Gastro Flashcards
1
Q
Diverticula
A
are saccular dilations or outpouchings of the mucosa that develop in the colon.
2
Q
Diverticulitis
A
is the inflammation of the diverticula resulting in perforation into the peritoneum.
3
Q
Clinically, diverticular disease convers a spectrum from:
A
asymptomatic, uncomplicated diverticulosis to diverticulitis with complications such as perforation, abscess, fistula, and bleeding.
4
Q
Do you always get “itis”?
A
- Diverticula are common, most people never develop the diverticulitis.
5
Q
Where are they found?
A
- Can occur anywhere in the Gi tract, but are most commonly found in the left (descending, sigmoid) colon.
6
Q
Symptoms
A
- Pain (usually lower left descending colon)
- Nausea/vomiting
- Fever
- Tenderness
- Constipation (less commonly diarrhea)
7
Q
Assessment/diagnostic
A
- Hx and physical exam
- Testing of stool for occult blood
- Barium enema
- Sigmoidoscopy
- Colonoscopy
- CBC
- Urinalysis
- Blood culture
- CT scan with oral contrast
- Abdominal x-ray
- Chest xray
8
Q
Teaching
A
- High fiber diet
- Dietary fiber supplements
- Stool softeners
- Anticholinergics
- Bed rest
- Clear liquid diet
- Oral antibiotics
- Mineral oil
- Bulk lacatives
- Weight reduction
9
Q
Treatment
A
Antibiotics
- goal of treatment is to let the colon rest and the inflammation subside.
- clear liquid diet
- acute care- NG suction and IV fluid
- surgery is reserved for patients with complications such as an abscess or obstruction that cannot be managed medically.
10
Q
Which foods should the nurse encourage a client with diverticulosis to incorporate into the diet? Select all that apply.
- Bran cereal.
- Broccoli.
- Tomato juice.
- Navy beans.
- Cheese.
A
1, 2, 4.
Clients with diverticulosis are encouraged to follow a high-fiber diet. Bran, broccoli, and navy beans are foods high in fiber. Tomato juice and cheese are low-residue foods.
11
Q
Which of the following laboratory findings would the nurse expect to find in a client with diverticulitis?
- Elevated red blood cell count.
- Decreased platelet count.
- Elevated white blood cell count.
- Elevated serum blood urea nitrogen concentration.
A
- Because of the inflammatory nature of diverticulitis, the nurse would anticipate an elevated white blood cell count. The remaining laboratory findings are not associated with diverticulitis. Elevated red blood cell counts occur in clients with polycythemia vera or fluid volume deficit. Decreased platelet counts can occur as a result of aplastic anemias or malignant blood disorders, as an adverse effect of some drugs, and as a result of some heritable conditions. Elevated serum blood urea nitrogen concentration is usually associated with renal conditions.
12
Q
The nurse is aware that the diagnostic tests typically ordered for acute diverticulitis do not include a barium enema. The reason for this is that a barium enema:
- Can perforate an intestinal abscess.
- Would greatly increase the client’s pain.
- Is of minimal diagnostic value in diverticulitis.
- Is too lengthy a procedure for the client to tolerate.
A
- Barium enemas and colonoscopies are contraindicated in clients with acute diverticulitis because they can lead to perforation of the colon and peritonitis. A barium enema may be ordered after the client has been treated with antibiotic therapy and the inflammation has subsided. A barium enema is diagnostic in diverticulitis. A barium enema could increase the client’s pain; however, that is not a reason for excluding this test. The client may be able to tolerate the procedure but the concern is the potential for perforation of the intestine.
13
Q
The nurse should teach the client with diverticulitis to integrate which of the following into a daily routine at home?
- Using enemas to relieve constipation.
- Decreasing fluid intake to increase the formed consistency of the stool.
- Eating a high-fiber diet when symptomatic with diverticulitis.
- Refraining from straining and lifting activities.
A
- Clients with diverticular disease should refrain from any activities, such as lifting, straining, or coughing, that increase intra-abdominal pressure and may precipitate an attack. Enemas are contraindicated because they increase intestinal pressure. Fluid intake should be increased, rather than decreased, to promote soft, formed stools. A low-fiber diet is used when inflammation is present.
14
Q
After instructing a client with diverticulosis about appropriate self-care activities, which of the following client comments indicate effective teaching? Select all that apply. 1. “With careful attention to my diet, my diverticulosis can be cured.”
- “Using a cathartic laxative weekly is okay to control bowel movements.”
- “I should follow a diet that’s high in fiber.”
- “It is important for me to drink at least 2,000 mL of fluid every day.”
- “I should exercise regularly.”
A
3, 4, 5.
Clients who have diverticulosis should be instructed to maintain a diet high in fiber and, unless contraindicated, should increase their fluid intake to a minimum of 2,000 mL/ day. Participating in a regular exercise program is also strongly encouraged. Diverticulosis can be controlled with treatment but cannot be cured. Clients should be instructed to avoid the regular use of cathartic laxatives. Bulk laxatives and stool softeners may be helpful to maintain regularity and decrease straining.
15
Q
A client with diverticular disease is receiving psyllium hydrophilic mucilloid (Metamucil). The drug has been effective when the client tells the nurse that he:
- Passes stool without cramping.
- Does not have diarrhea any longer.
- Is not as anxious as he was.
- Does not expel gas like he used to.
A
- Diverticular disease is treated with a high-fiber diet and bulk laxatives such as psyllium hydrophilic mucilloid (Metamucil). Fiber decreases the intraluminal pressure and makes it easier for stool to pass through the colon. Bulk laxatives do not manage diarrhea, anxiety or relieve gas formation.
16
Q
A client with diverticulitis has developed peritonitis following diverticular rupture. The nurse should assess the client to determine which of the following? Select all that apply.
- Percuss the abdomen to note resonance and tympany. 2. Percuss the liver to note lack of dullness.
- Monitor the vital signs for fever, tachypnea, and bradycardia.
- Assess presence of polyphagia and polydipsia.
- Auscultate bowel sounds to note frequency.
A
1, 2, 5.
Assessment during peritonitis will reveal fever, tachypnea, and tachycardia. The abdomen becomes rigid with rebound tenderness and there will be absent bowel sounds. Percussion will show resonance and tympany indicating paralytic ileus; loss of liver dullness may indicate free air in the abdomen. There is anorexia, nausea, and vomiting as peristalsis decreases.
17
Q
Inflammatory bowel disease (IBD)
A
Chronic inflammation of the GI tract. It is characterized by periods of remission interspersed with periods of exacerbation. The exact cause is unknown, and there is no cure.
IBD is classified as either Crohn’s disease or ulcerative colitis
18
Q
Location of ulcerative colitis and crohns
A
Ulcerative colitis- colon
crohn’s- mouth to anus
** both are autoimmune**
19
Q
Environmental factors that cause IBD
A
- diet
- hygiene
- stress
- smoking
- NSAID use ( influence microbial system)
20
Q
Where in the world is IBD most prevalent?
A
Industrialized regions
21
Q
Genetic factors that cause IBD
A
- white
- Jewish decedent
- familial genome- but if not exposed to trigger agent it can remain dormant.
22
Q
Canned elemental food
A
High protein, low fiber, calorie rich supplement for ulcerative colitis
23
Q
Why do you have bloody diarrhea in ulcerative colitis
A
The lining of the colon sloughs off and causes bloody diarrhea
24
Q
Signs/symptoms of UC
A
Anemia skin breakdown fever diarrhea boody stools, weight loss, abdominal pain, fatigue
25
Five major classes of medications used to treat IBD
```
aminosalicylates
antimicrobial
corticosteroids
immunosuppressants
biologic and targeted therpy
```
26
Describe Crohn cells
cobblestone cells in large colon, no parastalsis and an have blockage
** steroids are last resort**
27
The nurse is assigning clients for the evening shift. Which of the following clients are appropriate for the nurse to assign to a licensed practical nurse to provide client care? Select all that apply.
1. A client with Crohn's disease who is receiving total parenteral nutrition (TPN).
2. A client who underwent inguinal hernia repair surgery 3 hours ago.
3. A client with an intestinal obstruction who needs a Cantor tube inserted.
4. A client with diverticulitis who needs teaching about his take-home medications.
5. A client who is experiencing an exacerbation of his ulcerative colitis.
2, 5.
The nurse should consider client needs and scope of practice when assigning staff to provide care. The client who is recovering from inguinal hernia repair surgery and the client who is experiencing an exacerbation of his ulcerative colitis are appropriate clients to assign to a licensed practical nurse as the care they require fall within the scope of practice for a licensed practical nurse. It is not within the scope of practice for the licensed practical nurse to administer TPN, insert nasoenteric tubes, or provide client teaching related to medications.
28
A client who has had ulcerative colitis for the past 5 years is admitted to the hospital with an exacerbation of the disease. Which of the following factors was most likely of greatest significance in causing an exacerbation of ulcerative colitis?
1. A demanding and stressful job.
2. Changing to a modified vegetarian diet.
3. Beginning a weight-training program.
4. Walking 2 miles every day.
1.
Stressful and emotional events have been clearly linked to exacerbations of ulcerative colitis, although their role in the etiology of the disease has been disproved. A modified vegetarian diet or an exercise program is an unlikely cause of the exacerbation.
29
A client who is experiencing an exacerbation of ulcerative colitis is receiving I.V. fluids that are to be infused at 125 mL/ hour. The I.V. tubing delivers 15 gtt/ mL. How quickly should the nurse infuse the fluids in drops per minute to infuse the fluids at the prescribed rate? ________________________ gtt/ minute.
31 gtt/ minute
To administer I.V. fluids at 125 mL/ hour using tubing that has a drip factor of 15 gtt/ mL, the nurse should use the following formula: 125 mL/ 60 minutes × 15 gtt/ 1 mL = 31 gtt/ minute.
30
When planning care for a client with ulcerative colitis who is experiencing an exacerbation of symptoms, which client care activities can the nurse appropriately delegate to an unlicensed assistant? Select all that apply.
1. Assessing the client's bowel sounds.
2. Providing skin care following bowel movements.
3. Evaluating the client's response to antidiarrheal medications.
4. Maintaining intake and output records.
5. Obtaining the client's weight.
2, 4, 5.
The nurse can delegate the following basic care activities to the unlicensed assistant: providing skin care following bowel movements, maintaining intake and output records, and obtaining the client's weight. Assessing the client's bowel sounds and evaluating the client's response to medication are registered nurse activities that cannot be delegated.
31
Which goal for the client's care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis?
1. Promoting self-care and independence.
2. Managing diarrhea.
3. Maintaining adequate nutrition.
4. Promoting rest and comfort.
2.
Diarrhea is the primary symptom in an exacerbation of ulcerative colitis, and decreasing the frequency of stools is the first goal of treatment. The other goals are ongoing and will be best achieved by halting the exacerbation. The client may receive antidiarrheal agents, antispasmodic agents, bulk hydrophilic agents, or anti-inflammatory drugs
32
The client with ulcerative colitis is following orders for bed rest with bathroom privileges. When evaluating the effectiveness of this level of activity, the nurse should determine if the client has:
1. Conserved energy.
2. Reduced intestinal peristalsis.
3. Obtained needed rest.
4. Minimized stress.
2.
Although modified bed rest does help conserve energy and promotes comfort, its primary purpose in this case is to help reduce the hypermotility of the colon. Remaining on bed rest does not by itself reduce stress, and if the client is having stress, the nurse can plan with the client to use strategies that will help the client manage the stress.
33
A client's ulcerative colitis signs and symptoms have been present for longer than 1 week. The nurse should assess the client for signs and symptoms of which of the following complications?
1. Heart failure.
2. Deep vein thrombosis.
3. Hypokalemia.
4. Hypocalcemia.
3.
Excessive diarrhea causes significant depletion of the body's stores of sodium and potassium as well as fluid. The client should be closely monitored for hypokalemia and hyponatremia. Ulcerative colitis does not place the client at risk for heart failure, deep vein thrombosis, or hypocalcemia.
34
A client who has ulcerative colitis says to the nurse, "I can't take this anymore! I'm constantly in pain, and I can't leave my room because I need to stay by the toilet. I don't know how to deal with this." Based on these comments, an appropriate nursing diagnosis for this client would be:
1. Impaired physical mobility related to fatigue.
2. Disturbed thought processes related to pain.
3. Social isolation related to chronic fatigue.
4. Ineffective coping related to chronic abdominal pain.
4.
It is not uncommon for clients with ulcerative colitis to become apprehensive and upset about the frequency of stools and the presence of abdominal cramping. During these acute exacerbations, clients need emotional support and encouragement to verbalize their feelings about their chronic health concerns and assistance in developing effective coping methods. The client has not expressed feelings of fatigue or isolation or demonstrated disturbed thought processes.
35
A client newly diagnosed with ulcerative colitis who has been placed on steroids asks the nurse why steroids are prescribed. The nurse shuld tell the client?
1. "Ulcerative colitis can be cured by the use of steroids."
2. "Steroids are used in severe flare-ups because they can decrease the incidence of bleeding."
3. "Long-term use of steroids will prolong periods of remission."
4. . "The side effects of steroids outweigh their benefits to clients with ulcerative colitis."
2.
Steroids are effective in management of the acute symptoms of ulcerative colitis. Steroids do not cure ulcerative colitis, which is a chronic disease. Long-term use is not effective in prolonging the remission and is not advocated. Clients should be assessed carefully for side effects related to steroid therapy, but the benefits of short-term steroid therapy usually outweigh the potential adverse effects.
36
A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost 12 lb since the exacerbation of his ulcerative colitis. Which of the following will be most effective in helping the client meet his nutritional needs?
1. Continuous enteral feedings.
2. Following a high-calorie, high-protein diet.
3. Total parenteral nutrition (TPN).
4. Eating six small meals a day.
3.
Food will be withheld from the client with severe symptoms of ulcerative colitis to rest the bowel. To maintain the client's nutritional status, the client will be started on TPN. Enteral feedings or dividing the diet into six small meals does not allow the bowel to rest. A high-calorie, high-protein diet will worsen the client's symptoms.
37
A client with ulcerative colitis is to take sulfasalazine (Azulfidine). Which of the following instructions should the nurse provide for the client about taking this medication at home? Select all that apply.
1. Drink enough fluids to maintain a urine output of at least 1,200- 1,500 mL per day.
2. Discontinue therapy if symptoms of acute intolerance develop and notify the health care provider.
3. Stop taking the medication if the urine turns orange-yellow.
4. Avoid activities that require alertness.
5. If dose is missed, skip and continue with the next dose.
1, 2, 4.
Sulfasalazine may cause dizziness and the nurse should caution the client to avoid driving or other activities that require alertness until response to medication is known. If symptoms of acute intolerance (cramping, acute abdominal pain, bloody diarrhea, fever, headache, rash) occur, the client should discontinue therapy and notify the health care provider immediately. Fluid intake should be sufficient to maintain a urine output of at least 1,200- 1,500 mL daily to prevent crystalluria and stone formation. The nurse can also inform the client that this medication may cause orange-yellow discoloration of urine and skin, which is not significant and does not require the client to stop taking the medication. The nurse should instruct the client to take missed doses as soon as remembered unless it is almost time for the next dose.
38
The physician prescribes sulfasalazine (Azulfidine) for the client with ulcerative colitis to continue taking at home. Which instruction should the nurse give the client about taking this medication?
1. Avoid taking it with food.
2. Take the total dose at bedtime.
3. Take it with a full glass (240 mL) of water.
4. Stop taking it if urine turns orange-yellow.
3.
Adequate fluid intake of at least 8 glasses a day prevents crystalluria and stone formation during sulfasalazine therapy. Sulfasalazine can cause gastrointestinal distress and is best taken after meals and in equally divided doses. Sulfasalazine gives alkaline urine an orange-yellow color, but it is not necessary to stop the drug when this occurs.
39
The nurse has an order to administer sulfasalazine (Azulfidine) 2 g. The medication is available in 500-mg tablets. How many tablets should the nurse administer? ________________________ tablets.
4 tablets
| To administer 2 g sulfasalazine (Azulfidine), the nurse will need to administer 4 tablets.
40
A client with ulcerative colitis expresses serious concerns about her career as an attorney because of the effects of stress on ulcerative colitis. Which of the following nursing interventions will be most helpful to the client?
1. Review her current coping mechanisms and develop alternatives, if needed.
2. Suggest a less stressful career in which she would still use her education and experience.
3. Suggest that she ask her colleagues to help decrease her stress by giving her the easier cases.
4. Prepare family members for the fact that she will have to work part-time.
1.
A client with ulcerative colitis need not curtail career goals. Self-care is the cornerstone of long-term management, and learning to cope with and modify stressors will enable the client to live with the disease. Giving up a desired career could discourage and even depress the client. Placing the responsibility for minimizing stressors at work in the hands of others leads to a feeling of loss of control and decreases the sense of responsibility needed for sound self-care. Working part-time rather than full-time is unnecessary.
41
Which of the following diets would be most appropriate for the client with ulcerative colitis?
1. High-calorie, low-protein.
2. High-protein, low-residue.
3. Low-fat, high-fiber.
4. Low-sodium, high-carbohydrate.
2.
Clients with ulcerative colitis should follow a well-balanced high-protein, high-calorie, low-residue diet, avoiding such high-residue foods as whole-wheat grains, nuts, and raw fruits and vegetables. Clients with ulcerative colitis need more protein for tissue healing and should avoid excess roughage. There is no need for clients with ulcerative colitis to follow low-sodium diets.
42
A client who has a history of Crohn's disease is admitted to the hospital with fever, diarrhea, cramping, abdominal pain, and weight loss. The nurse should monitor the client for:
1. Hyperalbuminemia.
2. Thrombocytopenia.
3. Hypokalemia.
4. Hypercalcemia.
3.
Hypokalemia is the most expected laboratory finding owing to the diarrhea. Hypoalbuminemia can also occur in Crohn's disease; however, the client's potassium level is of greater importance at this time because a low potassium level can cause cardiac arrest. Anemia is an expected development, but thrombocytopenia is not. Calcium levels are not affected.
43
A client with Crohn's disease has concentrated urine, decreased urinary output, dry skin with decreased turgor, hypotension, and weak, thready pulses. The nurse should do which of the following first?
1. Encourage the client to drink at least 1,000 mL per day. 2. Provide parenteral rehydration therapy ordered by the physician.
3. Turn and reposition every 2 hours.
4. Monitor vital signs every shift.
2.
Initially, the extracellular fluid (ECF) volume with isotonic I.V. fluids until adequate circulating blood volume and renal perfusion are achieved. Vital signs should be monitored as parenteral and oral rehydration are achieved. Oral fluid intake should be greater than 1,000 mL/ day. Turning and repositioning the client at regular intervals aids in the prevention of skin breakdown, but it is first necessary to rehydrate this client.
44
The nurse is developing a plan of care for a client with Crohn's disease who is receiving total parenteral nutrition (TPN). Which of the following interventions should the nurse include? Select all that apply.
1. Monitoring vital signs once a shift.
2. Weighing the client daily.
3. Changing the central venous line dressing daily.
4. Monitoring the I.V. infusion rate hourly.
5. Taping all I.V. tubing connections securely.
2, 4, 5.
When caring for a client who is receiving TPN, the nurse should plan to weigh the client daily, monitor the I.V. fluid infusion rate hourly (even when using an I.V. fluid pump), and securely tape all I.V. tubing connections to prevent disconnections. Vital signs should be monitored at least every 4 hours to facilitate early detection of complications. It is recommended that the I.V. dressing be changed once or twice per week or when it becomes soiled, loose, or wet.
45
Which of the following should be a priority focus of care for a client experiencing an exacerbation of Crohn's disease? 1. Encouraging regular ambulation.
2. Promoting bowel rest.
3. Maintaining current weight.
4. Decreasing episodes of rectal bleeding.
2.
A priority goal of care during an acute exacerbation of Crohn's disease is to promote bowel rest. This is accomplished through decreasing activity, encouraging rest, and initially placing client on nothing-by-mouth status while maintaining nutritional needs parenterally. Regular ambulation is important, but the priority is bowel rest. The client will probably lose some weight during the acute phase of the illness. Diarrhea is nonbloody in Crohn's disease, and episodes of rectal bleeding are not expected.
46
Mild UC has how many poops a day
no more than 4
47
Moderate UC has how many poops a day?
up to 10
48
severe UC has how many poops a day
10-20
49
Which one, UC or krohn's is just the mucosal lining?
Ulcerative colitis
50
Which one, UC or krohn's, cause fitula, abscess and pockets?
Krohn's
51
Treatment for IBD
```
High calorie, high, vitamin, high protien, low residu lactose free
drug therapy
elemental diet or parenteral nutrition
physical and emotional rest
surgery
```
52
Gerd
Chronic symptom of mucosal damage caused by erlux of stomach acid into the lower esophagus. Increase in HCL. Can be because of a bad lower esophageal sphincter.
53
Is GERD a disease or syndrome?
Sundrome
54
Pyrosis
Heart burn
55
Diagnosing GERD
EGD, PH study
56
What foods exasperate GERD
caffeine, chocolate, peppermint
57
Respiratory symptoms of GERD
Wheezing, coughing, dyspnea, hoarseness, sore throat, globulus sensation, choking.
58
Treatment of GERD
Step method- antacid, H2 blocker, PPI
prop up bed, sleep on right side (ELDON says this, but book and internet said DONT sleep on right side.)
decrease spicy, decrease dairy, no food 3-4 hrs before bed.
59
What is a stricture?
scar tissue makes narrowing - fixed with dialation/balloon
60
What is Nissen
Fundus of the stomach is wrapped around the lower end of the esophagus to help reduce GERD
61
Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing gastroesophageal reflux disease (GERD)?
1. Limit caffeine intake to two cups of coffee per day.
2. Do not lie down for 2 hours after eating.
3. Follow a low-protein diet.
4. Take medications with milk to decrease irritation.
2.
The nurse should instruct the client to not lie down for about 2 hours after eating to prevent reflux. Caffeinated beverages decrease pressure in the lower esophageal sphincter and milk increases gastric acid secretion, so these beverages should be avoided. The client is encouraged to follow a high-protein, low-fat diet, and avoid foods that are irritating.
62
A client who has been diagnosed with gastroesophageal reflux disease (GERD) complains of heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet?
1. Lean beef.
2. Air-popped popcorn.
3. Hot chocolate.
4. Raw vegetables.
3.
With GERD, eating substances that decrease lower esophageal sphincter pressure causes heartburn. A decrease in the lower esophageal sphincter pressure allows gastric contents to reflux into the lower end of the esophagus. Foods that can cause a decrease in esophageal sphincter pressure include fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol. A diet high in protein and low in fat is recommended for clients with GERD. Lean beef, popcorn, and raw vegetables would be acceptable.
63
The client with gastroesophageal reflux disease (GERD) complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions?
1. Development of laryngeal cancer.
2. Irritation of the esophagus.
3. Esophageal scar tissue formation.
4. Aspiration of gastric contents.
4.
Clients with GERD can develop pulmonary symptoms, such as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing.
64
Bethanechol (Urecholine) has been ordered for a client with gastroesophageal reflux disease (GERD). The nurse should assess the client for which of the following adverse effects?
1. Constipation.
2. Urinary urgency.
3. Hypertension.
4. Dry oral mucosa.
2.
Bethanechol (Urecholine), a cholinergic drug, may be used in GERD to increase lower esophageal sphincter pressure and facilitate gastric emptying. Cholinergic adverse effects may include urinary urgency, diarrhea, abdominal cramping, hypotension, and increased salivation. To avoid these adverse effects, the client should be closely monitored to establish the minimum effective dose.
65
The client attends two sessions with the dietitian to learn about diet modifications to minimize gastroesophageal reflux. The teaching would be considered successful if the client says that she will decrease her intake of which of the following foods?
1. Fats.
2. High-sodium foods.
3. Carbohydrates.
4. High-calcium foods.
1.
Fats are associated with decreased esophageal sphincter tone, which increases reflux. Obesity contributes to the development of hiatal hernia, and a low-fat diet might also aid in weight loss. Carbohydrates and foods high in sodium or calcium do not affect gastroesophageal reflux.
66
The nurse explains to the patient with gastroesophageal reflux disease that this disorder: A. results in acid erosion and ulceration of the esophagus caused by frequent vomiting, B. will require surgical wrapping or repair of the pyloric sphincter to control the symptoms, C. is the protrusion of a portion of the stomach into to esophagus through an opening in the diaphragm, D. often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the espophagus
Answer: D. The acidic contents of the stomach touching the inside of the esophagus are responsible for the physical sensation known as "heart-burn" that is a cardinal symptom of GERD
67
Small Bowell Obstruction S&S
Nausea, vomiting, bloating, pain comes on fast
68
TX of small B O
NPO, NG tube, on TPN
69
A nurse is assessing a client who has been admitted with a diagnosis of an obstruction in the small intestine. The nurse should assess the client for? Select all that apply.
1. Projectile vomiting.
2. Significant abdominal distention.
3. Copious diarrhea.
4. Rapid onset of dehydration.
5. Increased bowel sounds.
1, 4, 5.
Signs and symptoms of intestinal obstructions in the small intestine may include projectile vomiting and rapidly developing dehydration and electrolyte imbalances. The client will also have increased bowel sounds, usually high-pitched and tinkling. The client would not normally have diarrhea and would have minimal abdominal distention. Pain is intermittent, being relieved by vomiting. Intestinal obstructions in the large intestine usually evolve slowly, produce persistent pain, and vomiting is less common. Clients with a large-intestine obstruction may develop obstipation and significant abdominal distention.
70
A client is admitted with a bowel obstruction. The client has nausea, vomiting, and crampy abdominal pain. The physician has written orders for the client to be up ad lib, to have narcotics for pain, to have a nasogastric tube inserted if needed, and for I.V. Ringer's Lactate and hyperalimentation fluids. The nurse should do the following in order of priority from first to last:
1. Assist with ambulation to promote peristalsis
2. Administer Ringer's Lactate
3. Insert a nasogastric tube.
4. Start and infusion of hyperalimentation fluids.
1,2,3,4
The nurse should first help the client ambulate to try to induce peristalsis; this may be effective and require the least amount of invasive procedures. I.V. fluid therapy can be done to correct fluid and electrolyte imbalances (sodium and potassium), and normal saline or Ringer's Lactate to correct interstitial fluid deficit. Nasogastric (NG) decompression of G.I. tract to reduce gastric secretions and nasointestinal tubes may also be used. Hyperalimentation can be used to correct protein deficiency from chronic obstruction, paralytic ileus, or infection.
71
Before abdominal surgery for an intestinal obstruction, the nurse monitors the client's urine output and finds that the total output for the past 2 hours was 35 mL. The nurse then assesses the client's total intake and output over the last 24 hours and notes that he had 2,000 mL of I.V. fluid for intake, 500 mL of drainage from the nasogastric tube, and 700 mL of urine for a total output of 1,200 mL. This would indicate which of the following?
1. Decreased renal function.
2. Inadequate pain relief.
3. Extension of the obstruction.
4. Inadequate fluid replacement
4.
Considering that there is usually 1 L of insensible fluid loss, this client's output exceeds his intake (intake, 2,000 mL; output, 2,200 mL), indicating deficient fluid volume. The kidneys are concentrating urine in response to low circulating volume, as evidenced by a urine output of less than 30 mL/ hour. This indicates that increased fluid replacement is needed. Decreasing urine output can be a sign of decreased renal function, but the data provided suggest that the client is dehydrated. Pain does not affect urine output. There are no data to suggest that the obstruction has worsened.
72
Esophageal varices
dilated, tortuous veins occurring in the lower portion of the esophagus as a result of portal hypertension. Common complication of liver cirrhosis.
73
S&S
Bleeding
| might throw up
74
TX
```
Balloon down (blakemore)
deflate by cutting in emergency
EGD- cauterize
banding
inject the w epinephrine (vasoconstriction)
```
75
A client with bleeding esophageal varices has undergone sclerotherapy. After the procedure, the client is unable to swallow. The nurse realizes this finding could indicate:
This could mean a complication and the doctor should be called.
Complications of sclerotherapy can include dysphagia.
76
What is Hepatitis?
Broad term meaning inflammation of the liver.
77
Hepatitis A
Fecal to Oral
78
Is Hep A a chronic infection?
No, it is not. (says Josh with a head bob and hand swag)
79
S&S
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Mild flu like symptoms
nausea/vomitting/diarrhea
jaundice/yellow
high billirubin
abdominal pain.
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80
Is there a vaccine for hep A?
Yes! at the age of one.
81
Hep B
Blood born
can travel in body fluids (mucosal)
SEX - NEEDLES!
82
S&S of hep B
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anorexia
nausea
vomitting
hepatomegaly
splenomegaly
abnormal LFT
dark urine
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83
TX for hep B
Interferon SQ
| - gives flu like symptoms- should be taken at night with anti emetic and Tylenol.
84
Is there a vaccine??
three dose vaccine
85
How many types of hepatitis are there?
A,B,C,D,E,F,G
86
Hepatitis C
No vaccine
Blood born- progress slowly over 2 decades. Might not know they have it.
DARK urine
HCV genotype 1 is the most common virus
87
S&S
bleeding
bruising
fluid accumulation in stomach
liver failure
88
what is ascites?
fluid in abdomen
89
hepatic encephalopathy
confusion - altered LOC - coma from liver failure. loss of function when a damaged liver doesn't remove toxins from the blood.
90
TX Hep C
very expensive- $100000
6mo-1 yr
tx response is 50-80%
91
"A patient with hepatitis B is being discharged in 2 days. In the discharge teching plan the nurse should include instructions to:
a. Avoid alcohol for the first 3 weeks
b. Use a condom during sexual intercourse
c. Have family members get an injection of immunoglobin
d. Follow a low-protein, moderate-carbohydrate, moderate-fat diet
"A patient with hepatitis B is being discharged in 2 days. In the discharge teching plan the nurse should include instructions to:
a. Avoid alcohol for the first 3 weeks
b. Use a condom during sexual intercourse
c. Have family members get an injection of immunoglobin
d. Follow a low-protein, moderate-carbohydrate, moderate-fat diet
92
A client is suspected of having hepatitis. Which diagnoistic test result will assist in confirming this diagonis ?
A.Elevate hemoglobin level B. Elevated serum bilirubin level C. Elevated blood urea nitrogen level D. Decreasd erythrocycte sedimentation rate
Correct Answer B Laboratory indicator of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels.Thinking about the organ that is involved in hepatitis should assist in directing to choose option B liver function test.
93
"A client with acute hepatitis is prescribed lactulose. The nurse knows this medication will:
A. Prevent the absorption of ammonia from the bowel.
B. Prevent hypoglycemia.
C. Remove bilirubin from the blood.
D. Mobilize iron stores from the liver"
"Correct Answer: A
Rationale: Lactulose helps prevent the absorption of ammonia from the bowel because it will cause frequent bowel movements, which facilitates the removal of ammonia from the intestines."
94
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"To prevent the spread of hepatitis A virus (HAV) infection the nurse is especially careful
when
A. Disposing of food trays
B. Emptying bed pans
C. Taking an oral temperature
D. Changing IV
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B is the correct answer. HAV is transmitted primarily person-to-person by the fecal-oral route. Food can be a method of transmission but needs to be fecally contaminated. Since the transmission of hepatitis A is fecal-oral and not saliva or blood like hepatitis B, taking a temperature and changing IV tubing would not spread hepatitis A.
95
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"Which type of hepatitis is transmitted by the fecal-oral route via contaminated food, water, or direct contact with an infected person?
"1. Hepatitis A
2. Hepatitis B
3. Hepatitis C
4. Hepatitis D"
```
1
96
The client is in the preicteric phase of hepatitis. Which signs/symptoms would thenurse expect the client to exhibit during this phase?
1.Clay-colored stools and jaundice.2.Normal appetite and pruritus.3.Being afebrile and left upper quadrant pain.4.Complaints of fatigue and diarrhea.
Correct Answer 4
"Flu-like" symptoms are the first com-plaints of the client in the preicteric phase of hepatitis, which is the initial phase and may begin abruptly or insidiously
97
"A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that:
"A. pruritus is a common problem with jaundice in this phase.
B. the patient is most likley to transmit the disease during this phase.
C. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B.
D. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase."
Correct: A
The acute phase of jaundice may be icteric (i.e., symptomatic, including jaundice) or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin.
98
The nurse is caring for a client with a diagnosis of hepatitis who is experiencing pruritis. Which would be the most appropriate nursing intervention?
A.Suggest that the client take warm showers. B.Add baby oil to the client's bath water. C.Apply powder to the client's skin. D.Suggest a hot-water rinse after bathing.
Answer B. Applying baby oil could help soothe the itchy skin. Answer A, C, and D would increase dryness and worsen the itching.
99
A client is hospitalized with hepatitis A. Which of the client's regular medications is contraindicated due to the current illness? http://www.rnpedia.com/home/exams/nclex-exam/nclex-rn-practice-questions-6 "1. Prilosec (omeprazole)
2. Synthroid (levothyroxine)
3. Premarin (conjugated estrogens)
4. Lipitor (atorvastatin)
Correct: 4
Lipid-lowering agents are contraindicated in the client with active liver disease. Answers A, B, and C are incorrect because they are not contraindicated in the client with active liver disease.
100
A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are:
a. whole blood and albumin.
b. platelets and packed red blood cells.
c. fresh frozen plasma and whole blood.
D.cryoprecipitate and fresh frozen plasma.
Correct: D
Answer D. The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren't specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma.
