Gastrointestinal Flashcards
GERD
GERD stands for Gastroesophageal Reflux Disease
chronic condition where stomach contents flows back up into the esophagus which is mainly due to a damaged/weak lower esophageal sphincter.
GERD is sometimes referred to as “acid reflux disease” or “heart burn”
Some people have random episodes of acid reflux and it goes away,
but GERD is when it occurs more than twice a week for a long period of time.
Limit caffeine, alcohol
Use Tums
Use Antiaccids to nutrualize acid production and keep it form moving up towards esophagus
Why is GERD happening?
Why is GERD happening?
the LES (lower esophageal sphincter) is not staying closed
This allows backwash of stomach contents and acids into the esophagus
leads to major irritation to the esophagus.
Complications of GERD
Inflammation of the esophagus (increased risk of cancer from the chronic inflammation)
Narrowing of the esophagus: strictures
Lung problems: asthma, pneumonia, voice changes, wheezing, fluid in the lungs
Barrett’s esophagus: lining of the esophagus is replaced with similar lining that makes up the intestinal lining…increase risk of cancer.
Signs and Symptoms of GERD
Note: not all people with GERD will have heartburn
You will have…
Gastric pain (upper)
Excess regurgitation of food… bitter taste in the back of the throat
Regular, occurring burning sensation in the chest or abdomen (it can be so intense it feels similar to a MI)
Dry cough (frequent)…worst at night
Nausea
Problems Swallowing…feels like a lump is in the throat
Lung Infections
Diagnosis off GERD
Endoscopy: used to assess the esophagus for changes…erosions, strictures etc.
Treatment GERD
Eat small meals rather than large ones (prevents over eating)
Avoid foods that relax the LES: greasy, fatty, ETOH, soft drinks,coffee, peppermint/spearmint
Avoid eating right before bed (last meal should be 3 hours before bed)
Sit up after eating for at least 1 hour
Weight loss
Smoking cessation
Watch acidic foods: citrus and tomatoes
Medications for GERD
Antacids, H2 blockers, PPIs, prokinetics
Gastritis
Too much acid production inside your stomach
Causes Inflammation of the lining of your stomach itself
can lead to peptic ulcer
GI Bleed
Gastrointestinal bleeding is a condition that involves bleeding in one or many parts of the digestive tract
Not a disorder in itself but a symptom of many GI disorders including peptic ulcer disease, inflammatory bowel disease and gastric cancer
Usually suspected when there is blood in the stool, could be mild, moderate or severe and could be fatal
Signs and Symptoms GI bleed
visible blood in the stool or black tarry-coloured stool
Rectal bleeding
Hematemesis (vomiting blood)
Fainting
Lightheadedness
Fatigue
Abdominal pain
Chest pain
Upper GI bleed causes
Peptic ulcers in the stomach lining and small intestine
Lower GI Bleed causes
Diverticulitis: the formation, inflammation and infection bulging pouches in the GI tract
Ulcerative colitis
Crohn’s disease
Benign or cancerous tumours
Hemorrhoids
Anal fissures
Colon polyp formation
GI bleed complications
Anemia and Hypovolemia
GI bleeding can lead to the loss of blood volume (hypovolemia) and loss of red blood cells which contain hemoglobin and iron (anemia)
If left untreated anemia and hypovolemia can be fatal
Shock: losing more than 20% of blood volume can lead to hypovolemic shock and can lead to significant organ failure
Diagnosis of GI bleed
Stool test: looking for black tarry stool for occult blood
Blood tests: may reveal low hemoglobin/hemocritt or low iron levels
Nasogastric lavage: insertion of NG tube from nose into stomach in order too aspirate stomach contents and analyze them
Imaging: abdominal CT scan
Endoscopy/colonoscopy
GI bleed treatment
Dr may be able to remove the polyps that causes the bleeding during colonoscopy
Can also treat bleeding peptic ulcers during endoscopy
IV fluids (hypovolemia)
Blood transfusion: replace the loose blood volume and red blood cells
Medications for GI bleed
Medications: Upper GI bleed can benefit from PPI medications, antacids that do not contain aspirin, H2-receptors
Upper Vs Lower GI bleed
Upper: irritation and ulcers in the lining of the esophagus, stomach or duodenum causes vomiting BRB, coffee ground emesis, dark tary tools
Lower: Bleeding from large intestine (colon) and rectum
Bleeding consists of streaks or larger clots mixed with stools
Three Types of Peptic Ulcers:
Gastric Ulcers: located inside the stomach
Duodenum Ulcer: located inside the duodenum which is the first part of the small intestine
Esophageal Ulcer: located inside the lower part of the esophagus
Complications of Peptic Ulcers
GI bleeding
formation of holes in the stomach =perforation and this can lead to peritonitis
bowel blockage in the pylorus due to chronic ulceration from a duodenal ulcer
increased risk of GI cancer
Duodenal Ulcers Signs and Symptoms
Duodenal Ulcers
Pain happens when stomach empty…food makes it BETTER (pain 3-4 hours after eating)
Wake in middle of night with pain
Report of pain gnawing
Weight normal
Severe: tarry, dark stool from GI bleeding
Causes off peptic ulcer disease
*Bacterial infection due to Helicobacter pylori (H. pylori):
These bacteria are spiral-shaped which helps them invade the GI mucosa.
*NSAIDs (long term usage):
Zollinger-Ellison Syndrome: tumor formation that causes increased release of gastrin which increases stomach acid production.
Other factors that can increase susceptibility: smoking, alcohol, genetics, NOTE: stress and certain foods do not causes ulcers but can irritate them and prolong their healing.
Gastric Ulcers Signs and Symptoms
Mainly: Indigestion and Epigastric pain….described as burning, dull, or gnawing pain
Food makes pain worst (pain 1-2 hours after eating)
Report of pain dull and aching
Weight loss
Severe: vomit blood more common
Treatment Peptic Ulcer Disease
Medications: proton pump inhibitors, antibiotics, Histamine receptor blockers, antacids, bismuth subsalicylates
Surgery:
Vagotomy
Pyloroplasty
Gastric resection
Watch for dumping syndrome post-opt:
Dumping syndrome: stomach is not able to regulate the movement of food due to the removal of sections of the stomach (usually the pyloric valve and duodenum) so it enters into the small intestine too fast before the stomach can finish digesting it.
Dumping Syndrome
Dumping syndrome: stomach is not able to regulate the movement of food due to the removal of sections of the stomach (usually the pyloric valve and duodenum) so it enters into the small intestine too fast before the stomach can finish digesting it.
Peptic Ulcer Education
Eat many small meals rather than large ones
lie down for 30 minutes after eating
eat without drinking fluids, wait 30 minutes after meals and then consume liquids
Avoid spicy, acidic foods(tomato/citric juices/fruits), foods with caffeine, chocolate, soft drinks , fried foods, alcohol
Consume a low-fiber diet that is bland and easy to digest, eat white rice, bananas etc.
Hiatal Hernia
Muscles of the Diaphragm becomes week which allows a portion of the stomach and bowel to protrude up into the thorax
Signs and Symptoms Hiatal Hernia
Heart burn
Regurgitation
Dysphagia
Fullness
Bowel sounds heard over the chest
IBS
Irritable boowel syndrome
Functional disorder
Recurrent Abdominal Pain and abnormal bowel motility causing things like constipation or diarrhea or a mixture
Abdominal pain usually improves after a bowel movement
Different than Inflammatory bowel disease which include the same symptoms aswell as inflammation, ulcers and other damages to the bowel
IBS Signs and Symptoms
Abdominal Pain
bowel motility: Lactose and fructose usually trigger the symptoms
IBS causes
most common in middle aged women
Gastroenteritis
Stress
Treatment IBS
Diet modifications (avoid short chain carbohydrates)
For constipation: soluble fiber, stool softeners and osmotic laxatives
For spasms and pain: anti-diarrheals like serotonin antagonists
Manage Stress
Peritonitis
inflammation of the peritoneum
Serum membrane that surrounds the abdominal organs
Contamination of the peritoneal cavity with bacteria caused by trauma, infection, perforation of an organ such as perforation of the appendix or diverticulitis
Diverticulitis
Occurs when diverticula (small pouches in the colon) become inflamed or infected
Less than 5% of people with diverticulosis develop diverticulitis
Symptoms:
severe pain left lower side of abdomen
fever and chills
nausea and Vomiting
blood in stool
Important to seek medical attention
Could cause obstruction or perforation
Treatment: clear liquid diet to rest colon
Diverticulosis
Occurrs wehn small bulging puches (diverticula) begin to develop in your digective tract, on the wall of the large intestine or colon
Cause unknown
factors that increase risk: low-fibre diet, red meat, lack of exercise, obesity, smoking NSAIDS, genetics
Usually no symptoms
Treatment: High fibre diet and probiotics
Signs and Symptoms of Peritonitis
Rigid board like abdomen
Abdominal pain
nausea vomiting
Fever
Rebound tenderness
Tachycardia
Diagnosis Peritonitis
Abdominal Xray, CT, ultrasound
Treatment Peritonitis
NPO
NG tube to decompress stomach
IV fluids, antibiotics, analgesics
If the cause is due to a ruptured organ the patient will need surgery to remove or repair that organ and intraadominal visage = wash our perineal cavity due to complication, monitor for sepsis
Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. Which additional assessment finding will the nurse assess for?
severe abdominal pain with direct palpation or rebound tenderness
Where is McBurneys Point
Right Lower Quadrant of the abdomen
Appendicitis
Inflammation of the appendix
opening of the appendix becomes obstructed by something like a fecalith which is a hard tone mass of faces or a tumor due to some kind of infection
This causes inflammation and ischemia (imparied blood flow) to the appendix which can lead to bacteria overgrowth
Appendicitis signs and symptoms
Hallmark symptom = right lower quadrant pain at mcburneys point, rebound tenderness at this area
Loss of appetite
Nausea and vomitting
Fever
Diagnosis Appendicitis
CT Scan
Elevated WBCs
Appendicitis treatment
NPO
IV fluid and antibiotics
Surgery: appendectomy, removal of appendix through scope
If appendix has ruptured may require an open appendectomy
Complications of appendicitis
Peritonitis and perforation if appendix ruptures
If pain suddenly goes away = red flag may mean appendix has ruptured
Ulcerative Colitis
Inflammatory bowel disease can cause inflammation in the small and large intestine
Colitis is the inflammation of the colon that form ulcers along the inner surface of the lumen (large intestine) including both the colon and the rectum
Flares: new damage (new ulcers)
Remission: tissues heal
Most common type off inflammatory bowel disease: affects the mucosa and sub mucosa of large intestine only (this sets it apart from crohn’s disease)
Causes of Ulcerative Colitis
Stress and Diet make symptoms worse
Autoimmune disease:
thought is that inflammation and ulceration in the large intestine is caused by T cells destroying the cells lining the walls of the large intestine leaving behind the ulcers
Genetics: patients with a family history are more likely to develop the disease themselves
More common in young women teen - 30s
Signs and Symptoms of colitis
Pain in left lower quadrant (corresponds to the rectum)
Severe + frequent = diarrhea with blood
As these cells are destroyed the large intestine cannot absorb water as efficiently contributing to diarrhea
Diagnosis Colitis
Colonoscopy
Treatment Colitis
Depends on severity of symptoms
Anti-inflammatory medications
sulfasalazine, mesalamine
Immunospressors (corticosteriods, azathioprine, cyclosporin)
Colectomy: removal of colon
Crohn’s Disease
Inflammatory bowel disease causes inflammation of bowel.
unlike colitis which only affects the large intestine
Crohn disease causes inflammation and tissue destruction anywhere along the gastrointestinal tract from the mouth to the anus
Crohn’s disease causes
Crohn disease is an immune related disorder - triggered by pathogen
Inflammatory response is large and uncontrolled and leads to destruction of the cells in the gastrointestinal tract
Genetics increase risk
Crohn’s Disease Signs and Symptoms
Affects the Ileum + Colon most commonly seen (can affect any part of GI tract)
Pain in affected area - right lower quadrant (ileum)
Diarrhea + blood in stool
Malabsorption issues
Treatment for Crohn’s disease
Antibiotics: controls gut bacteria, reduced immune response
Anti-inflammatory medications
Immunosuppressants (corticosteriods)
Removal does not cure disease
Viral Hepatitis
Inflammation of liver that is caused by a virus or a hepatic medication or chemical
Hepatitis A,B,C,D,E
Hepatitis A and E are spread through the fecal oral route (contaminated water)
Hepatitis B,C,D are spread through blood and bodily fluids
We have vaccines for hepatitis A and B
No vaccine for Hepatitis C
You can only get hepatitis D if you have hepatitis B
Chronic hepatitis can lead to cirrhosis of the liver or liver cancer
Risk Factors Viral Hepatitis
IV drug use
Body piercings
tattoos
High risk sexual practices
travel to underdeveloped countries
Signs and Symptoms of viral hepatitis
Fever
Lethargy
Nausea
Vomiting
Jaundice
Clay coloured stool
Dark urine
Abdominal pain
Joint pain
Abnormal labs for Hepatitis
Increase in ALT, AST, bilirubin
Diagnosis: serological testing tests for presence of antibodies
treatment Hepatitis
Hepatitis A and E are usually self resolving
Anti viral agents for hepatitis B or acute and chronic hepatitis C
Liver Cirrhosis Pathophysiology
Heathy tissue of the liver is replaced by scar tissue making the liver hard like a rock
Causes of Liver Cirrhosis
Anything that can scar the liver
Alcohol
Chronic hepatitis
Cystic Fibrosis
Major Roles of the Liver
Recycling company
Filtration.
Digestion.
Metabolism and Detoxification.
Protein synthesis.
Storage of vitamins and minerals.
What does the liver produce?
Albumiin
Bile
Clotting factors
What is Albumin?
Albumin is a protein inside the blood that does 3 things
Transports drug in the body
Attracts water to keep it inside the vascular space
Binds with calcium to make bones strong
In liver cirrhosis the body cannot produce albumin so we get hypoalbuminemia
drugs don’t get transportedand water builds up in the body because albumin isn’t here to attract the water =
edema and third spacing (ascites),
low calcium in the blood = week bones and osteoporosis
Hypocalcemia: Trousseau’s and Chvostek’s
The Role of Bile
Helps to scoop up excess cholesterol and bilirubin taking it from the body and exerts it out through bowels.
Cholesterol: lipids that clogs arteries if we have too much leads too major cardiac issues
Bilirubin: Dead red blood cells
When liver fails we have lack of bile = get a build up of high cholesterol and high bilirubin
Bilirubin turns the body jaundice (yellow eyes and skin)
Role of clotting factors
Clotting factors (coagulation factors) helps the blood to clot
With liver disease the blood doesn’t clot fast enough leading to huge bleeding risks
#1 concern is bleeding
Risk for anemia, leukopenia, thrombocytopenia
Hepatic Encephalopathy
Cloudy toxic brain from too much ammonia
twitching in arms and legs = asterixis
Confusion + bizarre behaviour
Sleepiness
Key Assessment Hepatic encephalopathy
Assess hand movements with arms extended
Assess mental status with those from previous shifts
Assess recent blood draws for ammonia levels
Which assessment would indicate if a client with cirrhosis has progressed to hepatic encephalopathy
Ask the client their date of birth, name, date and location, monitor mental status
Tell the client too extend their arms (assess for muscle twitching)
Compare ammonia blood levels to the pervious shifts (ammonia levels should not be going up)
Not assessing the skin for thinning blood vessels for eyes or skin for jaundice = present for any client with liver failure not specific for hepatic encephalopathy
A client with cirrhosis shows signs of hepatic encephalopathy. The nurse should pain a dietary consultation to limit which ingredient?
protein - protein has the ammonia waste. limiting protein = limiting ammonia
Liver Failure Labs
Ammonia High = hepatic encephalopathy
Albumin low (under 3.5) = calcium low = low platelets
Bilirubin High
Coagulation panel = high pt, put, INR
Elevated ALT and AST
Which blood lab values are expected to be elevated in a client with worsening liver cirrhosis?
Ammonia
Bilirubin
Prothrombin time (PT)
A client with worsening liver failure presents to the med sure floor, which assessment finding should the nurse expect?
Enlarged abdomen from ascites
Bruise marks on the skin
Fatigue and possible confusion
Sclera that appears yellow
Reports of itchy skin
Drug Toxicity
During cirrhosis the body can no longer break down drugs, drug toxicity builds up inside the blood leading to major adverse effects
Caution when giving medications
Avoid: Acetaminophen (toxic to the liver)
Antidote: Acetylcysteine (mucomyst)
Cirrhosis Signs and Symptoms
Portal hypertension
Portal vein connects the pancreas, spleen, stomach and intestine these will all enlarge (specifically the spleen - splenomegaly)
Esophageal varices: enlargement of veins in esophagus = major pressure in esophagus veins become thin from pressure = very deadly.
Unoticed until rupture, once varies pop causes explosion of blood, heavy bleeding filling up stomach = vomitting bloodd = hypovolemic shock swell as airway obstruction
Blood flow in the third spacing of abdomen (Ascites)
Pruritus - itchy skin
Things to keep in mind for Esophageal Varies
No NG tube
No straining (bowel movement)
Diagnostics Cirrhosis
Liver Biopsy
After procedure lay on RIGHT SIDE to prevent bleeding
Ascites = paracentesis
Albumin IV = increased BP and bounding pulses
How do you know if IV albumin has been effective
Asses vital signs (must remain in normal limits)
Does not depend on abdominal circumferences
Does not resolve muscle twitching
Cirrhosis Nursing Care
Diet: low protein =low ammonia
Low sodium, low fluid
No alcohol
oral care before meals
Bleed risk
Soft toothbrush
Electric razor
monitor blood in stools
Esophageal varices
Avoid valsalva maneuver
No bearing down (bowel movements)
No new NG tubes
Cirrhosis Pharmacology
Neomycin used to decrease ammonia producing bacteria
Lactulose: loose the ammonia via loose bowels, lose potassium (hypokalemia)
Nursing interventions for paracentesis
Ascites = paracentesis drainage of fluid from abdomen with needle.
Empty bladder
Vital signs monitor for BP
measure abdominal circumference and weight
HOB UP - High fowlers position
A nurse is assisting with paracentesis for a patient with ascites caused by cirrhosis. Which action should the nurse take first?
Have the patient empty their bladder
Client with history of cirrhosis which suspected gastroesophageal varices. which order would the nurse question?
New NG tube
Client with cirrhosis, portal hypertension, ascites and esophageal varices. Which of the following is correct patient teaching?
Avoid straining when having a bowel movement
First action when a client with cirrhosis begins vomiting blood after a meal
Obtain vital signs (probable esophageal varices)
Which nursing intervention would be the highest priority in managing a patient with ruptured esophageal varices
Protecting the airway
A patient with cirrhosis and esophageal varices is vomiting and the nurse notes hematemesis. Which action should the nurse take first?
Place the client in side lying position
Expected laboratory result of Cirrhosis
Elevated bilirubin levels
Longer coagulation times
Which complication is a patient with cirrhosis at risk for?
Bleeding
Pancreatitis Pathophysiology
Inflammation off the pancreas
Inflammation comes from auto-digestion of the pancreas (pancreases digestive enzymes have accidentally activated early) and begin to digest the pancreas
If the pancreatic duct is blocked for any reason ex. inflammation in liver cirrhosis or hepatitis this means the enzymes cannot get out of the pancreas and into the intestine so they accidentally prematurely activate within the pancreas which causes inflamation within the pancreas
3 Pancreatic Enzymes
Protease: Breaks down protein
Lipase: breaks down fat
Amylase: breaks down carbs
Causes of Pancreatitis
Alcohol abuse
Gallbladder disease
Cystic fibrosis
Surgery: may accidentally cause trauma
common With ERCP procedure - endoscopic retrograde cholangiopancreatography
Pancreatitis Signs and Symptoms
Epigastric Pain (heartburn)
LUQ pain “radiates to the back”
Bruising
Turner’s sign: bruising or echimosis on the flanks or sides off the body)
Cullen’s sign: Edema and bruising around the belly button
Can present with liver S/S such as:
Jaundice: elevated bilirubin
Hypotension “Low BP” - internal bleeding, ascites
A client admitted to the hospital, which assessment finding would be consistent with acute pancreatitis?
Gary blue colour at the flank
Abdominal guarding and tenderness
Left Upper quadrant pain that radiates to the back
Pancreatitis Diagnosis
Elevated Labs: Amylase and Lipase
Elevated Glucose: hyperglycaemia = lack of insulin, cannot get out of pancreas due to blockage
Elevated WBC (Over 10,000)
Fever
Elevated Coagulation time
PT and aPTT risk for bleeding
Elevated bilirubin
Pancreatitis Complications
ARDS (acute respiratory distress syndrome)
Peritonitis
Fever over (100.3)
Rebound tenderness
Rigid or board like abdomen
Increasing pain, tenderness
Restless
Fast HR and RR (tachycardia/tachypnea)
Pancreatitis Interventions
NPO for at least 24 hours: pt will eventually progress too a low fat and low sugar diet + enzymes with meals
NG tube for suction
IV pain meds hydromorphone
NO morphine
IIV fluids
Monitor glucose: Hyperglycemia = insulin
Other medications:
Antacids
Proton pump inhibitors
H2 blockers
After preforming a physical assessment and obtaining vital signs for a client with acute pancreatitis which nursing intervention is the priority?
IV fluids and pain control
Which foods would be most appropriate for a patient who recently had a bout of acute pancreatitis?
Reduced fat cheese and whole what crackers
Grilled chicken and baked potato
Main functions of Pancreas
Exocrine: Produce digestive enzymes which helps break down foods and is a critical part of digestion
Endocrine: Secrete insulin and glucagon to stabilize glucose balance
Cholecystitis
Inflammation of gallbladder caused by gallstone
Risk Factors Cholecystitis
Cholelithiasis
High fat diet
Obesity
Older age
Genetics
Female gender
Signs and Symptoms Cholecystitis
Right upper quadrant pain that radiates to the right shoulder
Pain upon ingestion off Hugh fat foods
Nausea and vomiting
Dyspepsia (indigestion)
Gas and Bloating
If gallstone is in common bile duct we may end up with symptoms such as jaundice, dark colour urine and clay-coloured stools due to involvement of the liver
Cholecystitis Diagnosis
Elevated White Blood Cells
If there is liver involvement then liver enzymes such as AST and bilirubin may be elevated
Pancreatic involvement (pancreatic duct joins with bile duct before it reaches the small intestine) = elevation in amylase and lipase
Ultrasound
Cholecystitis Treatment
analgesics
Lithotripsy: Uses shockwaves to break up those gallstones
Cholecystectomy: removal off the gallbladder
Monitor for complications:
Pancreatitis if pancreases becomes involved
Peritonitis due to perforation of gallbladder
Patient reaching
Low fat diet
Lose weight if applicable
Role off Gallbladder
Gallbladders job is to store and concentrate bile until the time comes to send it too the small intestine
Nasogastric (NG) tube connected to low suction. What should the nurse do?
Monitor the client for nausea, vomiting, and abdominal distention.
Which finding indicates the development of a leaking anastomosis?
pain, fever, and abdominal rigidity
To prevent complications of TPN, the nurse should
cover the catheter insertion site with an occlusive dressing.
The client with a peptic ulcer is taking antibiotics and bismuth salts. The nurse should give the client which information about the expected outcome of these medications?
Eradicate the Helicobacter pylori bacteria.
A client who has been diagnosed with gastroesophageal reflux disease (GERD) has heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which item from their diet?
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.
When evaluating a client for complications of acute pancreatitis, the nurse should observe for
decreased urine output.
to minimize gastroesophageal reflux. The teaching would be considered successful if the client decreases the intake of which foods?
fats
pyloric stenosis
an enlarged muscle below the stomach
A client with cholecystitis is taking propantheline bromide. What should the nurse tell the client to expect as a result of taking this drug?
decreased biliary spasm
Which laboratory finding is expected when a client has diverticulitis?
elevated white blood cell count
A client is admitted with a diagnosis of ulcerative colitis. What should the nurse assess the client for?
bloody, diarrheal stools
which is a priority focus of care for a client experiencing an exacerbation of Crohn’s disease?
promoting bowel rest
After being admitted to the emergency department for severe lower right quadrant pain, a child reports that the pain has suddenly resolved. Which finding would the nurse suspect?
ruptured appendix
Which nursing intervention should the nurse perform for a client receiving enteral feedings through a gastrostomy tube?
Change the tube feeding administration set at least every 24 hours.
A client who has ulcerative colitis is taking sulfasalazine to treat inflammation. Which instruction(s) related to drug therapy should the nurse include in the client’s teaching plan?
Avoid exposure to direct sunlight
Drink a full glass of water when taking the medication
Report any bruising or bleeding
The nurse is developing a care management plan with a client who has been diagnosed with gastroesophageal reflux disease (GERD). What should the nurse instruct the client to do? Select all that apply.
Avoid a diet high in fatty foods
Avoid beverages that contain caffeine
Avoid all alcoholic beverages
What intervention will minimize the risk for diarrhea in a client receiving enteral tube feedings?
using strict aseptic technique when preparing the formula
The nurse is educating a client with a new colostomy on how to regain bowel control. Which action would the nurse emphasize as a priority?
an irrigation routine of the ostomy
. The client’s morning ammonia level is 110 mcg/dl. The nurse should suspect which situation?
The client’s hepatic function is decreasing.
giving TPN too rapidly may cause
hyperglycemia
A client is preparing to undergo abdominal paracentesis. Which nursing interventions should be performed before the procedure? Select all that apply.
explain the procedure to the client
Make sure informed consent was obtained
instruct the client to void
The client should be sitting up in bed with he abdomen exposed
Use sterile technique for procedure
a client has a nasogastric (NG) tube connected to low suction. What should the nurse do?
Monitor the client for nausea, vomiting, and abdominal distention
The nurse assesses a client who is receiving a tube feeding. Which situation would require prompt intervention from the nurse?
Feeding solutions that have not been infused after hanging for 8 hours should be discarded because of the increased risk for bacterial growth.
Which activity should the nurse encourage the client with a peptic ulcer to avoid?
smoking cigarettes
What should the nurse do when caring for a client with ulcerative colitis?
Suggest using sitz baths as needed.
A client is diagnosed with pancreatitis. Which assessment would be of most concern to the nurse?
bluish discoloration in periumbilical area
A client’s stools are light gray in color. What additional information should the nurse obtain from the client? Select all that apply.
Intolerance to fatty foods
Fever
Jaundice
After a nasogastric (NG) tube has been inserted, which finding helps the nurse determine that the tube is in the proper place?
The pH of the aspirated fluid is measured.
A client has just returned from surgery for a gastrectomy. The nurse should position the client in which position?
low Fowler’s
The nurse is caring for a client with an inguinal hernia. Which position is best for the nurse to assess the client’s hernia?
standing
A client is receiving a tube feeding and has developed diarrhea, cramps, and abdominal distention. What should the nurse do?
Change the feeding apparatus every 24 hours
Slow the administration rate
Use a diluted formula, gradually increasing the volume and concentration
Anticipate changing to a lactose-free formula
A client with appendicitis is experiencing excruciating abdominal pain. An abdominal X-ray film reveals intraperitoneal air. What should the nurse prepare the client for?
surgery
The nurse provides care for a client who is diagnosed with both diabetes mellitus (DM) and gastroparesis. The healthcare provider (HCP) prescribes metoclopramide as pharmacotherapy for the gastroparesis. Which finding noted upon assessment requires priority action by the nurse?
Frequent batting of the eyes.
Tardive dyskinesia is an adverse reaction associated with metoclopramide. Thi condition can be permanent if the medication is not discontinued immediately; therefore, this finding requires priority action by the nurse.
The nurse provides care for a client who returns to the unit following a colonoscopy. Which clinical manifestation indicates a need for action by the nurse? Select all that apply.
Abdominal Distention
Rebound abdominal tenderness
Which supplement that is conventionally supplied by milk can be obtained by other sources for a child with an allergy to milk? Select all that apply.
Calcium
Vitamin D
The nurse provides care for a newborn who is diagnosed with tracheoesophageal fistula (TEF) and esophageal atresia (EA). Which nursing action is appropriate to include in the newborn’s care plan? Select all that apply.
Esophageal atresia/tracheoesophageal fistula (EA/TEF) is a condition that results from abnormal fetal development of the tube that carries food from the mouth to the stomach.
This condition is potentially life-threatening and generally require surgery to correct the malformation in order to allow feeding and prevent lung damage from repeated exposure to esophageal fluids.
Ensure the neonate remains NPO
Ensure emergency equipment including suction is at the bedside at all times
Places neonate in semi-folwer to decrease risk of aspiration
A client with a new ileostomy receives nutritional teaching from the nurse. Which food should the nurse instruct the client to include in the diet? Select all that apply.
Low residue diet
Creamy peanut butter
Cooked potatoes
Not citrus fruit
Which finding necessitates immediate action by the nurse when providing care for a child who is diagnosed with intussusception?
Abdominal rigidity and rebound tenderness noted upon assessment
= intestinal obstruction and is life threatening
Intussusception
Intussusception is a condition in which part of the intestine telescopes into itself. Obstruction of the intestine is a complication associated with this disease process; therefore, assessment data indicative of this complication requires immediate action by the nurse.
This complication prevents the passage of food that is being digested through the intestine. Findings that are indicative of an obstruction include abdominal rigidity and rebound tenderness.
Signs and symptoms of intussusception
Sausage shaped protrusion upon palpation of the abdomen
Currant jelly like stools
What is contraindicated for paralytic ileus
Opioid analgesics are contraindicated for a client who exhibits symptoms indicative of a paralytic ileus; therefore, the nurse questions this HCP prescription
Paralytic ileus
A paralytic ileus, an obstruction of the intestine due to paralysis, is a common complication after surgery.
clinical manifestations: abdominal distention and pain leading to nausea and vomiting
Absent bowel sounds
The nurse provides care for a one-month-old infant who is admitted with a probable diagnosis of pyloric stenosis. What laboratory data supports the infant’s probable diagnosis?
Elevated Bun
Elevated Ph
Low Potassium
Pyloric stenosis
Narrowing of the opening between the stomach and small intestine
thickens resulting in forceful vomiting, dehydration, and weight loss. Infants who are diagnosed with this condition may always appear to be hungry and will require surgical intervention to correct the issue.
While providing total parenteral nutrition (TPN) to a client diagnosed with Crohn’s disease, the registered nurse (RN) will monitor which assessment for the client that will aid in identifying complications related to this therapy?
Measure intake and output
Assess serum electrolytes daily
Monitor lung/heart sound per shift
Hirschsprung disease.
Hirschsprung disease is a condition of the large intestine (i.e., colon) that causes difficulty passing stool. It involves missing nerve cells in the muscles of part or all of the child’s colon.
Clinical manifestations include: explosive, malodorous stools; elevated temperature; distention of the abdomen which progressively and rapidly worsens; and general lethargy. A child who exhibits any of these symptoms requires priority intervention by the nurse.
A client who is diagnosed with peptic ulcer disease states, “I will only take three medications. No more!” Which prescribed medications are the highest priority for the client to receive?
Amoxicillin
Amoxicillin is an antibiotic often prescribed for PUD caused by the H pylori bacteria. Priority should be given to PUD pharmacotherapy; therefore, this medication should be administered to the client
Omeprazole
Omeprazole is a proton pump inhibitor (PPI) and an important part of the treatment for PUD. This medication suppresses acid by inhibiting enzymes that make gastric acid; therefore, this is priority pharmacotherapy.
Ondansetron
Ondansetron is an antiemetic medication to address nausea that often occurs with this medication diagnosis; therefore, this is priority pharmacotherapy for this client to enhance comfort.
