Download Key Points Review these Key Points for each NCLEX Examination

Key Points
Review these Key Points for each NCLEX Examination Client Needs Category.
Safe and Effective Care Environment
• Remember that the priority for care is to check for the return of the gag reflex after an upper
endoscopic procedure before offering fluids or food; aspiration may occur if the gag reflex is not intact.
Health Promotion and Maintenance
• If an endoscopic procedure on an ambulatory basis is scheduled, remind the patient to have
someone available to drive him or her home because of the effects of moderate sedation.
• Teach patients having invasive colon diagnostic procedures to follow instructions carefully for the
bowel preparation before testing; the bowel must be clear to allow visualization of the colon.
• Instruct the patient to drink plenty of fluids and take a laxative as prescribed to eliminate barium if
used during diagnostic testing.
Psychosocial Integrity
• Remember that problems of digestion, nutrition, and elimination can markedly affect lifestyle.
Physiological Integrity
• Perform a focused abdominal assessment using inspection, auscultation, and light palpation.
• Do not palpate or auscultate any abdominal pulsating mass because it could be a life-threatening
aortic aneurysm.
• Assess and report any major complications of GI testing to the health care provider.
• Review and interpret laboratory results, and report abnormal findings to the health care provider
(see Chart 55-3).
• Monitor vital signs carefully for the patient having any endoscopic procedure and moderate
sedation.
• Assess patients who have endoscopies for bleeding, fever, and severe pain.
• For patients having a colonoscopy, check for passage of flatus before allowing fluids or food.
Key Points chapter 57
Safe and Effective Care Environment
• Consult with the dietitian, patient, and family regarding nutritional restrictions for patients with
GERD.
• Collaborate with the health care team for the patient with impaired swallowing and/or limited
nutrition.
• Teach the patient and family to recognize the symptoms of dysphagia.
• Remain with the dysphasic patient during meals to prevent or assist with choking episodes.
Health Promotion and Maintenance
• Teach the patient oral exercises aimed at improving swallowing.
• Stress the importance of recognizing and controlling reflux through nutrition therapy and
medications to avoid further esophageal damage that could lead to Barrett's esophagus.
• Teach the patient to elevate the head of the bed by 6 inches for sleep to prevent nighttime reflux.
• Instruct the patient to sleep in the right side-lying position to minimize the effects of nighttime
episodes of reflux.
• Teach the patient with esophageal cancer to monitor his or her body weight and to notify the health
care provider for a loss of 5 pounds or greater within 1 month.
• Teach the patient to avoid alcoholic beverages, smoking, and other substances as listed in Chart 572 because they lead to increased gastroesophageal reflux.
• Teach the patient to prevent gas bloat syndrome by avoiding drinking carbonated beverages, eating
gas-producing foods, chewing gum, and drinking with a straw.
• Review postprocedure instructions for patients having endoscopic therapies for GERD as outlined in
Chart 57-4.
Psychosocial Integrity
• Allow the patient the opportunity to express fear or anxiety regarding the diagnosis of esophageal
cancer and related treatment regimen of surgery, chemotherapy, and radiation.
• Explain all procedures, restrictions, drug therapy, and follow-up care to the patient and family.
• Refer the patient or family members to psychological counseling, hospice, pastoral care, and the
case manager as needed.
Physiological Integrity
• For patients with GERD, teach the importance of strict adherence to antireflux agents in preventing
esophageal damage (see Chart 57-3).
• Be aware that laparoscopic Nissen fundoplication (LNF) is the most common surgical procedure for
patients with GERD and hiatal hernia.
• Recall that achalasia is an esophageal motility disorder caused by esophageal denervation, which
can lead to severe complications, such as carcinoma and aspiration pneumonia.
• Assess for complications and provide postoperative care for patients having the LNF procedure, as
described in Charts 57-6 and 57-7.
• Be sure to frequently monitor the nutritional status of the patient with esophageal cancer.
• Teach the patient having open conventional esophageal surgery about incisions, drains, and
jejunostomy tube placement before he or she undergoes surgery for esophageal cancer.
• For the patient with a nasogastric (NG) tube, check the NG tube every 4 to 8 hours for proper
placement and anchorage; follow guidelines as outlined in Chart 57-9.
• Assess the patient after esophageal surgery for pulmonary and cardiac complications of surgery, and
report changes to the health care provider.
• Assess patients for key features of esophageal tumors as listed in Chart 57-8.
Chapter 58 Key Points
Review these Key Points for each NCLEX Examination Client Needs Category.
Safe and Effective Care Environment
• Provide information about organizations for digestive disorders to receive information and support;
refer the patient to the American Cancer Society if gastric cancer is the diagnosis.
Health Promotion and Maintenance
• Identify patients at risk for gastritis and PUD, especially older adults who take large amounts of
NSAIDs and those with H. pylori.
• Teach patients behaviors to prevent PUD, such as avoiding large consumption of caffeine, alcohol,
coffee, aspirin, and other NSAIDs. Also teach them to avoid contaminated foods and water and smoking
(see Chart 58-1).
• Teach patients about various complementary and alternative therapies that are currently used for
gastritis and PUD.
Psychosocial Integrity
• Allow patients with gastric cancer to express feelings of grief, fear, and anxiety.
• For patients with advanced gastric cancer, identify the need for end-of-life care, including referral to
hospice care.
Physiological Integrity
• Teach patients the importance of adhering to H. pylori treatment to prevent the risk for gastric
cancer.
• For patients who have undergone a gastrectomy, collaborate with the dietitian and instruct the
patient regarding diet changes to avoid abdominal distention and dumping syndrome.
Teach patients with abnormal symptoms (e.g., abdominal tenderness, abdominal pain that is relieved by
food or pain that becomes worse 3 hours after eating, dyspepsia, melena, and/or distention) to consult
with their physician immediately for a prompt diagnosis and treatment.
• Teach patients that hematemesis is a medical emergency and that they should go to the emergency
department for prompt treatment.
• Teach the proper administration of antacids (one to two after meals). Tell patients that antacids can
interfere with the effectiveness of certain drugs, such as phenytoin (Dilantin).
• Teach the proper administration of H2 antagonists. Explain that they should be given on an empty
stomach (see Chart 58-3).
• Teach the proper administration of antisecretory agents, noting that most cannot be crushed because
they are sustained-release or enteric-coated tablets.
• Assess patients for clinical manifestations of gastritis.
• Monitor patients with ulcers for any of the signs and symptoms of GI bleeding that are listed in Chart
58-4. Report any of these symptoms if noted to a physician immediately.
• Insert a nasogastric tube (NGT) as outlined in Chart 58-5.
• After an EGD, monitor the patient's vitals signs, heart rhythm, and oxygen saturation frequently until
they return to baseline. To prevent aspiration, assess the gag reflex and ensure that it is intact before
giving the patient food.
• Observe the patient for signs and symptoms of dumping syndrome after gastric surgery; teach the
manifestations and management of this syndrome. Advise the patient to eat six small meals per day and
to consume a diet high in protein and fat but low in carbohydrate-rich foods. Liquids should not be taken
with meals.
Chapter 59 Key Points
Safe and Effective Care Environment
• Refer patients with familial CRC syndromes for genetic counseling and testing.
• Refer ostomy patients to the United Ostomy Associations of America, Inc. and the American Cancer
Society for additional information and support groups.
• Consult with the certified wound, ostomy, continence nurse (CWOCN) or enterostomal therapist
(ET) when a patient is scheduled for or has a new colostomy.
• Prioritize care for patients experiencing abdominal trauma: first assess airway, breathing, and
circulation (ABCs), and then monitor mental status, vital signs, and skin perfusion to assess for
hypovolemic shock.
Health Promotion and Maintenance
• Teach patients with irritable bowel syndrome (IBS) to avoid GI stimulants, such as caffeine, alcohol,
and milk and milk products, and to manage stress.
Instruct patients on dietary modifications to decrease the occurrence of colorectal cancer (CRC).
• Teach adults 50 years and older to have routine screening for CRC as listed in Chart 59-1; people
with genetic predispositions should have earlier and more frequent screening.
• Teach patients and caregivers how to provide colostomy care, including dietary measures, skin care,
and ostomy products.
• Teach people measures for preventing constipation to minimize hemorrhoid occurrence.
Psychosocial Integrity
• Assess effects of IBS on patient lifestyle; recommend stress management techniques.
• Assist the patient with CRC with the anticipatory grieving process.
• Be aware that having a colostomy is a life-altering event that can severely impact one's body image;
issues related to sexuality and fear of acceptance should be discussed.
Physiological Integrity
• Assess patients with IBS for elimination pattern, abdominal pain, and nausea.
• Be aware that minimally invasive inguinal hernia repair is an ambulatory procedure done via
laparoscopy; postoperative management requires health teaching regarding rest for a few days and
inspection of incisions for signs of infection.
Chapter 60 Key Points
Safe and Effective Care Environment
• Teach patients to use infection control measures to prevent transmission of gastroenteritis as stated
in Collaborate with a CWOCN or ET nurse for ileostomy teaching and care; collaborate with a case
manager when planning for patient discharge.
Health Promotion and Maintenance
• Teach patients with chronic IBD to avoid GI stimulants, such as alcohol and caffeine; each patient's
response to foods differs.
• Instruct patients with diverticulosis about nutrition modifications, such as avoiding nuts, foods with
seeds, and GI stimulants.
• Teach patients with diverticulosis to eat a high-fiber diet; diverticulitis requires a low-fiber diet.
Psychosocial Integrity
• Be aware that all inflammatory bowel diseases (acute and chronic) are very disruptive to one's daily
routine; chronic IBD requires a lifetime of modifications.
• Recognize that having an ileostomy impacts the patient's body image and self-esteem; assess for
coping strategies that the patient has previously used, and identify personal support systems to assist in
coping.
Chapter 62 Key Points
Safe and Effective Care Environment
1 Collaborate with health care team members to provide care for patients with pancreatic disorders.
Health Promotion and Maintenance
2 Teach people about health promotion practices to prevent gallbladder disease.
3 Teach people about health promotion practices to prevent pancreatitis.
4 Identify community-based resources for patients with pancreatic disorders.
Psychosocial Integrity
5 Describe the psychosocial needs of patients with pancreatic cancer and their families.
6 Assess patient and family response to a diagnosis of pancreatic cancer.
Chapter 63 Key Points
Safe and Effective Care Environment
• Ensure that feeding tube placement is verified by x-ray; check placement every 4 to 8 hours by
aspirating gastric contents and assessing pH for nasogastric tubes.
• Place patients receiving tube feeding in a semi-Fowler's position at all times to prevent aspiration;
check residual contents every 4 hours or as designated per facility policy.
• Use gloves when changing feeding system tubing or adding product; use sterile gloves when working
with critically ill or immunocompromised patients.
• Use a feeding pump when the patient receives continuous or cyclic tube feeding.
• Collaborate with the interdisciplinary health care team, especially the dietitian, health care provider,
and case manager, when caring for patients with malnutrition or obesity. 13561357
• Be sure that bariatric furniture and equipment are available for the obese patient in the hospital or
other health care setting; avoid pressure on skinfold areas.
• Perform nutritional screening for all patients to determine if they are at risk (see Charts 63-1 and 632).
• For patients receiving enteral or parenteral nutrition at home, teach family members or other
caregivers how to provide nutrition while avoiding complications.
• Teach patients who are undernourished to eat high-protein, high-calorie foods and nutritional
supplements.
• Instruct obese patients about the importance of health care provider–approved exercise for weight
reduction.
Psychosocial Integrity
• Be aware that some obese patients may not view their weight as a problem and are therefore
unlikely to be part of a weight-reduction plan.
• Recognize that obesity can cause depression or anxiety, low self-esteem, and a disturbed body
image.
• Be aware of legal and ethical issues related to tube-feeding older adults with chronic or terminal
illness.
Physiological Integrity
• Review serum prealbumin, hemoglobin, and hematocrit levels to identify patients at nutritional risk.
• Older patients are at increased risk for malnutrition (see Chart 63-2).
• Assess patients with severe malnutrition for common complications, such as edema; lethargy; and
dry, flaking skin.
• Implement interventions to promote nutritional intake in older adults as specified in Chart 63-3.
• Provide nursing interventions for managing total enteral nutrition as listed in Chart 63-4.
• Maintain feeding tube patency for patients receiving total enteral nutrition as described in Chart 635.
• Provide care for patients receiving total parenteral nutrition as specified in Chart 63-6.
• Recognize that many people are following low-carbohydrate rather than low-fat diets to lose
weight.
• Recall that normal body mass index (BMI) for adults should be between 18.5 and 25; older adults
should have a BMI between 23 and 27. A BMI of 27 to 30 indicates overweight, over 30 indicates
obesity, and 40 and greater indicates morbid obesity.
• Recall that obesity causes early onset of many chronic illnesses, such as osteoarthritis, diabetes
mellitus, hypertension, and coronary artery disease. Pulmonary problems, such as obstructive sleep
apnea, delayed wound healing, and infections are also common.
• Remember that bariatric surgery includes gastric restriction procedures or gastric bypass; a
panniculectomy may be performed to remove skinfolds once weight is stabilized.
• Be alert for signs and symptoms of anastomotic leak after bariatric surgery, including severe pain,
restlessness, anxiety, and unexplained tachycardia.
• Provide postoperative care for patients having bariatric surgery to prevent complications such as
wound dehiscence, respiratory distress, skin breakdown, and thromboembolitic complications, such as
pulmonary embolism. Observe for complications, such as dumping syndrome in patients who have a
gastric bypass. Tachycardia, nausea, diarrhea, and abdominal cramping are common manifestations of
dumping syndrome.
• Provide discharge teaching for patients having bariatric surgery as described in Chart 63-7.
Best Practice for Patient Safety & Quality Care
Care and Maintenance of Total Parenteral Nutrition
• Check each bag of total parenteral nutrition (TPN) solution for accuracy by comparing it with the
physician's or pharmacist's prescription.
• Monitor the IV pump for accuracy in delivering the prescribed hourly rate.
• If the TPN solution is temporarily unavailable, give 10% dextrose/water (D/W) or 20% D/W until the
TPN solution can be obtained.
• If the TPN administration is not on time (“behind”), do not attempt to “catch up” by increasing the
rate.
• Monitor the patient's weight daily or according to facility protocol.
• Monitor serum electrolytes and glucose daily or per facility protocol. (Many facilities require fingerstick blood sugars [FSBSs] every 4 hours, especially if the patient is receiving insulin. Urine testing for
ketones may also be requested.)
• Monitor for, report, and document complications, including fluid and electrolyte imbalances.
• Monitor and carefully record the patient's intake and output.
• Assess the patient's IV site for signs of infection or infiltration (see Chapter 15).
• Change the IV tubing every 24 hours or per facility protocol.
• Change the dressing around the IV site every 48 to 72 hours or per facility protocol.
• Before administering TPN, have a second nurse check the prescription and solution to prevent
patient harm.