🟦 TYPE 1 — DISEASE / CONDITION CARDS

What is a peptic ulcer?

SIMPLE: A sore in the lining of the stomach or duodenum. WHY: The protective lining becomes damaged, allowing acid to injure the tissue. SEE: Pain related to eating, indigestion/dyspepsia, and possible bleeding or hematemesis. DANGER: PERFORATION is the most lethal complication. DO: Reduce acid, protect the stomach, treat H. pylori if present, and monitor for bleeding/perforation. DRUG CONNECTION: PPIs, H2 blockers, antacids, mucosal protectants, and antibiotics for H. pylori. LIFE SCENARIO: Imagine the stomach has a protective raincoat. An ulcer is like a hole in the raincoat, allowing strong acid underneath to burn the tissue. PATIENT EXAMPLE: Mr. Jones has an ulcer and suddenly develops severe pain, low BP, and blood in his NG tube. Think PERFORATION. NCLEX CLUE: Ulcer + sudden pain + hypotension + blood = PERFORATION.

What is the important difference between peptic-ulcer pain and duodenal-ulcer pain in this chapter?

SIMPLE: Peptic-ulcer pain is associated with eating, while duodenal-ulcer pain often occurs 1–2 hours after eating. LIFE SCENARIO: One patient says, “My stomach hurts when I eat.” Another says, “I eat and then an hour or two later it starts hurting.” The second pattern points toward a duodenal ulcer. NCLEX CLUE: Pain 1–2 hours AFTER eating = DUODENAL ULCER.

What is H. pylori and why does it matter with ulcers?

SIMPLE: H. pylori is bacteria associated with peptic ulcers. WHY: If bacteria are helping cause the ulcer, simply reducing acid doesn't eliminate the infection. DO: Antibiotics are used to eradicate H. pylori. LIFE SCENARIO: Imagine fixing water damage but leaving the leaking pipe. You also have to fix the cause. PATIENT EXAMPLE: A patient has an H. pylori-positive ulcer. The provider gives antibiotics because the goal is to kill the bacteria. NCLEX CLUE: H. pylori = ANTIBIOTICS.

What is a perforated peptic ulcer?

SIMPLE: The ulcer has eaten completely through the stomach or duodenal wall. WHY DANGEROUS: Stomach/intestinal contents can leak into the abdomen and cause peritonitis. SEE: Pain, hypotension, hematemesis. DO: Report immediately. LIFE SCENARIO: Imagine a hole going completely through the wall of a container so everything inside begins leaking out. PATIENT EXAMPLE: Your ulcer patient suddenly becomes hypotensive and has severe pain and blood. This is no longer routine ulcer discomfort. NCLEX CLUE: PERFORATION = EMERGENCY.

What is dumping syndrome?

SIMPLE: Food moves through too rapidly after certain stomach surgeries. TRIGGER: High-carbohydrate food eaten quickly. DO: Six small meals, high protein and fat, low carbohydrates, avoid fluids with meals, and lying down after meals may help. LIFE SCENARIO: Instead of groceries being unloaded slowly, someone dumps the whole shopping cart at once. PATIENT EXAMPLE: A patient after Billroth II eats a large sugary breakfast and drinks a large beverage with it. Think DUMPING SYNDROME risk. NCLEX CLUE: Gastric surgery + high carbs = DUMPING.

Why can a patient need vitamin B12 monitoring after gastrectomy?

SIMPLE: Removing part of the stomach can reduce vitamin B12 absorption because of loss of intrinsic factor. DANGER: B12 deficiency can lead to pernicious anemia. DO: Monitor serum B12. LIFE SCENARIO: Think of intrinsic factor as the "ticket" B12 needs to get absorbed. Less stomach = fewer tickets = less B12 gets through. PATIENT EXAMPLE: A patient had a gastrectomy years ago. The nurse knows B12 levels need monitoring. NCLEX CLUE: GASTRECTOMY = B12.

What is achalasia?

SIMPLE: A problem involving movement of food through the esophagus into the stomach. AFTER ESOPHAGEAL DILATION: The chapter teaches drinking fluid with each meal to help push food into the stomach. LIFE SCENARIO: Imagine food getting stuck at a tight doorway. Fluid helps move it through. PATIENT EXAMPLE: A patient has esophageal dilation for achalasia. Teaching includes drinking fluid with meals. NCLEX CLUE: Achalasia + dilation = FLUID WITH MEALS.

What is a hiatal hernia?

SIMPLE: Part of the stomach moves upward through the diaphragm and may contribute to heartburn. SEE: Pyrosis/heartburn. DO: Eat SMALL meals and avoid overeating. LIFE SCENARIO: Think of an overfilled bag—the more you stuff inside, the easier it is for contents to push upward. PATIENT EXAMPLE: Your patient with a hiatal hernia eats three huge meals and has frequent heartburn. Teach smaller meals. NCLEX CLUE: Hiatal hernia + heartburn = SMALL MEALS.

What is diverticulosis?

SIMPLE: Small pouches called diverticula form in the intestinal wall. RISK CLUE FROM THIS CHAPTER: Large amounts of refined carbohydrates are associated with its development. LIFE SCENARIO: Imagine weak little pockets forming along a garden hose. Those pockets are diverticula. NCLEX CLUE: DiverticulOSIS = POUCHES are PRESENT.

What is diverticulitis?

SIMPLE: Diverticula become inflamed/infected. SEE: May have fever, elevated WBC, abdominal symptoms, nausea, diarrhea, and flatulence. DANGER: Infection can progress to septic shock. DO FROM THIS CHAPTER: High-fiber diet can help reduce/prevent recurrent symptoms, decrease meat/fat, and avoid activities increasing intra-abdominal pressure. LIFE SCENARIO: Diverticulosis is having the pockets; diverticulITIS is when those pockets become angry/inflamed. PATIENT EXAMPLE: A patient with diverticulitis has temp 102°F and high WBC, then becomes tachycardic. Think worsening infection/septic shock. NCLEX CLUE: Fever + WBC + tachycardia/hypotension = SEPTIC SHOCK.

What is Crohn disease?

SIMPLE: An inflammatory bowel disease that can cause diarrhea, nutritional problems, and major fluid loss. NUTRITION: Tube feedings may allow rapid absorption in the upper GI tract, followed by a low-residue, high-protein, high-calorie diet. WATCH: I&O closely because major fluid loss can occur. LIFE SCENARIO: Think of an irritated digestive tract that has trouble handling food and keeping fluid/nutrients in the body. PATIENT EXAMPLE: A Crohn patient has severe diarrhea. The nurse watches urine output closely to make sure the kidneys are still being perfused. NCLEX CLUE FROM CHAPTER: Aim for at least 1500 mL urine/day.

What is ulcerative colitis?

SIMPLE: An inflammatory bowel disease involving the colon. Severe disease may require surgery and an ileostomy. NURSING CONNECTION: Liquid ileostomy output can irritate skin. LIFE SCENARIO: If the diseased colon must be bypassed/removed, intestinal waste may need another exit. PATIENT EXAMPLE: A patient with ulcerative colitis returns after ileostomy surgery. A major nursing concern becomes the stoma and surrounding skin. NCLEX CLUE: UC + ileostomy = WATCH PERISTOMAL SKIN.

What is an ileostomy?

SIMPLE: An opening from the ileum through the abdomen that allows intestinal contents to leave the body. OUTPUT: Virtually liquid. DANGER: Digestive enzymes in the output can severely irritate surrounding skin. DO: Assess peristomal skin integrity. LIFE SCENARIO: Imagine irritating digestive liquid sitting on your skin repeatedly—it can make the skin raw quickly. PATIENT EXAMPLE: The pouch leaks watery stool around the stoma. Your priority assessment includes the skin around it. NCLEX CLUE: ILEOSTOMY = LIQUID output = SKIN protection.

What is an important psychosocial intervention for a new colostomy?

SIMPLE: A patient may struggle emotionally with the body change. DO: Encourage the patient to express concerns instead of giving false reassurance. LIFE SCENARIO: If someone says, “I don't think I'll ever get used to this,” telling them “You'll be fine” shuts down communication. Let them talk. PATIENT EXAMPLE: Patient says, “I'll never adjust to this colostomy.” Best response is to encourage expression of concerns. NCLEX CLUE: New ostomy + emotional concern = LISTEN/ENCOURAGE EXPRESSION.

What is a bowel obstruction?

SIMPLE: Intestinal contents cannot move normally through the bowel. EARLY SEE: Distention, nausea, visible peristaltic waves, faint high-pitched bowel sounds. LIFE SCENARIO: Imagine squeezing toothpaste through a tube with a blockage. Everything backs up and the bowel works hard trying to push it through. PATIENT EXAMPLE: Patient has distention, nausea, visible peristalsis, and high-pitched bowel sounds. Think early BOWEL OBSTRUCTION. NCLEX CLUE: Early obstruction = HIGH-PITCHED sounds.

What is a nonmechanical bowel obstruction?

SIMPLE: The bowel stops moving even though there is not necessarily an object physically blocking it. EXAMPLE: Paralytic ileus. LIFE SCENARIO: A road can stop traffic because a tree blocks it OR because every car stops moving. Paralytic ileus is like the cars stopped moving. NCLEX CLUE: PARALYTIC ILEUS = NONMECHANICAL.

What is a strangulated hernia?

SIMPLE: A hernia becomes trapped and the blood supply and intestinal flow are cut off. SEE: Pain and abdominal distention. DANGER: Tissue is losing blood supply. LIFE SCENARIO: Imagine tying a rubber band tightly around your finger—the tissue beyond it loses blood flow. PATIENT EXAMPLE: A patient with a large inguinal hernia develops pain and distention. Think STRANGULATION. NCLEX CLUE: Hernia + pain + distention = STRANGULATED.

What is appendicitis?

SIMPLE: Inflammation of the appendix. COMFORT INTERVENTION FROM THIS CHAPTER: Ice bag decreases blood flow to the area and impedes inflammation. LIFE SCENARIO: Think of the appendix as a small swollen pouch that is already irritated—you don't want to encourage more inflammation. PATIENT EXAMPLE: An appendicitis patient needs comfort. The chapter's correct intervention is an ICE BAG. NCLEX CLUE: Appendicitis = ICE in this chapter.

What is celiac disease?

SIMPLE: Gluten damages the villi of the small intestine. WHY BAD: Villi absorb nutrients. SEE: Malabsorption, diarrhea, weight loss, vitamin deficiencies. LIFE SCENARIO: Imagine villi as millions of tiny fingers grabbing nutrients. Gluten damages those fingers, so they can't grab food nutrients properly. PATIENT EXAMPLE: Patient eats gluten and develops diarrhea, weight loss, and vitamin deficiencies. Think CELIAC. NCLEX CLUE: Gluten → VILLI DAMAGE → MALABSORPTION.

What is irritable bowel syndrome (IBS) according to the Rome Criteria in this chapter?

SIMPLE: A bowel disorder involving recurring abdominal discomfort and changes in bowel habits. CLUES: Discomfort at least 3 days/month within the last 3 months, pain relieved by defecation, and onset associated with changes in stool frequency/appearance. LIFE SCENARIO: Patient says, “My stomach cramps, but after I poop it feels better, and my stool pattern has changed.” Think IBS. NCLEX CLUE: Pain relieved by DEFECATION + stool change.

What findings can suggest colorectal cancer in this chapter?

SEE: Changing bowel habits between diarrhea and constipation, abdominal pain, cachexia, cramps, rectal bleeding, and anemia. LIFE SCENARIO: A patient says, “Sometimes I'm constipated, sometimes I have diarrhea,” has unexplained weight loss and rectal bleeding, and labs show anemia. That combination needs investigation. NCLEX CLUE: BOWEL CHANGE + RECTAL BLEEDING + ANEMIA.

What are important esophageal cancer prevention/early-detection clues?

DO: Stop smoking, limit alcohol, monitor Barrett's esophagus, and seek medical evaluation for dysphagia. LIFE SCENARIO: A long-term smoker says food has recently become difficult to swallow. Don't dismiss it as aging—dysphagia needs evaluation. NCLEX CLUE: DYSPHAGIA = GET CHECKED.

What is antibiotic-associated pseudomembranous colitis?

SIMPLE: Colitis that may develop after prolonged antibiotic use. ORGANISM: Clostridium difficile (C. difficile). LIFE SCENARIO: Antibiotics are like weed killer that may also kill helpful gut bacteria, allowing C. difficile to take over. PATIENT EXAMPLE: Older patient has been taking antibiotics and develops significant diarrhea/colitis. Think C. DIFFICILE. NCLEX CLUE: ANTIBIOTICS + COLITIS = C. DIFF.

What is an anal fissure?

SIMPLE: An ulceration/laceration of the anal skin. CAUSE IN CHAPTER: Overstretching from passing constipated stool. LIFE SCENARIO: Think of dry, hard stool stretching delicate skin until it cracks. PATIENT EXAMPLE: Bedfast patient has frequent constipation and painful damaged anal skin. Think ANAL FISSURE. NCLEX CLUE: HARD STOOL + ANAL TEAR.

How can constipation be prevented in an older adult according to Chapter 45?

DO: Increase fiber, drink adequate fluids, schedule toileting after meals, and bulk-forming laxatives may be used. Routine daily stool softeners and tap-water enemas are not recommended in this question set. LIFE SCENARIO: Instead of waiting until Grandma is severely constipated, build a routine—breakfast, fluids, fiber, then scheduled bathroom time. NCLEX CLUE: CONSTIPATION prevention = FIBER + FLUID + ROUTINE.

What are intestinal villi?

SIMPLE: Millions of tiny fingerlike projections in the small intestine containing small blood vessels. JOB: Absorb products of digestion into the bloodstream. LIFE SCENARIO: Imagine millions of tiny hands lining the intestine and grabbing nutrients from food. NCLEX CLUE: Nutrient absorption = SMALL-INTESTINE VILLI.

What is pepsin?

SIMPLE: The chief enzyme of gastric juice that is activated by hydrochloric acid. JOB: Begins digestion of protein. LIFE SCENARIO: Think of pepsin as tiny scissors that start cutting big proteins into smaller pieces. NCLEX CLUE: PEPSIN = PROTEIN digestion.