerulonephritis?
What are the two categories?
What is the most common type?
What does the most common type generally start as? What assessment finding would
lead a nurse to suspect glomerulonephritis?
What are beginning symptoms of glomerulonephritis? What are other symptoms?
Why is prompt recognition and treatment important?
What are the nursing management for glomerulonephritis?
What is important about the patient’s diet?
Nephrotic Syndrome:
What are the key factors in nephrotic syndrome?
What causes nephrotic syndrome?
What are the signs and symptoms (and lab changes)?
What assessment data will the nurse expect?
What are the complications?
What does flank pain indicate and what should be done about it?
What is the treatment?
What is the nursing care?
Compare nephrotic syndrome to glomerulonephritis.
Urinary tract calculi:
Who do “kidney stones” usually affect? Increased incidence?
What are some potential causes of stones?
What are the symptoms of stones?
What are diagnostic test performed?
Why do patients get fluids with stones? Why would you stop/limit fluid?
What is the priority intervention for a patient with kidney stones?
What would indicate a need for a procedural treatment for a stone?
What nursing education is provided to patients on ways to prevent stones?
What dietary restrictions are indicated for which type of calculi?
DIABETES MELLITUS:
What are the two major types of diabetes mellitus?
What are risk factors for type 1 diabetes? Type 2?
What is the difference between type 1 and type 2?
What medication do all type 1 diabetics need? Why?
NURA 3810 Medical Surgical Nursing I
is referred
to),
and
Tables
48.11,
Read pp.
292-295.
Study
Table
16.20
Do all patients with type 2 diabetes need medications?
What are the cells that are involved in diabetes? What are they together called?
What organ in the body is most closely related to diabetes?
What are the symptoms of type 1 diabetes? Type 2?
Which type of diabetes is more prevalent? Which type is preventable?
What for studies are used to diagnose diabetes?
What are the symptoms of hypoglycemia? What is the home treatment for
hypoglycemia? Inpatient treatment? What about for patients who cannot tolerate PO
medications?
What is the range of blood glucose for hyper and hypoglycemia?
What is diabetic ketoacidosis? Which type of diabetes does it primarily affect?
What are the symptoms of ketoacidosis?
What makes the patient emergent vs. home care?
What are the main causes of DKA? What is the initial treatment for DKA?
What can you expect to find on the assessment of someone with DKA? What are the
expected or potential lab values of someone with DKA? BGL? Electrolytes? ABG? UA?
What electrolyte should always be checked and controlled before starting insulin? How
should a patient be monitored before administering this electrolyte? Why?
What will happen if BGL is dropped too quickly?
What is often added to fluids when BLG get below 250?
How often should a BGL be checked for a patient in DKA?
What teaching needs to be performed for patients with diabetes?
What is hyperosmolar hyperglycemic syndrome? How is it different than DKA?
What are the symptoms of HHS? Which type of diabetes does it affect? What is the initial
treatment for HHS?
Why is the mortality rate of HHS higher than that of DKA?
What are the potential chronic complications of diabetes?
Know the types of insulin, their onset, peak, and duration.
How is insulin stored? How is insulin given? Where? Cleaning before? Angle of needle?
How long leave needle in? How is insulin mixed?
How does an insulin pump work?
What is the Somogyi effect? What is the teaching for this effect? What is the dawn
phenomenon?
What should you teach a patient with type 1 diabetes about “sick days”?
What are the classes of oral diabetes agents? How does each work?
What is important teaching related to Metformin?
How does prednisone affect a patient with diabetes?
What should all type 2 diabetics have checked annually to monitor for complications?
CVAD
How does the nurse care for the CVAD site? What is the preferred method and
preparation for cleaning the site?
How does the nurse flush the CVAD?
What are complications associated with CVADs?