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Med Surg 1 > Chapter 55 > Flashcards

Chapter 55 Flashcards

1
Q

The upper sphincter of the stomach is called the ______ while the lower sphincter is called the ____________.

A

Cardiac, pyloric

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2
Q

The ______ secretes enzymes needed for the digestion of carbohydrates, fats, and proteins.

A

Exocrine part of the pancreas

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3
Q

The ________ produces insulin.

A

Endocrine part of the pancreas

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4
Q

The liver functions in metabolism for _______ which is considered essential for human survival.

A

Proteins

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5
Q

Normal findings for an older adult include _______- in hydrochloric acid levels, _________ absorption of vitamin B12 and iron, and ___________________ as a result of bacterial growth.

A

Decreased, decreased, Atrophic gastritis

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6
Q

For the older adult who has decreased hydrochloric acid levels, the nurse should encourage which type of diet and asses for what?

A

Bland foods, high in vitamins and iron

Assess for epigastric pain

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7
Q

Normal findings for the older adult include ________ sensation to defecate which leads to ________ and ________.

A

Decreased, constipation, impaction

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8
Q

For the older adult with constipation, which type of diet should be encouraged? What type of lifestyle changes?

A

High-fiber diet with 1500mL fluid intake

Encourage as much activity as tolerated

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9
Q

Normal findings for the older adult include __________ lipase levels that results in __________ and ________________.

A

Decrease, decreased fat absorption, steatorrhea

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10
Q

The nurse should encourage ____________________________ for the patient with decreased lipase and steatorrhea.

A

Small, frequent meals

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11
Q

Normal findings for the older adult is _________ enzyme activity in the liver which depresses _____________________.

A

decrease, drug metabolism

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12
Q

The older adult has decreased enzyme activity in the liver, the nurse should therefore assess…

A

Adverse effects of all drugs and drug levels.

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13
Q

________ adults are a higher risk for stomach cancer and _________ adults are at higher risk for IBS

A

Older, younger

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14
Q

Long-term use of laxatives or enemas can cause _______, result in _______, and lead to ________________.

A

Dependency, constipation, electrolyte imbalances.

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15
Q

True or False: Socioeconomic status may affect nutritional status

A

True

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16
Q

PQRST method for pain assessment

A 
P: Precipitating or Palliative
Q: Quality or Quanitity
R: Region or Radiation 
S: Severity Scale
T: Timing
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17
Q

Familial Adenomatous Polyposis (FAP) is an inhereited autosomal dominant disorder that predisposes the patient to…

A

Colon cancer

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18
Q

What quadrant are the following parts located in?

  1. Liver
  2. Appendix
  3. Stomach
  4. Pancreas
  5. Duodenum
  6. Gallbladder
  7. Sigmoid colon
  8. Spleen
A
  1. RUQ
  2. RLQ
  3. LUQ
  4. LUQ
  5. RUQ
  6. RUQ
  7. LLQ
  8. RUQ
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19
Q

Sequence for assessment of abdomen:

A

Inspection, auscultation, percussion, palpitation

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20
Q

True or False: The nurse should palpate for pain when abdominal aneurysm is suspected

A

FALSE- You should not touch the area

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21
Q

The nurse notices a bulging, pulsating mass during assessment of the patient’s abdomen. The nurse recognizes this as __________ and does what?

A

Abdominal aortic aneurysm, Notify the health care provider immediately.

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22
Q

The nurse sees peristaltic movements when looking at the patient’s abdomen. The nurse recognizes this could be a sign of ________ and does what?

A

Intestinal obstruction, notify the provider.

*Peristalsis may be seen in very thin patients

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23
Q

Cullen’s sign is an indication of ___________ and manifests as _________________

A

Intra-abdominal bleeding, Ecchymosis around the umbilicus

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24
Q

Auscultation of the abdomen should be performed with the _____ of the stethoscope because the bowel sounds are usually ____________.

A

diaphragm, high pitched

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25
Q

High-pitched, irregular gurgles should be heard every ______ seconds, with ______ per minute

A

5-15, 5-30

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26
Q

Loud, gurgling sounds (borborygmus) are typically heard in patients with…

A

Diarrhea, gastroenteritis, or above a complete intestinal obstruction

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27
Q

A swooshing sound when auscultating the abdomen indicates ______ and the nurse should….

A

bruit, not percuss or palpate- notify health care provider

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28
Q

Areas of pain when palpating the abdomen should be evaluated for…

A

Rebound tenderness (Blumberg’s sign)

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29
Q

What is Blumberg’s sign?

A

Fingers placed at 90 degree angle to the abdomen, push slowly in and release quickly. Pain felt on release is positive and should be reported to the health care provider

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30
Q

CBC can help diagnose ______ and ______.

A

Anemia, infection

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31
Q

Anemia indicated by a CBC may indicate….

A

GI bleeding, GI cancer, PUD, and IBS

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32
Q

______ is useful in evaluating clotting factors.

A

PT (prothrombin time): measures rate at which prothrombin is converted to thrombin.

33
Q

_________ levels may be measured to detect malabsorption. _______ and ______ levels may be depleted from excessive vomiting and diarrhea

A

Calcium, sodium, potassium

34
Q

________ and _________ are two enzymes found in the liver and are usually elevated in most liver disorders, especially those such as severe viral hepatitis and cirrhosis

A

AST, ALT

Aspartate aminotransferase, alanine aminotransferase

35
Q

Elevations in ________ and ________ indicate extensive pancreatic necrosis.

A

Lipase, amylase

36
Q

These two primary oncofetal antigens are evaluated to diagnose cancer and monitor cancer therapy. They will be elevated, even in benign GI conditions.

A

CA19-9 and CEA

37
Q

American cancer society recomends colon cancer screening every….

38
Q

The most common test to detect C. diff. is…

Results are avialble…

A

ELISA (enzyme-linked immunosorbent assay) toxin A+B

2-6 hours

39
Q

The most reliable test for C. Diff is…

A

Cytotoxic Assay

40
Q

The first x-ray study that the health care provider requests when diagnosing a GI problem is usually….

A

A plain film of the abdomen

41
Q

Before an x-ray plain film of the abdomen, the nurse must instruct the client to…

A

Remove all jewelry and belts that may interfere

42
Q

If abdominal pain is severe or when bowel perforation is suspected, a ______________ is requested.

A

Acute Abdomen series

chest xray + upright abdomen film + supine abdomen film

43
Q

Bilirubin levels help indicate evaluation of the ________

44
Q

Ammonia levels can indiacte ________ function, with increased levels related to _______ or _______.

A

Liver, cirrhosis, fulminant hepatitis

45
Q

_______ is the msot common and easiest at home fecal occult blood test.

46
Q

C. diff is usually seen and older adults and caused from…

A

prolonged antibiotic use

47
Q 
Normal ranges:
Calcium
Potassium
Albumin
ALT
AST
Bilirubin
Ammonia
Amylase
Lipase
A 
Calcium- 9.0-10.5
Potassium- 3.5-5.0
Albumin- 3.5-5.0
ALT- 3-35/8-20
AST- 5-40
Bilirubin- 0.1-1.0
Ammonia- 15-110
Amylase- 56-90/25-125
Lipase- 0-110
48
Q

An x-ray visualization from the mouth to the duodenojejunal junction. Used to detect disorders of structure or function of the esophagus, stomach, or duodenum by following barium.

A

Upper GI radiographic series

49
Q

Before the patient has an upper GI radiographic series, the nurse should instruct the patient to… .

A
  1. Withhold foods and liquids for 8 hours before the test
  2. Withhold opiod analgesics and anticholinergic medications for 24 hours
  3. Teach patient about the procedure and need to swallow 16 oz of barium
  4. Explain the rotating examination table (vertical, supine, prone, and lateral positions)
50
Q

An extention of the upper GI series that continues tracing the barium through the small intestine to detect disorders of the jejunum or ileum.

A

Small bowel follow-through (SBFT)

51
Q

The upper GI radiographic series takes _____ minutes. It may help identify ___________ and ______. The SBFT may take…

A

30, hiatal hernia, gastroesophageal reflux, a few hours

52
Q

Post-op teaching for the uppper GI radiogrpahic series includes….

A
  1. Instruct patient to drink plenty of fluids to help eliminate barium
  2. A mild laxative/stool softener may be given
  3. Stools may be chalky white for 24-72 hours
  4. Instruct patient to report abdominal fullness, pain, or delay in return to brown stools
53
Q

A _______ is an x-ray of the large intestines and an option to determine the presence of colorectal cancer.

A

Barium Enema (lower GI series)

54
Q

In preparation for a barium enema, the nurse should instruct the patient….

A
  1. Take laxatives as prescribed
  2. Be on a clear liquid diet
  3. An enema will be administered.
55
Q

The post-op teaching for the barium enema includes…

A
  1. Teach the patient to drink plenty of fluids
  2. A laxative may be given
  3. Stools are chalky white for 24-72 hours, notify provider if no BM within 2 days
  4. If the result is positive, the patient will be scheduled for a colonoscopy
56
Q

The ___________ looks for colorectal cancer and polyps.

A

Barium enema

57
Q

A ______________ is a direct visualization of the GI tract using a flexible fiberoptic endoscope. It is commonly requested to evaluate bleeding, ulceration, inflammation, tumors, and cancer of the esophagus, stomach, biliary system or bowel. MUST have informed consent.

58
Q

A visual examination of the esophagus, stomach, and duodenum. This procedure significantly reduced the number of upper GI series done.

A

EGD (esophagogastroduodenoscopy)

59
Q

Before the patient undergoes and EGD, what patient teaching is needed?

A
  1. NPO for 6-8 hours before the procedure
  2. Usual drug therapies may be taken the morning of the test. IF the patient is diabetic, tell them to contact the physician for special instructions (eating, insulin are concernes)
  3. Patients should avoid anti-coagulants, aspirin, NSAIDs several days before the test
  4. Inform the patient they will be under moderate sedation
  5. A local anesthetic will be sprayed to inactivate the gag reflex
60
Q

Nursing interventions postoperatively for the EGD include…

A
  1. Checking vital signs every 30 minutes
  2. Keep siderails raised
  3. Patient kept NPO until gag reflex returns (usually 1-2 hours)
  4. Remind patient not to drive for at least 12 hours
  5. Teach patient sore throat and hoarse voice may remain for several days and throat lozenges may be used.
61
Q

The priority care after an EGD is to prevent __________. This means, the patient must remain NPO until…..
The nurse should also monitor for signs of perforation which are…

A

Aspiration, gag reflex has returned

Pain, bleeding, fever

62
Q

Includes visual and radiogarphic examination of the liver, gallbladder, bile ducts, and pancreas to identify the cause and loaction of obstructions. It is commonly used therapeuticly rather than to diagnose

A

ERCP (endoscopic retrograde cholangiopancreatography)

63
Q

In this procedure, a radiopaque dye is instilled and then several x-ray images are obtained. The physician may perform a papillotomoy to remove gallstones and stents may be placed to keep ducts open. Biopsies of tissue may also be taken.

A

ERCP (endoscopic retrograde cholangiopancreatography)

64
Q

Preoperative care the the patient undergoing an ERCP includes….

A
  1. NPO for 6-8hrs before
  2. Ensure IV access for moderate sedation
  3. Ask about prior exposure to x-ray contrast media and any sensitivities or allergies
  4. Remove dentures, ensure the patient has no implantable devices
  5. The physician decides which drugs are safe and which will be stopped
65
Q

Postoperative care for the patient who has had an ERCP include…

A
  • Assess vital signs every 15 minutes until patient is stable
  • Ensure gag reflex has returned before allowing anything by mouth
  • Teach patient and family to assess for cholangitis (gallbladder inflammation), bleeding, perforation, sepsis, and pancreatitis
  • Immediately report fever as this is a sign of sepsis
  • Instruct atient to report abdominal pain, fever, nausea or vomiting
66
Q

Provides a view of the small intestine and is used to evaluate and locate the source of GI bleeding. The patient swallows a capsule and returns to normal activity for the remainder of the study.

A

Enteroscopy

67
Q

Teaching for an eteroscopy:

A
  1. Water fast 8-10 hours before
  2. NPO first 2 hours of testing
  3. Normal diet 4 hours after and normal activity right after swallowing the capsule with a class of water
  4. Patient will return to the facility with capsule to download to a computer.
  5. Procedure lasts 8 hours. Capsule will be seen in stool.
68
Q

An endoscopic examination of the entire large bowel. Physician maay obtain tissue biopsy specimens or remove polyps. Can also evaluate the cause of chronic diarrhea or locate source of GI bleeding.

A

Colonoscopy

69
Q

Recommended by the ACS for patients over ___ years have one every _____ years. Those with high risk for cancer or who have had _______ should have one more often.

A

50, 10, polyps

70
Q

Patient preparation for the colonoscopy includes:

A
  1. Clear liquid diet day before: avoid red, orange, purple drinks
  2. Drink an abundant amount of Gatorade to replace electrolytes
  3. NPO (except water) 4-6 hours before
  4. Avoid aspirin, anticoagulants, antiplatelet drugs several days before
  5. Diabetic patients should check with the provider for special instructions
  6. Patient drinks CHILLED liquid preparation for cleansing the bowel the evening before the exam. (watery diarrhea starts 1 hours after)
  7. IV access needed for moderate sedation
71
Q

Postoperative care for the patient who has had an colonoscopy include…

A
  1. Check vital signs every 15 minutes until patient is stable
  2. Keep siderails up until patient is fully alert
  3. NPO status until after stable and peristalsis returns
  4. Observe for signs of perforation (severe pain, hemorrhage, drop in BP)
  5. Reassure patient that feeling of fullness, cramping, and passage of flatus are expected for several hours.
  6. If polypectomy is performed, small amounts of blood will be in first stool, but excessive bleeding/severe pain needs to be reported
72
Q

A noninvasive imaging procedure to obtain multi-dimensional views of the entire colon

A

CT colonography (virtual colonoscopy)

73
Q

Most common form of stomatitis

A

Aphthous ulcers

74
Q

Extensive stomatitis may require treatment with…

A

opioid analgesics

75
Q

Primary stomatitis is the most common type and includes…

A
  1. Aphthous stomatitis
  2. Herpes simplex stomatitis
  3. Traumatic ulcers
76
Q

Secondary stomatitis usually results from…

A

infection by opportunistic viruses, fungi, or bacteria in patients who are immunocompromised. also, chemotherapy

77
Q

A common type of secondary stomatitis is… and is caused by…

A 
Candida Albicans (Thrush) 
Long-term antibiotic therapy
78
Q

A fungal infection in the mouth that is very painful

A

Candidiasis

Med Surg 1 (5 decks)

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