Medical Surgical Nursing Study Guide
System/Part/Type Affected: Complication after Surgery
Disease: Dumping Syndrome
Pathophysiology/Definition:
Definition:
Common complication that occur after any
surgical procedure that involves the
removal/resection of any significant portion
of stomach. A condition of rapid emptying
of gastric contents into the small intestine
usually after gastric surgery.
Laboratory and Diagnostics:
Nursing Intervention:
1. Advice patient to eat low carbohydrate,
high fat, high protein diet
2. Instruct to eat small frequent meal, with
more dry items
3. Instruct to avoid consuming fluid with
meals
4. Instruct to lie down after meals.
Sign and Symptoms:
Early Symptoms:
 Will occur after 10-30 minutes after
eating.
 Nausea and Vomiting, early satiety
 Abdominal Fullness, Diarrhea
 Abdominal Cramping, pain
Initial Sign:
 Diaphoresis and tachycardia
 *Resolve within one hour with
defecation.
Later Sign:
 Hypoglycemia (2-3 hours after eating)
 Burning epigastric pain increase after
meal cause of bile reflux.
Medication Treatment:
Medication for Bile Reflux:
Sucralfate (Carafate)
Cholestyramine (Questran)- prevent in
reabsorption of bile to eliminate via stool.
Patient Education:
 Medical Surgical Nursing Study Guide
System/Part/Type Affected: Complication after Surgery
Disease: Pernicious Anemia

Pathophysiology/Definition: Sign and Symptoms/Assessment

Definition:
Result from deficiency of vitamin B 12 due
to autoimmune destruction of parietal cells,
lack of intrinsic factor or total removal of
stomach.
Finding:
Assessment findings:
Severe Pallor, patient look pale
Fatigue, Weight loss
Significant Finding: Smooth beefy red
tongue and paresthesia of extremities.

Laboratory and Diagnostics: Medication Treatment:

Nursing Intervention: Patient Education:

1. Lifetime injection of B12 initially weekly,
then monthly.
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System/Part/Type Affected: Esophagus
Disease: Hiatal Hernia

Pathophysiology/Definition: Sign and Symptoms/Assessment

Protrusion of the esophagus into the Finding:
diaphragm may be caused by congenital Assessment Findings:
weakening of the muscle in the diaphragm  Heart Burn (pyrosis)
around the esophagogastric opening. More  Regurgitation
common in women.  Dysphagia
Types:  Intermittent Epigastric Pain
Sliding: upper stomach and gastro
 Fullness after eating
esophageal junction displaced upward and
Large Hiatal Hernia:
slide in and out of the thorax.
 Intolerance of food, nausea, and
Paraoesophageal: all or part of the
vomiting
stomach pushes through the diaphragm
Both Type:
besides the esophagus.
 Hemorrhage
 Obstruction and strangulation
Laboratory and Diagnostics: Medication Treatment:
 Confirmed by X-Ray
 Barium Swallow
 EGD, esophagogastroduodenoscopy
 CT Scan
Nursing Intervention: Surgical Management:
1. Small Frequent feeding  Surgical Hernia Repair
2. Avoid supine position 1hr after eating  Laparoscopic approach with an open
3. Elevate the head of the bed 4-8 inch or transabdominal or transthoracic
two pillows approach if complications such as
bleeding, dense adhesion, injury of the
4. Avoid activities that will increase the spleen.
intra-abdominal pressure
IN CASE SURGERY:
AFTER SURGERY:
 Slowly from liquid to solid diet after sign
of bowel movement
 WOF: bleaching, vomiting, gagging,
abdominal distention, and epigastric
chest pain, which may indicate the need
for surgical revisions.
 Medical Surgical Nursing Study Guide

System/Part/Type Affected: Esophagus

Disease: Esophageal Varices

Pathophysiology/Definition: Sign and Symptoms/Assessment

Definition: Finding:
Dilated, tortuous veins of the submucosal Assessment Findings:
vein of the distant esophagus. It is an  Hematemesis, blood in the vomitus
emergency condition.  Melena, blood in the stool, black tarry
Etiology: stool
Portal hypertension secondary to lover  Sign of shock if bleeding is severe
cirrhosis (it is the elevated pressure in the o Hypotension, Tachycardia,
vein that drains in the portal system)
Tachypnea
Pathophysiology:
 Ascites, increased accumulation of fluid
 Liver Problem (obstruction, bleeding,
in the peritoneal cavity
cirrhosis, hepatitis)
 Portal hypertension, caused by
resistance and it will increase portal
venous inflow
 It will then develop a portal pressure
gradient
o Higher than 10mmHg
 Venous collaterally develop from high
portal systemic vein
 Abnormal varicoid vessel form in any
above locations
 Vessels may rapture causing a life-
threatening hemorrhage
Laboratory and Diagnostics: Medication Treatment:
Diagnostic Procedure:  Sandostatin Octreotide, to control
 Endoscopy/Esophagoscopy bleeding
 Ultrasound  Vasopressin (Pitressin), to decrease
 CT Scan portal pressure
 Angiography  Beta-blockers such as propranolol,
Laboratory Test: nadolol, to decrease portal pressure
 Liver Function Test and to prevent a first bleeding episode
 Bilirubin, alkaline phosphatase, serum but should not be used in acute
aminotransferase, serum proteins bleeding
 Splenoportography
 Hepatoportography
 Celiac Angiography
Note: If no varices is detected, repeat after
2-3 years. If small varices, repeat 1-2 yrs.
Nursing Intervention: Surgical/Non-Surgical Management:
1. Monitor VS, note signs of shock Balloon Tamponade, however non-surgical
2. Prepare BT, IV, volume expander treatment is advise to avoid bleeding and
3. Assist in Sengstaken-Blakemore Tube further complication.
 Medical Surgical Nursing Study Guide
4. Assist in iced saline irrigation
System/Part/Type Affected: Esophagus
Disease: Diverticulum

Pathophysiology/Definition: Sign and Symptoms/Assessment

It is an outpouching of mucosa and Finding:
submucosa that protrudes through the Symptoms:
weak portion of the musculature of the  Dysphagia
esophagus.  Fullness in the neck
Site:  Belching
 Pharyngoesophageal, upper part,  Regurgitation
common site  Gurgling noises after eating
o Zenker Diverticula, common
 Coughing
type, due to dysfunctional
 Halitosis, due to undigested food
sphincter that fails to open
 Midesophageal, middle portion,
uncommon/rare site
 Epiphrenic, lower portion, larger
diverticula occur in this site, due to
malfunction of lower sphincter and
motor function of esophagus
 Intramural Diverticulosis, occurrence of
numerous small diverticula
Laboratory and Diagnostics: Medication Treatment:
Diagnostic Exam:
 Barium Swallow, to determine the
nature and location of the diverticula
 Manometric, to rule out motor disorder
 Esophagoscopy is contraindicated
because there can be a danger of
perforation
Nursing Intervention: Surgical/Non-Surgical Management:
 Observe for leakage and development  Diverticulectomy, to remove the pouch
of fistula  Myomectomy, to relieve the spasticity of
 Food and fluid are withheld until x-ray musculature.
suggest no leakage Note: NGT may be inserted at time of
 Diet should start with liquid until surgery
tolerated.  Endoscopic Stapler Diverticulectomy,
reduce the risk of fistula and does note
require NGT.