Gastrointestinal Disorder Flashcards by B -

Care of the Patient with a

Gastrointestinal Disorder

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LABORATORY AND DIAGNOSTIC EXAMINATIONS

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UPPER GASTROINTESTINAL STUDY (UPPER Gl SERIES, UGI)

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The patient should take nothing by mouth (NPO) and avoid smoking after midnight the night before the study. Explain the importance of rectally expelling all the barium after the examination.
A)UPPER GASTROINTESTINAL STUDY (UPPER Gl SERIES, UGI)
B)ulcers

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Explain the importance of rectally expelling all the barium after the examination.
A)UPPER GASTROINTESTINAL STUDY (UPPER Gl SERIES, UGI)
B)ulcers

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Stools will be light colored until all the barium is expelled (up to 72 hours after the test).
A)UPPER GASTROINTESTINAL STUDY (UPPER Gl SERIES, UGI)
B)ulcers

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Eventual absorption of fecal water may cause a hardened barium impaction. Increasing fluid intake is usually effective.
A)UPPER GASTROINTESTINAL STUDY (UPPER Gl SERIES, UGI)
B)ulcers

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Give the patient milk of magnesia(constipation) (60 mL) after the examination unless contraindicated.
A)UPPER GASTROINTESTINAL STUDY (UPPER Gl SERIES, UGI)
B)ulcers

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TUBE GASTRIC ANALYSIS

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The analysis helps determine the completeness of a vagotomy, confirm hypersecretion or achlorhydria (an abnormal condition characterized by the absence of hydrochloric acid in the gastric juice), estimate acid secretory capacity, or test for intrinsic factor.
A)TUBE GASTRIC ANALYSIS
B)GI STUDIES

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The analysis helps determine the completeness of a vagotomy, confirm hypersecretion, achlorhydria , estimate acid secretory capacity, or test for intrinsic factor.
A)TUBE GASTRIC ANALYSIS
B)GI STUDIES

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achlorhydria (an abnormal condition characterized by the absence of hydrochloric acid in the gastric juice)
A)true
B)false

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The patient should receive no anticholinergic medications for 24 hours before the test and should maintain NPO status after midnight to avoid altering the gastric acid secretion .
A)TUBE GASTRIC ANALYSIS
B)GI STUDIES

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lnform the patient that smoking is prohibited before the test because nicotine stimulates the flow of gastric secretions.
A)TUBE GASTRIC ANALYSIS
B)GI STUDIES

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The nurse or radiology personnel inserts a nasogastric (NG) tube into the stomach to aspirate gastric content.
A)TUBE GASTRIC ANALYSIS
B)GI STUDIES

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Remove the NG tube as soon as specimens are collected. The patient may then eat if indicated.
A)TUBE GASTRIC ANALYSIS
B)GI STUDIES

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ESOPHAGOGASTRODUODENOSCOPY (EGO, UGl ENDOSCOPY, GASTROSCOPY)

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The patient should maintain NPO status after midnight. Obtain the patient’s signature on a consent form and complete a preoperative checklist for the endoscopic examination.
A)ESOPHAGOGASTRODUODENOSCOPY (EGO, UGl ENDOSCOPY, GASTROSCOPY)
B)GI STUDIES

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The patient is us ually given a preprocedure intravenous (IV) sedative such as midazolam (Versed)
A)ESOPHAGOGASTRODUODENOSCOPY (EGO, UGl ENDOSCOPY, GASTROSCOPY)
B)GI STUDIES

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The patient’s pharynx is anesthetized by spraying it with lidocaine hydrochloride (Xylocaine). Therefore do not allow the patient to eat or drink until the gag reflex returns (usually about 2 to 4 hours).
A)ESOPHAGOGASTRODUODENOSCOPY (EGO, UGl ENDOSCOPY, GASTROSCOPY)
B)GI STUDIES

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Assess for any signs and symptoms of perforation, including abdominal pain and tenderness, guarding, oral bleeding, melena, and hypovolemic shock.
A)ESOPHAGOGASTRODUODENOSCOPY (EGO, UGl ENDOSCOPY, GASTROSCOPY)
B)GI STUDIES

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CAPSULE ENDOSCOPY

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In a capsule endoscopy, the patient swallows a capsule with a camera (approximately the size of a large vitamin) that provides endoscopic evaluation of the GI tract.
A)true
B)false

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Dietary preparation is similar to that for colonoscopy. The patient swallows the video capsule and is usually kept NPO until 4 to 6 hours later.
A)capsule endoscopy
B)GI STUDY

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Eight hours after swallowing the capsule, the patient returns to have the monitoring device removed. Peristalsis causes passage of the disposable capsule with a bowel movement. A)true B)false

BARIUM SWALLOW AND GASTROGRAFIN STUDIES

This barium contrast study is a more thorough study of the esophagus than that provided by most UGI examinations. A)BARIUM SWALLOW AND GASTROGRAFIN STUDIES B)ULCERS

Diatrizoate meglumine and diatrizoate sodium (Gastrografin) is a product now used in place of barium for patients who are susceptible to bleeding from the GI system and who are being considered for surgery. A)true B)false

The patient should maintain NPO status after midnight. Food and fluid in the stomach prevent the barium from accurately outlining the GI tract, and the radiographic results may be misleading. A)BARIUM SWALLOW AND GASTROGRAFIN STUDIES B)Ulcers

Explain the importance of rectally expelling all barium. Stools will be light colored until this occurs. Eventual absorption of fecal water may cause a hardened barium impaction. Increasing fluid intake is usually effective. Give milk of magnesia (60 mL) after the barium swallow examination unless contraindicated. A)BARIUM SWALLOW AND GASTROGRAFIN STUDIES B)Ulcers

ESOPHAGEAL FUNCTION STUDIES (BERNSTEIN TEST}

It helps differentiate esophageal pain caused by esophageal reflux from that caused by angina pectoris. A)ESOPHAGEAL FUNCTION STUDIES (BERNSTEIN TEST} B)capsule

If the patient suffers pain with the instillation of hydrochloric acid into the esophagus, the test is positive and indicates reflux esophagitis. A)ESOPHAGEAL FUNCTION STUDIES (BERNSTEIN TEST} B)capsule

The patient is NPO for 8 hours before the examination. Withhold any medications that may interfere with the production of acid, such as antacids and analgesics. A)ESOPHAGEAL FUNCTION STUDIES (BERNSTEIN TEST} B)capsule

Withhold any medications that may interfere with the production of acid, such as antacids and analgesics. A)ESOPHAGEAL FUNCTION STUDIES (BERNSTEIN TEST} B)capsule

EXAMINATION OF STOOL FOR OCCULT BLOOD

``` occult blood (blood that is obscure or hidden from view) is detected in the stool, suspect a benign or malignant GI tumor. Tests for occult blood are also called guaiac, Hemoccult, and Hematest. A)true B)false ```

Occult blood in the stool may occur also in ulceration and inflammation of the upper or lower GI system. Other causes include swallowing blood of oral or nasopharyngeal origin. A)EXAMINATION OF STOOL FOR OCCULT BLOOD B)ulcers

Instruct the patient to keep the stool specimen free of urine or toilet paper, since either can alter the test results. A)EXAMINATION OF STOOL FOR OCCULT BLOOD B)ulcers

The nurse or patient should don gloves and use tongue blades to transfer the stool to the proper receptacle. A)EXAMINATION OF STOOL FOR OCCULT BLOOD B)ulcer

The patient should keep the diet free of organ meat for 24 to 48 hours before a guaiac test. A)EXAMINATION OF STOOL FOR OCCULT BLOOD B)ulcer

SIGMOIDOSCOPY (LOWER Gl ENDOSCOPY)

Explain the procedure to the patient and have him or her sign a consent form. Administer enemas as ordered on the evening before or the morning of the examination to ensure optimum visualization of the lower Gl tract. A)SIGMOIDOSCOPY (LOWER Gl ENDOSCOPY) B)OCCULT BLOOD TEST

After the examination, observe the patient for evidence of bowel perforation (abdominal pain, tenderness, distention, and bleeding). A)SIGMOIDOSCOPY (LOWER Gl ENDOSCOPY) B)OCCULT BLOOD TEST

BARIUM ENEMA STUDY (LOWER Gl SERIES)

Barium sulfate assists in visualization of mucosal detail. A)true B)false

Therapeutically, the BE study may be used to reduce non-strangulated ileocolic intussusception (infolding of one segment of the intestine into the lumen of another segment) in children. A)true B)false

The evening before the BE, administer cathartics such as magnesium citrate or other cathartics designated by institution policy. A)BARIUM ENEMA STUDY (LOWER Gl SERIES) B)colonoscopy

Also administer a cleansing enema the evening before or the morning of the BE if directed by physician's order or hospital policy A)BARIUM ENEMA STUDY (LOWER Gl SERIES) B)colonoscopy

Milk of magnesia (60 mL) may be ordered after the BE to stimulate evacuation of the barium. A)true B)false

Retained barium may cause a hardened impaction. Stool will be ligh t colored until all the barium has been expelled. A)BARIUM ENEMA STUDY (LOWER Gl SERIES) B)COLONOSCOPY

COLONOSCOPY

The development of the fiberoptic colonoscope has enabled examination of the entire colon-from anus to cecum- in a high percentage of patients. A)true B)false

A less invasive test than a standard colonoscopy is called virtual colonoscopy. This test uses CT scanning or MRI with computer software to produce images of the colon and rectum. A)true B)false

Explain the procedure to the patient and have him or her sign a consent form. A)colonoscopy B)ulcers

Instruct the patient regarding dietary restrictions: Usually a clear liquid diet is permitted 1 to 3 days before the procedure to decrease the residue in the bowel, and then NPO status is maintained for 8 hours before the procedure. A)colonoscopy B)ulcers

Administer a cathartic, enemas, and premedication as ordered to decrease the residue in the bowel. GoLYTELY, an oral or NG colonic lavage, is an osmotic electrolyte solution that is now commonly used as a cathartic. A)colonoscopy B)enemas

It is a polyethylene glycol solution. If it is taken orally, instruct the patient to drink the solution rapidly: 8 ounces (240 mL) every 15 minutes until enough solution has been consumed to make the colonic contents a light yellow Fluid. Powdered lemonade may be added to make the oral solution more palatable A)GoLYTELY, B)enema

If it is given per lavage, it must be given rapidly. Taking the solution slowly will not clean the colon efficiently. Provide warm blankets during the procedure, since many patients experience hypothermia while taking GoLYTELY. A)true B) false

Provide warm blankets during the procedure, since many patients experience hypothermia while taking GoLYTELY. A)true colonoscopy B)false

Provide a commode at the bedside for older adults and frail patients. Check the patient's stool after the prep to make certain it is light yellow and liquid. A)colonoscopy B)enemas

A preprocedme IV sedative such as midazolam is often given. A)colonoscopy B)enemas

After the colonoscopy, check for evidence of bowel perforation (abdominal pain, guarding, distention, tenderness, excessive rectal bleeding, or blood clots) and examine stools for gross blood. Assess for hypovolemic shock. A)true B)false

After the colonoscopy, . Assess for hypovo- lemic shock. A)true B)false

GoLYTELY Bowel Preparation

Give patient one metoclopramide (Reglan) 10-mg tablet, as prescribed, orally 30 minutes before proceeding. A)true B)false

Administer GoLYTELY solution· (prepared by pharmacy) per physician's orders: a. 240 ml orally every 15 minutes or b. 30 ml/min via nasogastric tube. Use a Travasorb enteral feeding container and a size 10 feeding tube. Administer until stools are clear yellow. c. Keep patients warm with heated blankets; they often become chilled after consuming copious amounts of GoLYTELY solution. d. Provide a bedside commode for older or weak patients.

STOOL CULTURE

The feces (stool) can be examined for the presence of bacteria, ova, and parasites (a plant or animal that lives on or within another living organism and obtains some advantage at its host's expense) A)stool culture B)enemas

Usually at least three stool specimens are collected on subsequent days. Because culture results are not available for several days, they do not influence initial treatment, but they do guide subsequent treatment if bacterial infection is present. A)stool culture B)enemas

If an enema must be administered to collect specimens, use only normal saline or tap water. Soapsuds or any other substance could affect the viability of the organisms collected. A)stool culture B)enema

Stool samples for O&P are obtained before barium examinations. Instruct the patient not to mix urine with feces. A)stool culture B)enemas

Ensure the specimen is taken to the laboratory within 30 minutes of collection in specified container. A)stool culture B)enemas

OBSTRUCTION SERIES (FLAT PLATE OF THE ABDOMEN)

The obstruction series is a group of radiographic studies performed on the abdomen of patients who have suspected bowel obstruction, paralytic ileus, perforated viscus (any large interior organ in any of the great body cavities), or abdominal abscess. A)OBSTRUCTION SERIES (FLAT PLATE OF THE ABDOMEN) B)stool culture

Radiographs are examined for evidence of free air under the diaphragm, which is pathognomonic (signs or symptoms specific to a disease condition) of a perforated viscus. This radiographic study is used also to detect air-fluid levels within the intestine. A)OBSTRUCTION SERIES (FLAT PLATE OF THE ABDOMEN) B)stool culture

DISORDERS OF THE MOUTH

Common disorders of the mouth and esophagus that interfere with adequate nutrition include poor dental hygiene, infections, inflammation, and cancer. A)true B)false

DENTAL PLAQUE AND CARIES

Dental decay can be caused by several factors: • Dental plaque, a thin film on the teeth made of mucin and colloidal material found in saliva and often secondarily invaded by bacteria • The strength of acids and the inability of the saliva to neutralize them • The length of time the acids are in contact with the teeth • Susceptibility of the teeth to decay

True

Dental caries is treated by removal of affected areas of the tooth and replacement with some form of dental material A)DENTAL PLAQUE AND CARIES B)ulcers

Proper technique for brushing and flossing the teeth at least twice a day is the primary focus for teaching these patients A)DENTAL PLAQUE AND CARIES B)ulcers

carbohydrates create an environment in which caries develop and plague accumulates more easily, include proper nutrition in patient teaching. A)DENTAL PLAQUE AND CARIES B)ulcers

When the patient is ill, the mouth's normal cleansing action is impaired. illnesses, drugs, and irradiation all interfere with the normal action of saliva. If the patient is unable to manage oral hygiene, then nurse must assume this responsibility. A)DENTAL PLAQUE AND CARIES B)ulcers

Noncompliance, related to hygiene and dietary restrictions. An intervention would be A)Brush teeth twice daily and as needed with toothpaste or powder, baking soda, or mouthwash. Rinse with water or mouthwash B)Cleanse mouth with equal parts of hydrogen peroxide and water as needed for halitosis. Teach the patient about oral hygiene. C)both and b

halitosis is termed bad breath A)true B)false

CANDIDIASIS

Candidiasis is any infection caused by a species of Candida, usually C. albicans. Candida is a fungal organism normally present in the mucous membranes of the mouth, intestinal tract, and vagina; it is also found on the skin of healthy people. This infection is also referred to as thrush or moniliasis. A)true B)false

This disease appears more commonly in the new born infant, who becomes infected while passing through the birth canal. A)Candidiasis B)ulcer

In the older individual, candidiasis may be found in patients with leukemia, diabetes mellitus, or alcoholism, and in patients who are taking antibiotics (chlortetracycline or tetracycline), are undergoing corticosteroid inhalant treatment, or are immmosuppressed (e.g., patients with acquired immunodeficiency syndrome [AIDS] or those receiving chemotherapy or radiation therapy) A)true B)false

In the older individual, candidiasis may be found in patients with leukemia, diabetes mellitus, or alcoholism, and in patients who are taking antibiotics, corticosteroid inhalant treatment, or are immmosuppressed (e.g., patients with acquired immunodeficiency syndrome [AIDS] or those receiving chemotherapy or radiation therapy) A)true B)false

patients with acquired immunodeficiency syndrome [AIDS] or those receiving chemotherapy or radiation therapy, are at risk of CANDIDIASIS A)true B)false

CANDIDIASIS appears as pearly, bluish white " milk- curd" membranous lesions on the mucous membranes of the mouth, tongue, and larynx. A)true B)false

If the patch or plaque is removed, painful bleeding can occur. With CANDIDIASIS. A)true B)false

Use meticulous hand hygiene to prevent spread of infection. A)candidiasis B)ulcer

The infection may be spread in the nursery by carelessness of nursing personnel. Hand hygiene, care of feeding equipment, and cleanliness of the mother's nipples are important to prevent spread. A)CANDIDIASIS B)ulcer

Cleanse the infant's mouth of any foreign material, rinsing the mouth and lubricating the lips. Inspect the mouth using a flashlight and tongue blade. A)candidiasis B)ulcers

For adults, instruct the patient to use a soft-bristled toothbrush and administer a topical anesthetic (lidocaine or benzocaine) to the mouth 1 hour before meals. Give soft or pureed foods and avoid hot, cold, spicy, fried, or citrus foods. A)candidiasis B)ulcer

Give soft or pureed foods and avoid hot, cold, spicy, fried, or citrus foods. For patients with A)candidiasis B)ulcer

CARCINOMA OF THE ORAL CAVITY

Oral (or oropharyngeal) cancer may occur on the lips, the oral cavity, the tongue, and the pharynx. The tonsils are occasionally involved. A)true B)false

Most of these tumors are squamous cell epitheliomas that grow rapidly and metastasize to adjacent structures more quickly than do most malignant tumors of the skin. A)oral cancer B)lip cancer

Tumors of the salivary glands occur primarily in the parotid gland and are usually benign. A)true B)false

Tumors of the submaxillary gland have a high incidence of malignancy. These malignant tumors grow rapidly and may be accompanied by pain and impaired facial function A)true B)false

Kaposi's sarcoma is a malignant skin tumor that occurs primarily on the legs of men between 50 and 70 years of age. It is seen with increased frequency as a nonsquamous tumor of the oral cavity in patients with AIDS. The lesions are purple and nonulcerated. Irradiation is the treatment of choice. A) true B)false

The twnor seen with cancer of the lip is usually an epithelioma. It occurs most frequently as a chronic ulcer of the lower lip in men.Occasionally the tumor may be a basal cell lesion that starts in the skin and spreads to the lip. A)true B)false

Cancer of the anterior tongue and floor of the mouth may seem to occur together because their spread to adjacent tissues is so rapid. Because of the tongue's abundant vascular and lymphatic drainage, metastasis to the neck has already occurred in more than 60% of patients when the diagnosis is made. A)true B) false

There is a higher incidence of cancers of the mouili and throat among people who are heavy drinkers and have a history of tobacco use (e.g., cigar, cigarette, pipe, chewing tobacco). A)true B)false

Leukoplakia (a white, firmly attached patch on the mouth or tongu e mucosa) may appear on the lips and buccal mucosa. These nonsloughing lesions cannot be rubbed off by simple mechanical force. They can be benign or malignant. A)true oral cancer B)false

The patient may feel only a roughened area with the tongue. As the disease progresses, the first complaints may be (1) difficulty chewing, swallowing, or speaking; (2) edema, numbness, or loss of feeling in any part of the mouth; and (3) earache, facial pain, and toothache, which may become constant. A)subjective data for oral cancer B)objective data for oral cancer

Cancer of the lip is associated with discomfort and irritation caused by a nonhealing lesion, which may be raised or ulcerated. A)true subjective B)false subjective

Malignancy at the base of the tongue produces less obvious symptoms: slight dysphagia, sore throat, and salivation. A)true oral cancer B) false

Unusual bleeding in the mouth, some blood-tinged sputum, lumps or edema in the neck, and hoarseness may be observed. A) objective data for oral cancer B) subjective data for oral cancer

Indirect laryngoscopy is an important diagnostic test for examination of the soft tissue. A)oral cancer B)false

Oral exfoliative cytology is used for screening intraoral lesions. A)true B)false

Stage I oral cancers are treated by surgery or radiation. Stages Il and Ill cancers require both surgery and radiation. Treatment for stage IV cancer is usually palliative. A) true B) false

Chemotherapy may also be used when surgery and radiation therapy fail or as the initial therapy for smaller tumor. A)true for oral cancer B)false

Surgical options for oral cancer include a glossectomy, removal of the tongue; hemiglossectomy, removal of part of the tongue; mandibulectomy, removal of the mandible; and Total or supraglottic laryngectomy, removal of the entire larynx or the portion above the true vocal cords.

True

In radical neck dissection, all these structures are removed and reconstructive surgery is necessary after tissue resection. A)true for oral cancer B)false

Patients may have drains in the incision sites that are connected to suction to aid healing and reduce hematomas. A)true B)false

Because of the location of the surgery, for oral cancer, complications can occur. These include airway obstruction, hemorrhage, tracheal aspiration, facial edema, fistula formation, and necrosis of the skin flap. A)true B)false

If the patient has difficulty swallowing, a percutaneous endoscopic gastrostomy (PEG) tube may be inserted to allow for adequate nutritional intake. A)true B)false

The purpose of radiation therapy is to shrink the tumor. It can be given preoperatively or postoperatively, depending on the physician's preference and the patient's disease process. A)true B)false

Imbalanced nutrition, less than body requirements, related to: • oral pain postoperative tissue loss and oral pain mucous membranes. Nursing intervention would be A)Monitor the patient for changes in the character and quantity of m ucus after radiation therapy. B) Provide meticulous oral hygiene. C)both a and b

Prevention centers on predisposing factors: avoiding excess exposure to sun and wind on the lips, eliminating smoking or chewing tobacco, and eliminating plaque and caries through good oral and dental care. A)true for oral cancer B)false

The incidence of cancer of the mouth bears a high correlation to cirrhosis of the liver associated with alcohol intake A)true B)false

Early detection of oral cancer can increase the patient's chance of survival. A)true B)false

Any person with a mouth lesion that does not heal within 2 to 3 weeks is urged to seek medical care. A)true B)false

DISORDERS OF THE ESOPHAGUS

GASTROESOPHAGEAL REFLUX DISEASE

Gastroesophageal reflux disease (GERD) is a backward flow of stomach acid up into the esophagus. Symptoms typically include burning and pressure behind the sternum. A)true B)false

Symptoms of GERD develop when the LES is weak or experiences prolonged or frequent transient relaxation, conditions that allow gastric acids and enzymes to flow into the esophagus. A)true B)false

Reflux is much more common in the postprandial state (after meals); more than 60% of reflux sufferers have delayed gastric emptying. A)true B)false

GERD is the most common upper GI problem seen in adults A)true B)false

The irritation of chronic reflux produces the primary symptom, which is heartburn (pyrosis).

GERD

GERD,The pain is described as a substernal or retrostemal burning sensation that tends to radiate upward and may involve the neck, the jaw, or the back.The pain typically occurs 20 minutes to 2 hours after eating. A) true B)false

The second major symp-tom of GERD is regmgitation, which is not associated with either eructation or nausea. A)true B)false

The individual experiences a feeling of warm fluid moving up the throat. If it reaches the pharynx, a sour or bitter taste is perceived.

GERD

Water brash, a reflux salivary hypersecretion that does not taste bitter, occurs less commonly. In GERD A)true B)false

In severe cases, GERD can produce dysphagia or odynophagia (painful swallowing) A)true B)false

Nocturnal cough, wheezing, or hoarseness all may occur with reflux, and it is estimated that more than 80% of adult asthmatics(suffering from asthma) may have reflux. A)true B)false

Subjective data include heartburn, a substernal or retrosternal burning sensation that may radiate to the back or jaw (in some cases the pain may mimic angina); and regmgitation (not associated with nausea or eructation), which causes a sour or bitter taste in the pharynx. Frequent eructation, flatulence, and dysphagia or odynophagia usually occur commonly in severe cases. A) GERD B) ulcer

Subjective data include heartburn, a substernal or retrosternal burning sensation that may radiate to the back or jaw and regurgitation, which causes a sour or bitter taste in the pharynx. Frequent eructation(belch), flatulence, and dysphagia or odynophagia usually occur commonly in severe cases. A) GERD B)ulcer

Objective data of GERD include nocturnal cough, wheezing, and hoarseness A)true B)false

In its simplest form, GERD produces mild symptoms that occm infrequently (twice a week or less). In these cases, avoiding problem foods or beverages, stopping smoking, or losing weight may solve the problem. A)true B)false

Treatment with antacids or acid-blocking medications called H 2 receptor antagonists-such as cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), or nizatidine (Axid)- may also be used for GERD A)true B)false

More severe and frequent episodes of GERD can trigger asthma attacks, cause severe chest pain, result in bleeding, or promote a narrowing (stricture) or chronic irritation of the esophagus. ln these cases, more powerful inhibitors of stomach acid production called proton pump inhibitors, such as omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), rabeprazole (Aciphex), and lansoprazole (Prevacid), may be added to the treatment prescribed. A)true B)false

``` Metocloprarnide (Reglan) is used in moderate to severe cases of GERD. lt is in a class of drugs called promotility agents that increase peristalsis and therefore promote gastric emptying and reduce the risk of gastric acid reflux. A)true B)false ```

promotility agents that increase peristalsis and therefore promote gastric emptying and reduce the risk of gastric acid reflux. A)true B)false

As a last resort, a surgical procedure called fundoplication is performed to strengthen the sphincter. For GERD A)true B)false

Barrett's esophagus the normal squamous epithelium of the esophagus is replaced by columnar epithelium. Because patients w ith Barrett's esophagus are at higher risk for esophageal cancer, they may need to be monitored regularly (every 1 to 3 years) by endoscopy and biopsy. A) true B)false

Dietary instructions of GERD include (1) eat four to six small meals daily; (2) follow a low-fat, adequate-protein diet; (3) reduce intake of chocolate, tea, and other foods and beverages that contain caffeine; (4) limit or eliminate alcohol intake; (5) eat slowly, and chew food thoroughly; (6) avoid evening snacking, and do not eat for 2 to 3 hours before bedtime; (7) remain upright for 1 to 2 hours after meals when possible, and never eat in bed; (8) avoid any food that directly produces heartburn; and (9) reduce overall body weight if needed.

True

Cigarette smoking has been associated with decreased acid clearance from the lower esophagus. With GERD A)true B)false

Advise them to avoid constrictive clothing over the abdomen. They should avoid activities that involve straining, heavy lifting, or working in a bent-over position. A)intervention for GERD B)false

Also instruct them to never sleep flat in bed. They should elevate the head of the bed at least 6 to 8 inches for sleep, using wooden blocks or a thick foam wedge. A)intervention for GERD B)falsse

CARCINOMA OF THE ESOPHAGUS

Carcinoma of the esophagus is a malignant epithelial neoplasm that has invaded the esophagus and has been diagnosed as a squamous cell carcinoma or an adenocarcinoma A)true B)false

Risk factors for esophageal cancer include alcohol and tobacco use and possibly longstanding achalasia (an abnormal condition characterized by the inability of a muscle to relax, particularly the cardiac sphincter of the stomach). A)true B)false

Environmental carcinogens, nutritional deficiencies, chronic irritation, and mucosal damage have all been considered as causes of esophageal cancer. A)true B)false

Another risk factor is Barrett's esophagus. For esophageal cancer A)true B)false

The prevalent age-group for esophageal cancer is 55 to 70 years. It occurs more commonly in men. A)true B)false

The most common clinical symptom is progressive dysphagia (difficulty in swallowing) over a 6-month period . The patient may have a substernal feeling as though food is not passing through the esophagus. A)esophageal cancer B)ulcer

subjective data of esophageal cancer includes noting that initially the patient may have difficulty swallowing when eating bulky foods such as meat; later the difficulty occurs with soft foods and finally with liquids and even saliva. A)true B)false

objective data of esophageal cancer includes observing the patient for regurgitation, vomiting, hoarseness, chronic cough, choking, and iron deficiency anemia. Weight loss may be directly related to the tumor or a side effect of treatment or the inability to swallow. A)true B)false

When esophageal stenosis (narrowing) is severe, regurgitation of blood-flecked esophageal contents is common. A)esophageal cancer B)false

Hemorrhage occurs if the cancer erodes through the esophagus and into the aorta. Esophageal perforation with fistula formation into the lung or trachea sometimes develops. The tumor may enlarge enough to cause esophageal obstruction. A)esophageal cancer B)ulcer

Endoscopic ultrasonography is an important tool used to stage esophageal cancer A)true B)false

In advanced cases, surgery is palliative to relieve dysphagia and restore continuity of the alimentary tract. A)esophageal cancer B)ulcer

An aggressive approach provides excellent palliation (therapy designed to relieve or reduce intensity of uncomfortable symptoms but not to produce a cure), increased longevity, and a chance for a cure. A)esophageal cancer B)ulcer

Radiation therapy may be curative or palliative. In esophageal cancer A)true B) false

Chemotherapeutic agents cisplatin (Platinol), paclitaxel (Taxol), and fluorouracil (5-FU) are currently used in combination with radiation before and/ or after surgery. With esophageal cancer.Because of the extreme toxicity of these drugs, expect the patient to experience side effects of respiratory and liver dysfunction, nausea and vomiting, leukopenia, and sepsis. A)true B)false

The following four types of surgical procedures can be performed: 1. Esophagogastrectomy: 2. Esophagogastrostomy: 3. Esophagoenterostomy: 4. Gastrostomy:

True

anastomosis is surgical joining of two ducts, blood vessels, or bowel segments to allow flow from one to the other. A)true B)false

Ineffective breathing pattern, related to: • incisional pain and proximity to the diaphragm, a nursing intervention would be. A)Monitor respirations carefully because of proximity of incision to diaphragm and patient's difficulty in carrying out breathing exercises. B)take vitals

Imbalanced nutrition: less than body requirements, related to: • dysphagia • decreased stomach capacity and anorexia. A nursing intervention would be A)Monitor intake and output (I&O) and daily weights to determine adequate nutritional intake. B)Assess which foods patient can and cannot swallow to select and prepare edible foods. C)Administer tube feedings through gastrostomy, if present. D)all the above

Step-by-step explanations of all diagnostic tests, medications, procedures, and the treatment plan will help relieve the patient's anxiety. A)true B)false

High mortality rates of esophageal cancer among these patients are affected by the following issues: (1) the patient is generally older; (2) the tumor has usually invaded surrounding structures; (3) the malignancy tends to spread to nearby lymph nodes; and (4) the esophagus is close to the heart and lungs, making these organs accessible to tumor extension.

True

ACHALASIA

Achalasia, also called cardiospasm, is an abnormal condition characterized by the inability of a muscle to relax, particularly the cardiac sphincter of the stomach. A)true B)false

Thus little or no food can enter the stomach, and in extreme cases the dilated portion of the esophagus holds as much as a liter or more of fluid. This disease may occur in people of any age, but is more prevalent in those between 20 and 50 years. A)ACHALASIA B)ULCER

The primary symptom of achalasia is dysphagia. The patient has a sensation of food sticking in the lower portion of the esophagus. A)true B)false

As the condition progresses, the patient complains of regurgitation of food, which relieves prolonged distention of the esophagus. The patient may also have substernal chest pain. A)achalasia B)ulcer

Observe for loss of weight, poor skin turgor, and weakness for patient with achalasia A)true B)false

Conservative treatment of achalasia includes drug therapy and forceful dilation of the narrowed area of the esophagus. Anticholinergics, nitrates, and calcium channel blockers reduce pressure in the lower esophageal sphincter. A)true B)false

(achalasia) Imbalanced nutrition: less than body requirements, related to difficulty swallowing both liquids and solids a nursing intervention would be A)Encourage fluids with meals to increase lower esophageal sphincter pressure and push food into stomach. B)Monitor liquid diet for 24 hours after dilation procedure. C)both a and b

(achalasia) Anxiety, related to continuous dilation process with threat of complications, a nursing intervention would be. Select all that apply A)Monitor for signs of esophageal perforation (chest pain, shock, dyspnea, fever) after dilation. B)Provide calm, nonstressful environment. C)Reinforce physician's explanation of disease process. D)Encourage verbalization of fears; assist patient with identifying stressors and positive coping behaviors.

A B C D

Explain the need for a high-calorie, high-protein diet, and provide printed material describing same.for a patient with achalasia A)true B)false

Discuss methods of avoiding constipation by using high-fiber foods (if tolerated) and natural laxatives. A)true B) false

Nursing Interventions for the Patient Experiencing Esophageal Surgery

PREOPERATIVE NURSING INTERVENTIONS 1. Encourage improved nutritional status. a. Offer a high-protein, high-calorie diet if oral diet is possible. b. Total parenteral nutrition may be necessary for severe dysphagia or obstruction. c. Gastroscopy tube feedings may be indicated. 2. Give meticulous oral hygiene; breath may be malodorous. 3. Give preoperative preparation appropriate for thoracic surgery. 4. Give prescribed antibiotics before esophageal resection or bypass, as ordered.

True

POSTOPERATIVE NURSING INTERVENTIONS 1. Promote good pulmonary ventilation. 2. Maintain chest drainage system as prescribed. 3. Maintain gastric drainage system. a. Small amounts of blood may drain from nasogastric tube for 6 to 12 hours after surgery. b. Do not disturb nasogastric tube (to prevent traction on suture line). 4. Maintain nutrition. a. Start clear fluids at frequent intervals when oral intake is permitted. b. Introduce soft foods gradually, increasing to several small meals of bland foods. c. Have patient maintain semi-Fowler's position for 2 hours after eating and while sleeping if heartburn (pyrosis) occurs.

True

DISORDERS OF THE STOMACH

GASTRITIS (ACUTE)

Gastritis is an inflammation of the lining of the stomach A)true B)false

Acute gastritis is a temporary inflammation associated with alcoholism, smoking, and stressful physical problems, such as burns; major surgery; food allergens; viral, bacterial, or chemical toxins; chemotherapy; or radiation therapy. A)true B)false

If the condition is acute, the patient may experience fever, epigastric pain, nausea, vomiting, headache, coating of the tongue, and loss of appetite. A)gastritis B)ulcer

If the condition results from ingestion of contaminated food, the intestines are usually affected and diarrhea may occur. A)gastritis B)ulcer

Collection of subjective data of gastritis includes observing for anorexia, nausea, discomfort after eating, and pain. A)true B)false

Collection of objective data of gastritis includes observing for vomiting, hematemesis, and melena caused by gastric bleeding. A)true B)false

Antibiotics are given if the cause is a bacterial agent. IV fluids are used to correct fluid and electrolyte imbalances. With patients with gastritis A)true B)false

Patients who experience GI bleeding from hemorrhagic gastritis require fluid and blood replacement and NG lavage. A)true B)false

Patient with gastritis Clear liquids are increased to diet as tolerated. A)true B)false

(Gastritis) Deficient fluid volume, related to vomiting, diarrhea, and blood loss a nursing intervention would be. Select all that apply A)Keep patient NPO or on restricted food and fluids as ordered, and advance as tolerated. B)Monitor laboratory data for fluid and electrolyte imbalance (potassium, magnesium, sodium, and chloride). C)Maintain TV feedings. D)Record I&O.

A B C D

Patient education of gastritis includes explanations of (1) the effects of stress on the mucosal lining of the stomach; (2) how salicylates, nonsteroidal antiinflammatory drugs (NSAIDs), and particular foods may be irritating; and (3) how Lifestyles that include alcohol and tobacco may be harmful

True

Assist the patient in locating self-help groups in the community to deal with these behaviors. A)true B)false

PEPTIC ULCERS

Peptic ulcers are ulcerations of the mucous membrane or deeper structures of the GI tract. They most commonly occur in the stomach and duodenum. A)true B)false

The disease is increasing among older adults, perhaps as a result of the use of NSAIDs. Symptoms are common between the ages of 25 and 50, with peak occurrence at age 40. A)peptic ulcers B)gastritis

The GI tract has a high cell turnover rate, and the stomach's surface mucosa is renewed about every 3 days. A)true B)false

Peptic ulcers require the presence of gastric acid and result from four major causes: (1) excess of gastric acid (duodenal ulcers); (2) decrease in the natural ability of the GI mucosa to protect itself from acid and pepsin (gastric ulcers); (3) infection with spiral-shaped bacteria H. pylori; and (4) gastric injury from NSAIDs, aspirin, or corticosteroids.

True

H. pylori has been identified in more than 70% of gastric ulcer patients and 95% of those with duodenal ulcers. A)true B)false

In Western cultures, half of all people over age 50 harbor H. pylori, yet most do not develop peptic ulcer disease. A)true B) false

GASTRIC ULCERS

The most common site of a gastric ulcer is in the distal half of the stomach. A)true B)false

Gastric ulcers are related to factors such as diet; genetic predisposition; ingestion of excessive amounts of salicylates or NSAIDs; the use of tobacco; and H. pylori. A)true B)false

Gastric mucosal damage can occur in some individuals within 1 hour after the ingestion of acetylsalicylic acid. Reflux of duodenal contents (bile acids) also causes severe gastric mucosal damage. A)true B)false

PHYSIOLOGIC STRESS ULCERS

Physiologic stress ulcer or stress-related mucosal disease is an acute ulcer that develops after a major physiologic insult such as trauma or surgery. A)true B)false

A stress ulcer is a form of erosive gastritis. It is believed that the gastric mucosa of the stomach undergoes a period of transient ischemia in association with hypotension, severe injury, extensive burns, and complicated surgery. A)true B)false

The decrease in blood flow produces an imbalance between the destructive properties of hydrochloric acid and pepsin and protective factors of the stomach's mucosal barrier, especially in the fundus portion. A)stress ulcer B)ulcer

Because of the possibility of development of physiologic stress ulcers and high morbidity, patients at risk receive prophylaxis with antisecretory agents, including H 2 receptor blockers and proton pump inhibitors. A)true B)false

DUODENAL ULCERS

Risk factors include H. pylori infection, NSAIDs, cigarette smoking, and coffee. Ulceration occurs when the acid secretion exceeds the buffering factors. A)DUODENAL ULCERS B)gastritis

Pain is the characteristic symptom and is described as dull, burning, boring, or gnawing; it is located in the midline of the epigastric region. A)DUODENAL ULCERS B)gastritis

Nausea, eructation, and distention are common complaints; these are termed dyspepsia. All these subjective symptoms intensify if perforation and obstruction occur. A)DUODENAL ULCERS B)gastritis

objective data of duodenal ulcers includes observing for hemorrhage, a common complication with gastric ulcers; more gastric ulcers bleed than do duodenal ulcers. A)true B)false

Duodenal ulcers are more likely to have chronic bleeding and are more prone to perforation than gastric ulcers. A)true B)false

When GI bleeding occurs, one sign is vomiting blood (hematemesis) that has a coffee-grounds appearance as a result of action of the gastric acid on the hemoglobin molecule. A)true B)false

The patient may have melena (tarlike, fetid-smelling stool containing undigested blood) that occurs when the blood becomes black and tarry as it passes through the digestive tract. A)true B)false

Both salicylates and alcohol aggravate bleeding in patients with a history of pep tic ulcers. A)true B)false

Bleeding from a gastric ulcer is more difficult to control than bleeding from a duodenal ulcer. A)true B)false

Hemorrhage, with accompanying symptoms of shock, occurs when the ulcer erodes into a blood vessel. A)true B)false

Surgical intervention is indicated if the patient remains unstable after receiving blood over several hours. A)true B)false

Perforation occurs when the ulcer crater penetrates the entire thickness of the wall of the stomach or duodenum. A)true B)false

The release of air, gastric acid, pancreatic enzymes, or bile into the peritoneal cavity causes pain, emesis, fever, hypotension, and hematemesis. A)true, perforation B)false

Perforation is considered the most lethal complication of peptic ulcer. A)true B)false

Bacterial peritonitis may occur within 6 to 12 hours. A)true B)false

It occurs more frequently when the ulcer is located close to the pylorus. Symptoms may be relieved by constant NG aspiration of stomach contents. This allows edema and inflammation to subside and permits normal flow of gastric contents through the pylorus. A)Gastric outlet obstruction B)ulcer

Fiberoptic endoscopy can detect both gastric and duodenal ulcers. A)true B)false

The physician may order insertion of an NG tube to remove gastric content and blood. A)true B)false

Surgery is indicated usually for complications: perforation, penetration,obstruction, or intractability (no longer responding to medical managem ent). A)true B)false

Scar tissue builds up with repeat episodes of ulceration and healing, causing obstruction, particularly at the pylorus. The patient may be seen with gastric dilation, vomiting, and distention. When fluid and electrolyte balance are achieved, surgical intervention is possible. A)true B)false

The primary treatment for peptic ulcers is to reduce signs and symptoms by decreasing or neutralizing normal gastric acidity with drug therapy. The types of drugs most commonly used include the following, Antacids,Histamine (H2) receptor blockers, Proton pump inhibitors, Mucosal healing agent,Antisecretory and cytoprotective agent. A)true B)false

Histamine (H2) receptor blockers: Decrease acid secretions by blocking histamine (H2) receptors A)true B)false

Proton pump inhibitors: Antisecretory agents that inhibit secretion of gastrin by the parietal cells of the stomach. A)true B)false

Mucosal healing agent: Heals ulcers without antisecretory properties. Sucralfate is a cytoprotective drug. A)true B)false

Antisecretory and cytoprotective agent: Inhibits gastric acid secretion and protects gastric mucosa. A)true B)false

Antibiotic therapy eradicates H. pylori. The drugs used include metronidazole (Flagyl), tetracycline, amoxicillin, and clarithromycin (Biaxin). A)true B)false

Among patients whose H. pylori is treated with antibiotics, the peptic ulcer recurrence may be as low as 10%. Patients who do not receive antibiotics have a relapse rate of 75% to 90%. A)true B)false

Therefore it is recommended that the patient eat smaller meals more frequently throughout the day to decrease the degree of gastric motor activity. For duodenal ulcers A)true B)false

Smoking has an irritating effect on the mucosa, increases gastric motility, and delays mucosal healing. Smoking should be eliminated completely or severely reduced. A)DUODENAL ULCERS B)ulcer

The combination of adequate rest and cessation of smoking accelerates ulcer h ealing. Because caffeinated and decaffeinated coffee, tobacco, alcohol, and aspirin aggravate the mucosal lining of the stomach and duodenum, educate patients w ith ulcers about the need for lifestyle change. A)DUODENAL ULCERS B)ulcer

Types of surgical procedures include the following:

Antrectomy: Removal of the entire antrum, the gastric producing portion of the lower stomach, to eliminate the main s timu li to acid production. A)true B)false

Gastroduodenostomy (Billroth I): Direct anastomosis of the fundus of the stomach to the duodenum; used to remove ulcers or cancer located in the antrum of the stomach. A)true B)false

Gastrojejunostomy (Billroth II): Closure of the duodenum, and anastomosis of the fundus of the s tomach into the jejunum; used to remove ulcers or cancer located in the bod y of the fundus. A)true B)false

Total gastrectomy is removal of the stomach. A)true B)false

Vagotomy: Removal of the vagal inne rvation to the fundus, d ecreasing acid produced by the pa- rietal cells of the stomach A)true B)false

Pyloroplasty: Surgical enlargement of the pyloric sphincter to facilitate passage of contents from the stomach; A)true B)false

Bleeding may occur up to 7 days after gastric surgery. A)duodenal ulcer B)ulcer

Abdominal rigidity, abdominal pain, restlessness, elevated temperature, increased pulse, decreased blood pressure, and leukocytosis are all possible indications of postoperative bleeding. A)true B)false

Dumping syndrome is a rapid gastric emptying causing distention of the duodenum or jejunum produced by a bolus of hypertonic food . Increased intestinal motility and peristalsis and changes in blood glucose levels occur. A)true B)false

_________ is a rapid gastric emptying causing distention of the duodenum or jejunum produced by a bolus of hypertonic food . Increased intestinal motility and peristalsis and changes in blood glucose levels occur.

Dumping syndrome

Patients may report diaphoresis, nausea, vomiting, epigastric pain, explosive diarrhea,borborygmi (noises made from gas passing through the liquid of the small intestine), and dyspepsia.

Dumping syndrome

Dumping syndrome is the direct result of surgical removal of a large portion of the stomach and the pyloric sphincter. A)true B)false

Treatment of dumping syndrome includes eating six small meals daily that are high in protein and fat and low in carbohydrates, eating slowly, and avoiding fluids during meals. A)true B)false

Treatment of dumping syndrome also includes (1) anticholine rgic agents to decrease stomach motility, and (2) reclining for approximately 1 hour after meals. A)true B)false

Diarrhea is common and usually responds to conservative treatment of controlled diet and antidiarrheal agents. A)duodenal ulcer B)ulcer

Reflux esophagitis and nutritional deficits-including weight loss, malabsorption, anemia, and vitamin deficiency can also be life threatening. A)true B)false

Pernicious anemia is a serious potential complication for any patient who has had a total gastrectomy or extensive resections. A)true B)false

Pernicious anemia is a serious potential complication for any patient who has had a total gastrectomy or extensive resections.This is caused by a deficiency of the intrinsic factor, produced exclusively by the stomach, which aids intestinal absorption of vitamin B12. A)true B)false

Recommend that all patients with a partial gastrectomy have a blood serum vitamin B12 level measured every 1 to 2 years so that replacement therapy of vitamin B12 via a monthly injection or via nasal route weekly can be instituted before anemia appears. A)true B)false

NG or intestinal tube insertion, irrigation, and intermittent suctioning are often performed while a patient is feeling ill and uncomfortable A)true B)false

Helping patients through the experience of GI intubation requires understanding of the following points:

For most patients, NG or intestinal tube placement is a new and frightening experience. Convey the rationale for this therapy to the anxious patient and family. Help them understand that the advantages far outweigh the discomfort. A)true B)false

Inability to chew, taste, and swallow food and liquids may contribute to patient anxiety during GI intubation. A)true B)false

A patient with an NG or intestinal tube is usually on NPO status. Occasionally ice chips are allowed. A)true B)false

An NG or intestinal tube is connected to either continuous or intermittent suctioning, usually at 100 mm Hg for decompression. A)true B)false

An NG or intestinal tube is a constant irritant to the nasopharynx and nares, requiring frequent care to the mouth and nose. A)true B)false

A patient with a GI tube may be afraid that moving will dislodge the tube. Implement frequent position changes to enhance tube functioning and prevent complications of immobility. A)true B)false

An NG tube is inserted through the nose, pharynx, and esophagus into the stomach. A)true B)false

Deficient knowledge, related to: • medications • diet • signs and symptoms of bleeding, perforation, or gastric outlet obstruction nursing intervention would be A)Provide verbal and written instructions on exact dosage and time intervals for medications and whether medication is taken with or without food. B)Have dietitian provide instructions on therapeutic diet. C)Explain that repeat episodes are not uncommon; listen carefully for aggravating factors. D)all the above

Pain, related to gastric acid on ulceration of gastric or duodenal mucosa a nursing intervention would be A)Give prescribed H 2 receptor antagonists (cimetidine, ranitidine, famotidine, or nizatidine) with meals and at bedtime. B)Give prescribed antacid 1 and 3 hours after meals. C)both a and b

Pain, related to gastric acid on ulceration of gastric or duodenal mucosa-cont'd nursing intervention would be A) Give prescribed proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, or esomeprazole). B)Administer antibiotic therapy to eradicate H. pylori infections as prescribed. C)Instruct patient on side effects of antacid drugs (constipation or diarrhea) and importance of contacting physician if this occurs. D)all the above

Noncompliance, related to: • risk behaviors (use of tobacco or alcohol) • dietary patterns a nursing intervention would be select all that will apply A)Teach preventive measures, such as quitting smoking. B)Explain need for small and frequent meals. C)Caution patient to avoid high-fiber foods, sugar, salt, caffeine, alcohol, and milk. D)Remind patient to take fluids between meals, not with meals. E)Explain the need to eat slowly and chew food well. F)Discuss importance of adequate rest and exercise.

all the above

imbalanced nutrition: less than body requirements, related to preoperative food and fluid restrictions a nursing intervention would be select all the apply A)Maintain NPO status. B)Connect NG tube to intermittent suction apparatus. C)Note color and amount of gastric output every 4 hours. D)Do not reposition tube. E)Maintain patency of tube by irrigation with measured amounts of saline only if ordered. NOTE: After gastrectomy, output is minimal. F)Monitor parenteral fluids with electrolyte additives as ordered. G)Measure I&O. H)When bowel sounds return and flatus is expelled, administer clear. I)Liquids as ordered. J)Progress to small, frequent meals of soft food as ordered. K)Avoid milk because it may cause dumping syndrome.

all the above

When medications are prescribed, the patient must fully understand (1) the purpose of taking antibiotic therapy to eradicate H. pylori; (2) the importance of taking all medications such as H 2 receptor antagonists, antiulcer drugs, prostaglandin E analog, and proton pump inhibitors as prescribed; (3) why the antacids are taken in large doses (30 mL) seven times daily (1 and 3 hours after a meal and at bedtime) or at the specific times ordered; and (4) the known side effects (diarrhea and constipation)

True

Emphasize that the patient should eat six smaller meals daily and avoid any foods that cause noticeable stomach discomfort. A) true B)false

True for ulcers

Home Care Considerations | Peptic Ulcer Disease

The patient may be angry and frustrated, especially he or she has faithfully followed the prescribed therapy but failed to prevent the recurrence or extension of the disease process. A) true B)false

Explain immediate postoperative care, including deep breathing; coughing; position changes; frequent monitoring of vital signs; IV tubing, NG tubing, catheters, and other drainage tubes; and the use of patient controlled analgesia (PCA) or other medications for pain relief. A)true B)false

True ulcer

Unfortunately, many patients do not comply with the care plan and experience repeated exacerbations. A)true B)false

Changes in lifestyle are difficult for most people and may be resisted. A)true B)false

The goal should be adhering to the prescribed therapeutic regimen, including nutritional management, cessation of smoking, and decreased use of alcohol and caffeine. A)true B)false

Teach the patient to take all medications as prescribed. This includes both antisecretory and antibiotic drugs. Failure to take prescribep medications can result in relapse. A)true B)false

CANCER OF THE STOMACH

Because of the location, the tumor may metastasize to lymph nodes, liver, spleen, pancreas, or esophagus. Gastric cancer is more common in people 50 to 70 years of age. A)true B)false

Stomach carcinogenesis probably begins with a nonspecific mucosal injury as a result of aging; autoimmune disease; or repeated exposure to irritants such as bile, antiinflammatory agents, or smoking. A)true B)false

Because the stomach has prolonged contact with food, cancer in this part of the body is associated with diets that are high in salt, smoked and preserved foods (which contain nitrites and nitrates), and carbohydrates, and low in fresh fruits an d vegetables. A)true B) false

Whole grains and fresh fruits and vegetables are associated with reduced rates of stomach cancer. Infection with H. pylori, especially at an early age, is considered a definite risk factor for gastric cancer. A)true B)false

the patient may appear pale and lethargic if anemia is present. With a poor appetite and significant weight loss, the patient may app ear cachectic. A)stomach cancer B)ulcer

Subjective d ata include complaints of vague epigastric discomfort or indigestion, early satiety, and postprandial (after meal) fullness. A)stomach cancer B)ulcer

Anorexia and weakness are also common in stomach cancer . A)true B)false

Objective data include weight loss, bleeding in the stools, hematemesis, and vomiting after drinking or eating. Anemia is common. A)stomach cancer B)ulcer

The tumor is diagnosed by radiographic barium studies (GI series). A)stomach cancer B) ulcer

Surgery for advanced gastric cancer carries high morbidity and mortality rates. A)true B)false

Wound healing may be disrupted by dehiscence (a partial or complete separation of the wound edges) or by evisceration (protrusion of viscera through the disrupted wound). A)true, stomach cancer B)false, stomach cancer

Excessive coughing, straining, malnutrition, obesity, and infection may also increase the chances of dehiscence. A)true B)false

Nursing interventions include instructing the patient to remain quiet and to avoid coughing or straining. Keep the patient in a dorsal recumbent position (on back with knees flexed) to remove stress on the wounding viscera with a warm sterile saline dressing. Notify the surgeon immediately because treatment consists of reapproximating the wound edges. A)true, dehiscence & evisceration. B)false,dehiscence & evisceration.

Chemotherapy has greater response and longer survival rates than radiation. A)true, stomach ulcer B)false, stomach ulcer

However, it may be used as a palliative measure to decrease tumor mass and temporarily relieve obstruction. The combination of chemotherapy and radiation therapy may be used for patients who are at high risk for disease recurrence after surgery A)true, stomach cancer B)false,ulcer

The preoperative preparation includes improving the patient's nutritional status by monitoring total parenteral nutrition and providing supplemental feedings. A)stomach cancer B)ulcer

Postoperative teaching is necessary to relieve anxiety and promote understanding of drainage tubes, feeding tubes, dressing changes, weakness, medications, and other routine care. A)stomach cancer B)ulcer

Because care encompasses so many areas, instruction should be (1) planned according to the patient's needs and level of understanding, (2) given when the patient is free of pain and rested, and (3) communicated both verbally and in print.

True

Explain surgery, chemotherapy, radiation therapy, continued nutritional needs, pain relief, and support groups for psychosocial needs. A)true B)false

Ineffective breathing pattern, related to: • pain • exploration of chest and abdominal cavities • abdominal distention a nursing intervention would be A)Place the patient in a semi-Fowler's position to aid ventilation. Encourage and assist with gentle turning and repositioning. B)Encourage the patient to turn, brea the deeply, and cough at least every 2 hours until ambulating well; splint incision before coughing; use incentive spirometer; and ambulate as soon as possible. C)both a and b

Risk for injury, related to: • aspiration • infection • hemorrhage • anastomotic leak into abdominal cavity • anemia or vitamin deficiency A)Monitor closely for elevated temperature, bleeding from incision, pallor, dyspnea, cyanosis, tachycardia, increased respirations, and chest pain. B)Monitor labora tory results and activ ity tolerance beca use of possible anemia. C)Change dressings using sterile technique. D)all the above

DISORDERS OF THE INTESTINES

INFECTIONS

Postoperative Nursing Interventions for Ulcerative Colitis

1. Monitor nasogastric (NG) suction for patency until bowel function is resumed. Maintain correct wall suctioning. Accurately record color and amount of output. Irrigate NG tube as needed. Apply water-soluble lubricant to nares. Assess bowel sounds, being certain to turn off NG suction d uring auscultation. 2. initiate ostomy care and teaching when bowel activity begins. Be sensitive to patient's pain level and readiness for teaching of ostomy care.

True

3. Observe stoma (an artificial opening of an internal organ on the body's surface) for color and size (should be ery- thematous and slightly edematous). Document assess- ment (e.g., "stoma pink and viable"). 4. Select appropriate pouching system that has skin-protec- tive barrier, accordion flange to ease pressure applied to new incisional site, adhesive backing, and pouch opening no more than 1/16 of inch larger than the stoma. Stomas change in size over time and should be measured before new supplies are ordered.

True

5. Empty pouch when it is approximately one third full to prevent breaking the seal, resulting in pouch leakage. 6. Explain that initial dark green liquid will change to yellow- brown as patient is allowed to eat.

True

7. Teach patient to care for the stoma; this includes having patient look at stoma and gradually assist with emptying, cleaning, and changing pouch. Teach patient that normal grieving occurs after loss of rectal function. Be supportive of patient's concerns. 8. Promote independence and self-care to decrease s tate of denial.

True

9. Instruct on follow-up home care, including changing skin barrier (a piece of pectin-based or Karaya wafer with measurable thickness and hydrocolloid adhesive proper- ties) every 5 to 7 days. Using antacids, skin protective paste, and liquid skin barrier may be appropriate if skin excoriation is observed

True

10. Patient may shower or bathe with or without pouch on. 11 . Patient should avoid lifting objects heavier than 10 pounds until physician says it is allowed. 12. A special diet is not necessary, but patients should drink 8 to 10 glasses of water a day, chew food well, and limit or avoid certain gas-forming foods.

True

13. Sexual relationships can be resumed when physician feels it is not harmful to the surgical area. Counseling may be appropriate if patient has fear of resuming this activity.

True

CROHN'S DISEASE

crohn's d isease is characterized by inflammation of segments of the GI tract. It was once thought to be a disease specific to the small intestine and was called regional enteritis. A)true B)false

Both genetic and environmental factors seem to play a role. It commonly occurs during adolescence and early adulthood with a second peak in the sixth decade

Crohn's disease

Crohn's disease can occur anywhere in the GI tract from the mouth to the anus, but occurs most commonly in the terminal ileum and colon.The inflammation involves all layers of the bowel wall A)true B)false

Over time, horizontal rows of these ulcers fuse with vertical rows, giving the mucosa a cobbles tone appearance. Inflammation, fibrosis, and scarring often involving the entire thick- ness of the intestine are ch aracteristics of Crohn's disease A)true B)false

Patients with Crohn's disease are likely to have a bowel obstruction, fistulas, fissures, and abscesses A)true B)false

Malabsorption is the major problem when the small intestine is involved, and this contributes to nutritional problems. A)true B)false

A Crohn's disease

Fluid and electrolyte disturbances with acid-base imbalances can occur, particularly with depletion of sodium or potassium associated with diarrhea or with excessive small intestine drainage through fis tulas associated with the pathologic process. A)true B)false

A Crohn's disease

The onset of Crohn's disease is usually insidious, with nonspecific complaints such as diarrhea, fatigue, abdominal pain, weight loss, and fever. A)true B)false

Collection of subjective data for the patient with Crohn's disease includes noting the patient's list of vague complaints, including weakness, loss of appetite, abdominal pain and cramps, intermittent low-grade fever, sleeplessness caused by diarrhea, and stress. Right-lower-quadrant abdominal pain is characteristic of the disease and may be accompanied by a tender mass of thickened intestines in the same area. A)true B)false

Objective data of crhons disease include complaints of diarrhea- three or four semisolid stools daily, containing mucus and pus but no blood.Steatorrhea (excess fat in the feces) may also be present if the ulceration extends high in the small intestine A)true B) false

small bowel barium enema is preferred over an upper GI roentgenographic series; small bowel follow-through detects defining mucosal abnormalities such as cobblestoning of the mucosa, fistulas, and strictures of the ileum A)for Crohn's disease B)false

Those with mild to moderate disease usually take antiin- flammatory agents such as sulfasalazine, mesalamine, olsalazine, or balsalazide. A)true for Crohn's disease B)false

When inflammation is severe, corticosteroids such as prednisone may be prescribed. Patients are weaned off steroids as soon as possible to prevent dependency and long-term complications. A)true B)false

Chrons disease

Multivitamins and B12 injections are often recommended to correct deficiencies. A)true B)false

lnfliximab works by neutralizing tumor necrosis factor, a protein that causes much of the intestinal inflammation. Infliximab is the only medication for Crohn's disease A)TURE B)false

Minimize bowel symptoms and diarrhea by excluding from the diet (1) lactose-containing foods in patients suspected of having lactose intolerance; (2) brassica vegetables (cauliflower, broccoli, asparagus, cabbage, and brussels sprouts); (3) caffeine, beer, monosodium glutamate, and sugarless (sorbitol-containing) gum and mints; and (4) highly seasoned foods, concentrated fruit juices, carbona ted beverages, and fatty foods.

True

Diets high in protein (100 g/ day) are recommended for patients with hypoproteinemia caused by mucosal loss, malabsorption, maldigestion, or malnutrition. A)true B)false

Free elemental diets may help patients with diarrhea because they require minimal digestion and reduce stool volume. Such elemental dietary prepara tions include Criticare, Travasorb HN, and Preci- sion High Nitrogen. A)true B)false

Total parenteral nutrition has been shown to be more effective in p atients w ith Crohn's disease than in those with ulcerative colitis. A)true B)false

Corticosteroids are the preferred medical treatment of active Crohn's disease when the small intestine is involved A)true B)false

Problems with inadequate vitamin B12 absorption result when the terminal ileum is resected ; lifelong replacement of vitamin B12 is then necessary. A)true B)false

Resec tion is the preferred surgery because bypass has a greater failure rate. A)true B)false

About 75% of patients with Crohn's disease eventually require s urgery.Surgical removal of large segments of the small intestine can lead to short- bowel syndrome, a condition in which the absorption surface is inadequate to maintain life and parenteral nutrition is used. A)true B)false

Total parenteral nutrition may be ordered in cases of severe disease and marked weight loss. A)true B)false

Tube feedings that allow rapid absorption in the upper GI tract are begun, and then oral intake of a low-residue, high protein, high calorie diet is gradually introduced A)true B)false

A Crohn's Disease

Vitamin supplements are frequently necessary, and vitamin B12 is given when there is a marked loss of ileum. When anemia is present, iron dextran (DexFerrum) is given by Z-track injection because oral intake of iron is ineffective due to intestinal ulceration . A)true B)false

Oral diets of 2500 mL/ day to replace fluids and electrolytes lost from d iarrhea are not uncommon. Monitor weight for losses or gains. Monitor skin condition and all fluid I&O daily. A urinary output of at least 1500 mL/ d ay is desired . A)true B)false

When a patient is hospitalized, a bedside commode or a bedpan must be accessible at alI times because of the urgency and frequency of stools. A)true B)false

Emptying the bedpan immediately and deodorizing the room maintain an aesthetic environment. The anal region may become excoriated from frequent stools. Examine the anal area regularly and keep it clean using medicated wipes (Tucks) and sitz baths. A)true B)false

The onset of the disease (often at 10 to 15 years of age) often occurs before the person has the emotional development and maturity to cope. A)true B)false

A chrons disease

The support groups sponsored by the Crohn's and Colitis Foundation of America (formerly the National Founda tion of ileitis and Colitis) can play a major role in helping patients A)true B)false

Tranquilizers, antidepressants, and psychology or psychiatry services may be required when managing the disease A)true B)false

A | Chrons disease

Crohn's disease is no t ca used by psychological stress but that psychiatric disturbances a re the result of the disease's symptoms and chronicity. A)true B)false

Powerlessness, related to exacerbations and remissions a nursing diagnosis would be A)Explore with patient factors that aggravate the disease. B)Assist patient in Listing factors that can be controlled: diet, stressors, medication compliance, self-monitoring of symptoms C)both a and b

Imbalanced nutrition: less than body requiremen ts, related to: • bowel hypermotility • decreased absorption a nursing intervention would be A)Emphasize the importance of weighing daily, following special diets, and assessing energy levels B)none

APPENDICITIS

Appendicitis is the inilam.mation of the vermiform appendix, usually acute, which if undiagnosed leads rapidly to perforation and peritonitis. Appendicitis is most likely to occur in teenagers and young adults and is more common in men. A)true B)false

The most common causes of appendicitis are obstruction of the lumen by a fecalith (accumulated feces), foreign bodies, and tumor of the cecum or appendix multiply in the appendix and ca use an infection with the formation of pus. A)true B)false

Light palpation of the abdomen elicits rebound tenderness in the right lower quadrant. A)appendicitis B)false

The patient often lies on the back or side with knees flexed in an attempt to decrease muscular strain on the abdominal wall. A)true appendicitis B)false

Subjective data include the most common com plain t of cons tant pain in the right lower quad rant of the abdomen around McBurney's point (halfway between the umbilicus and the crest of the right ileum). The pain may be accom panied by nausea and anorexia. A)appendicitis B)false

Objective data include vomiting, a low-grade fever (99° to 102° F [37.2° to 38.8° C]), an elevated WBC count, rebound tenderness, a rigid abdomen, and decreased or absent bowel sounds. A)true appendicitis B)false

The physician orders a WBC count with differential. A)true, appendicitis B)false

Emergency surgical in tervention is the treatment of choice for acute appendicitis, or surgery may be performed when a patient is having another abdominal surgical procedure. A)true B)false

Antibiotic therapy is given when perforation is likely. Complications include infection, intra abdominal abscess, and mechanical small bowel obstruction. A)appendicitis B)false

Maintain bed rest and NPO status, provide comfort measures for pain relief so that symptoms are not masked by medication, and replace fluids and electrolytes. A)appendicitis B)false

Monitor the temperature, blood pressure, pulse, and respirations and document these every hour because of the threat of perforation with peritonitis. A)true appendicitis B)false

Administer prescribed opioids after the physician has assessed the patient. Opioids can mask symptoms of acute appendicitis. A)true B)false

In some cases an ice bag to relieve pain is given; no heat is applied because this increases circulation to the appendix and could lead to rupture. A cleansing enema is not ordered because of the danger of rupture. A)true B)false

Deficient fluid volume, related to vomiting interventions a nursing intervention would be A)Monitor patient for signs of dehydration and fluid and electrolyte imbalance (poor skin turgor; flushed dry skin; coated tongue; oliguria; confusion; and abnormal sodium, potassium, and chloride levels). B)false

Pain, related to inflammation a nursing intervention would be A)Administer opioids as soon as indicated after the physician assesses the patient. B)Monitor for increases in pain, rebound tenderness, and abdominal rigidity. C)Take vital signs frequently (every 15 minutes). D)all the above

Safety Alert! | Appendicitis

Encourage the patient with abdominal pain to see a health care provider and to avoid self treatment, particularly the use of laxatives and enemas. • The increased peristalsis of laxatives and enemas may cause perforation of the appendix Until the patient is seen by a health care provider, he or she should remain NPO to ensure the stomach is empty in case surgery is needed. • An ice bag may be applied to the right lower quadrant to decrease the flow of blood to the area and impede the inflammatory process. Heat is never used because it could cause the appendix to rupture. • Surgery is usually performed as soon as a diagnosis is made.

True

DIVERTICULOSIS AND DIVERTICULITIS

Intestinal obstruction can occur, causing abdominal distention, nausea, and vomiting. A)true B)false

Complaints of constipation and diarrhea accompanied by pain in the left lower quadrant are common. Other common symptoms include increased flatus and chronic constipation alternating with diarrhea, anorexia, and nausea. A)subjective B)objective

Objective data include abdominal distention, low-grade fever, leukocytosis, vomiting, blood in the stool, and sometimes a paLpable abdominal mass. A)true B)false

A diet high in fiber, mainly from fresh fruits and vegetables, and decreased intake of fat and red meat are recommended for preventing diverticular disease. High levels of physical activity also seem to decrease the risk.Weight reduction is important for the obese person. A)true B)false

Patients should avoid increased intraabdominal pressure, which may precipitate an attack. Factors that increase intraabdominal pressure are straining at stool; vomiting; bending; lifting; and tight, restrictive clothing. A)true B)false

Observe the patient for signs of possible peritonitis. Administer broad-spectrum antibiotics as ordered. Monitor the WBC count. A)true B)false

When the acute attack subsides, give oral fluids at first and then progress to semisolids. Ambulation is permitted. A)true B)false

A diverticulitis

Surgical treatment is advised if long-term problems do not respond to medical management and is mandatory if complications (e.g., hemorrhage, obstruction, abscesses, or perforation) occur. A)true B)false

Laxatives, enemas, or intestinal lavage by GoLYTELY are given to cleanse the bowel, depending on the surgeon's preference. A)true B)false

Closure of the temporary colostomy is the desired goal in the case of diverticular disease. Usually this takes place 6 weeks to 3 m onths after the ini tial surgical procedure A)true B)false

Again, the bowel must be prep ared for closure by a liquid diet; laxatives; antibiotics; intestinal lavage as mentioned ; and a cleansing colostomy irrigation of the proximal and, in the case of the loop or double-barrel colostomy, distal end of the stoma. A)true B)false

Remember that when the distal loop is irrigated, irrigating solution and bowel contents usually return from both the distal opening and rectum, so place the pa tient on the toilet or bedpan during the procedure A)true B)false

The return of bowel activity after closure may take several days. The patient will have IV fluids and an NG tube for the first few days postoperatively. A)true B)false

Deficient knowledge related to disease process and treatment a nursing intervention would be A)Instruct tient and family in disease process and signs and symptoms of acute diverticuli tis attack. B)false

Imbalanced nutrition: less than body requirements, related to decreased oral intake a nursing intervention would be A)Instruct patient about dietary fiber (for prevention) or bland, low-residue diet (for inflammatory phase). B)Assess daily weights, calorie counts, and I&0. C)Monitor serum protein and albumin. D)all the above

PERITONITIS

Peritonitis is an inflammation of the abdominal peritoneum. This con dition occurs after fecal matter seeps from a mpture site, causing bacterial contamination of the peritoneal cavity. A)true B)false

Peritonitis can also be caused by chemical irritants, s uch as blood, bile, necrotic tissue, pancreatic enzymes (pancreatitis), and foreign bodies. A)true B)false

Patients who use continuous am bulatory peritoneal dialysis are also a t high risk. For

Pertinitis

The patient usually lies on the back with the knees flexed to relax the abdominal muscles; any movement is painful. Rebound tenderness, muscula r rigidity, and spasm are major symptoms of irritation of the peritoneum. The abdomen is usually tympanic an d extremely tender to the touch. For

Peritonitis

Nausea and vomiting occur, and as peristalsis ceases, constipation occurs with no passage of flatus. Chills, weakness, and abdominal tenderness (local and diffuse, often rebound) are also manifested.is caused by peritonitis A)true B)false

objective data includes noting a weak and rapid pulse, fever, and lowered blood pressure. Leukocytosis and marked dehyd ration occur, and the patient can collapse and die. Occurs with peritonitis A)true B)false

A flat plate of the abdomen is ordered to find out whether free air is present under the diaphragm as a result of visceral perforation A)true peritonitis B)false

Aggressive therapy includes correction of the contamination or removal of the chemical irritant by surgery, and parenteral antibiotics. NG intubation is ordered to prevent GI distention A)true pertinotis B)false

Analgesics are provided intravenously via PCA pump. The patient may be placed on total parenteral nutrition because of increased nutritional requirements. A)true peritonitis B)false

N ursing interventions for the patient with peritonitis include the following:

Place p atient on bed rest in semi-Fowler 's position to help localize purulent exudate in lower abdomen or pelvis. * Give oral hygiene to prevent dlying of mucous membranes and cracking of lips from dehydration. * Monitor fluid and electroly te replacement. Encourage deep-breathing exercises; patient tends to have shallow respirations as a result of abdominal pain or distention. * Use measures to reduce anxiety. * Use meticulous surgical asepsis for w ound care

True

Ins truct the patient about the importance of ambulation, coughing, deep breathing, use of an incentive spirometer, and leg exercises. A)true B)false

Instruct the patient not to lift more than 10 pounds until the physician approves it. A)peritonitis B)false

EXTERNAL HERNIAS

most common infection of GI is through the mouth in contaminated food or water. A)true B)false

Some intestinal infections occur as a result of person-to-person contact. A)true B)false

Fecal-oral transmission occurs through poor hand hygiene after elimination. In active homosexual males, infectious agents can be introduced by single-cell protozoal infections. A)true B)false

long-term antibiotic therapy can destroy the normal flora. A)true B)false

Clostridia, Salmonella, Shigella, and Campylobacter bacteria are associated with intestinal infections. These bacteria produce toxic substances, and the mucosal cells respond by secreting water and electrolytes, causing an imbalance A)true B) false

______is transmitted in contaminated, undercooked meats such as hamburger, roast beef, ham, and turkey; in produce that has been rinsed with water contaminated by animal or human feces; or by a person who has been handling contaminated food. A)E.COLI B)HERPES

The bacterium has also been cultured in unpasteurized milk, cheese, and apple juice and can be found in lakes and pools that have been contaminated by fecal matter. A)e.coli B) herpes

``` Hemorrhagic colitis (which results in bloody diarrhea and severe cramping accompanied by diffuse abdominal tenderness) develops between the second and fourth days. A)true B)false ```

Antidiarrheals should not be given because these medications prevent the intestines from getting rid of the E. coli pathogen A)true B)false

Antimotility drugs such as diphenoxylate with atropine or antibiotic therapy is not recommended because they increase the likelihood of developing hemolytic-uremic syndrome, a pathologic condition of the kidney. A)true B)false

Usually little or no fever is present and the illness resolves in 5 to 10 days. A)true B)false

Sigmoidoscopic or colonoscopic examination and stool specimens are used to diagnose a type of inflammation or colitis called antibiotic-associated pseudomembranous colitis (AAPMC). A)true B)false

Immunosuppressed patients and older adults are particularly susceptible. C. difficile is a hazardous nosocomial infection because hospitalized patients are often immunosuppressed, antibiotic therapy is common, and the spores can survive for up to 70 days on inanimate objects. A)true B)false

C. difficile spores have been found on commodes, telephones, thermometers, bedside tables, floors, and other objects in the room, as well as on the hands of h ealth care workers. A)true B)false

Washing hands with soap and water is necessary because antiseptic hand rub does not destroy C. difficile A)true B)false

Trea tment with antibiotics (especially clindamycin, ampicillin, amoxicillin, and the cephalosporins) inhibits normal bacterial growth in the intestine. This inhibition of normal flora can lead to the overgrowth of other bacteria such as C. difficile. A)true B)false

Monitor signs and symptoms of the disease such as the d uration and severity of diarrhea. A)true B)false

Diarrhea is the most common manifestation of an intestinal infection. The fecal output has increased water content, and if the intestinal mucosa is directly invaded, the feces may contain blood and mucus. A)true B)false

subjective data includes noting complaints of diarrhea, rectal urgency, tenesmus (ineffective and painful straining with defecation), nausea, and abdominal cramping. A)intestinal infectios B)false

Objective data include a fever greater than 102° F (38.8° C) and vomiting.Noninfectious diarrhea may be caused by heavy metal poisoning, shellfish allergy, and ingestion of toxins from mushrooms or fish A)intestinal infection B)false

The key laboratory test for patients with intestinal infections is a stool culture. A)true B)false

Antibiotics are rarely used to treat acute diarrhea, but may be given in cases of prolonged or severe diarrhea with a stool positive for leukocytes. A)true B)false

The IV route is indicated if the patient cannot take sufficient fluids orally A)true B)false

The use of antidiarrheals and antispasmodic agents may actually increase the severity of the infection by prolonging the contact time of the infectious organism with the intestinal wall. A)true for intestinal infections B)false

Kaolin and pectin (Kaopectate) may be used to increase stool consistency. A)true B)false

``` Bismuth subsalkylate (Pepto-Bismol) can effectively decrease intestinal secretions and decrease the diarrhea volume. These medications require large doses to be effective (30 to 60 mL every 30 minutes to 1 hour), and their use remains controversial. A)true B)false ```

Also assess for fluid imbalance, including measurement of postural changes in blood pressure, skin turgor, mucous membrane hydration, and urinary output. A)patient with intestinal infection B)false

Deficient fluid volume, related to excessive losses from diarrhea and vomiting a nursing intervention of intestinal infection A)If oral intake is tolerated, offer apple juice, clear carbonated beverages, clear broth, plain gelatin, and water. B)If IV feedings are required to maintain intravascular volume, these fluids should have electrolytes added. C)Maintain accurate I&O. D)all the above

Imbalanced nutrition: less than body requirements, related to: • decreased intake • decreased absorption, a nursing intervention for intestinal infection would be A)Monitor for decreasing episodes of diarrhea. B)Monitor blood pressure, tissue turgor, mucous membranes, and urinary output. C)Monitor weight loss if symptoms are severe. D)all the above

Ensure that the patient and family understand the importance of hand hygiene after bowel movements to interrupt the fecal-oral route of transmission. A)true B)false

IRRITABLE BOWEL SYNDROME

Irritable bowel syndrome (IBS) is a disorder with episodes of altered bowel function and intermittent and recurrent abdominal pain. A)true B)false

The American Gastroenterological Association (2009) defines IBS as a combination of chronic and recurrent GI symptoms-mainly intestinal pain and disturbed defecation or abdominal distention-that are not explained by structural or biochemical abnormalities; it is a dysfunction of the intestinal muscles. A)true B)false

The _________ syndrome is now thought to result from hypersensitivity of the bowel wall, which leads to disruption of the normal functioning of the intestinal muscles.

Irritable bowel syndrome

The patient with IBS may have associated psychological problems. In patients without psychological problems, the symptoms are attributed to spastic and uncoordinated muscle contractions of the colon, usually related to ingestion of excessively coarse or highly seasoned foods. A)true B)false

also (1) a correlation of panic attacks in patients with IBS, and (2) an association of chronic low abdominal (pelvic) pain and a history of childhood sexual ab use. A)true, IBS B)false

Alterations of bowel function include abdominal pain relieved after a bowel movement; more frequent bowel movements with pain onset; a sense of incomplete evacuation; flatulence; and constipation, diarrhea, or both. Stress increases functional diarrhea; usually weight loss does not occur. With IBS A)true B)false

Subjective data include complaints of abdominal distress, pain at onset of bowel movements, abdominal pain relieved by defecation, and feelings of incomplete emptying after defecation. A)true IBS B)false IBS

Objective data include mucus in stools, visible abdominal distention, and frequent or unformed stools. A)true IBS B)false IBS

The key to accurate diagnosis of IBS is a thorough history and physical examination A)true B)false

Symptom-based criteria for IBS have been standardized and are referred to as the Rome criteria. A)true B)false

Rome II criteria include abdominal discomfort or pain that lasts at least 12 weeks (not necessarily consecutive) within 12 months and that has at least two of the following characteristics: (1) relieved w ith defecation, (2) onset associated with a change in stool frequency, and (3) onset associated w ith a change in stool appearance. A)true B)false

Increasing dietary fiber increases stool bulk, frequency of passage, and bloating. Adequate fiber is more reliably provided with bulking agents (e.g., Metamucil) than with diet unless the patient is a strict vegetarian. A)IBS B)false

Bulking agents most effective in treating constipation predominant IBS, although they may alleviate mild diarrhea. A)true B)false

Advise the patient whose primary symptoms are abdominal distention and increased flatulence to eliminate common gas-producing food s (e.g., broccoli, cabbage) from the diet and to substitute yogurt for milk products to help determine whether he or she is lactose intolerant. A)for IBS B)false

Anticholinergic drugs relieve abdominal cramps. A)true B)false

Milk of magnesia may be prescribed if constipation does not respond to augmented fiber or if the patient cannot tolerate it. A)true B)false

Opioids can be effective in diarrhea-predominant IBS. A)true B)false

Anti-anxiety drugs may help patients suffering from panic attacks associated with IBS. A)true B)false

Antidepressants may be used sparingly for diarrhea-predominant IBS in patients with severe pain who have not responded to other measures. A)true B)false

Drugs that affect serotonin receptors hold promise in the treatment of IBS. A)true B)false

Two serotonergic agents have been approved in select patients with IBS: tegaserod (Zelnorm), and alosteron (Lotronex). A)true B)false

Beca use of its serious side effects (e.g., severe constipation, ischemic colitis), alosteron is available only in a restricted access program for women who have not responded to other therapies and in whom other anatomical and chemical abnormalities have been ruled out. A)true B)false

Patients with IBS often report higher levels of psychological distress, including anxiety, panic, and depression, which can amplify symptoms and affect treatment response. A)true B)false

Psychological nonpharmacologic treatment for patients with IBS may include counseling and cognitive-behavioral interventions such as hypnotherapy and progressive muscle relaxation techniques to reduce stress. A)true B)false

Emphasize the importance of keeping a daily log showing diet; number and type of stools; presence, severity, and duration of pain; side effects of medica tion; and life stressors that aggravate the disorder. A)for a patient with IBS B)for a patient with herpes

Deficient knowledge, related to the effect of fiber content on spastic bowel a nursing intervention for IBS would be, A)Educate patient regarding the relationship of fiber to both constipation and diarrhea. B)Teach patient about the use of bulking agents. C)both a and b

Patient teaching includes diet management and ways to control anxiety in daily living. The goal of patient teaching is to empower the patient to control the disorder. A)for patient with IBS B)false

Provide community resources for counseling if psychological problems seem related to increased or decreased elimination accompanied by pain and discomfort. A)for patient with IBS B)false

Complementary &Alternative Therapies | Irritable Bowel Syndrome

Also called "psychophysiologic self-regulation," biofeedback is a relaxation training method that gives individuals a greater degree of awareness and control of physiologic function A)true B)false

Comfrey is used to treat gastritis A)true B)false

Queen Anne's lace seeds are used for flatulence, colic, singultus, and dysentery. A)true B) false

INFLAMMATORY BOWEL DISEASE

Ulcerative colitis and Crohn's disease are chronic, episodic, inflammatory bowel diseases. A)true B)false

These are immunologically related disorders that afflict young adults. __________

Chrons and ulcerative colitis

These diseases appear more often in women, in the Jewish population, and in the nonwhite population; there seems to be a familial tendency. ________

Ulcerative colitis and chrons disease

The causes of ulcerative colitis and Crohn's disease are unknown. Theories involve both genetic and environmental factors, including bacterial infection, immunologic factors, and psychosomatic disorders. A)true B)false

Inflammatory bowel diseases are characterized by exacerbations (increases in severity of the disease or any of its symptoms) and remissions (decreases in severity of the disease or any of its symptoms). A)true B)false

ULCERATIVE COLITIS

The incidence of ulcerative colitis is twice that of Crohn's disease. Ulcerative colitis is confined to the mucosa and sub-mucosa of the colon. The disease can affect segments A)true B)false

This disease ulcerative colitis usually starts in the rectum and moves in a continuous pattern toward the cecum. A)true B)false

The inflammation and ulcerations occur in the mucosal layer of the bowel wall. Since it does not extend through all bowel wall layers, fistulas and abscesses are rare. A)ulcerative colitis B) IBS

Capillaries become friable and bleed, causing the characteristic diarrhea containing pus and blood. Pseudopolyps are common in chronic ulcerative disease and may become cancerous. A)true B)false

With healing and the natural formation of scar tissue, the colon may lose elasticity and absorptive capability. A)true B)false

Patients with severe ulcerative colitis may have as many as 15 to 20 liquid stools per day, containing blood, mucus, and pus. With severe diarrhea, losses of sodium, potassium, bicarbonate, and calcium ions may occur. A) true B)false

Abdominal cramps may occur before the bowel movement. The urge to defecate lessens as scarring within the bowel progresses. This results in involuntary leakage of stool. In mild to moderate ulcerative colitis, diarrhea may consist of two to five stools per day with some blood present. A)true ulcerative colitis B) false, ulcerative colitis

Complications of ulcerative colitis include toxic megacolon (toxic dilation of the large bowel).The bowel becomes distended and so thin that it could be perforated at any time. Clinical manifestations of toxic megacolon include a temperature of 104° F (40° C) or more and abdominal distention. A)true B)false

Subjective data include complaints of rectal bleeding and abdominal cramping. Lethargy, a sense of frustration, and loss of control result from painful abdominal cramping and unpredictable bowel movements. A)ulcerative colitis B) chrons disease

Objective data include weight loss, abdominal distention, fever, tachycardia, leukocytosis, and observation of frequency and characteristics of stools. A)true ulcerative colitis B)true IBS

Double-contrast barium enema studies of the intestine, sigmoidoscopy and colonoscopy with biopsy, and stool testing for melena aid the physician in cliagnosis. A)true for ulcerative colitis B)false

Common treatment modalities include medication, diet intervention, and stress reduction. A)for ulcerative colitis B)false

The four major categories of drugs used are (1) those that affect the inflammatory response, (2) antibacterial drugs, (3) drugs that affect the immune system, and (4) antidiarrheal preparations.

True

Sulfasalazine (Azulfidine) is the drug of choice for mild chronic ulcerative colitis. A)true B)false

It affects the inflammatory response and provides some antibacterial activity. It is effective in maintaining clinical remission and in treating mild to moderately severe attacks. A)Sulfasalazine (Azulfidine) B)IBS

Corticosteroids are antiinflammatory drugs effective in relieving symptoms of moderate and severe colitis; they can be given orally or intravenously if inflammation is severe. A)true B)false

Antidiarrheal agents are recommended over anticholinergic agents because anticholinergic drugs can mask obstruction or contribute to toxic colonic dilation. A)true B)false

Loperamide may be used to treat cramping and diarrhea of chronic ulcerative colitis. A)true B)false

Patients with inflammatory bowel disease must eat a balanced, healthy diet with sufficient calories, protein, and nutrients. A)true B)false

Patients with diarrhea often decrease their oral intake to reduce the diarrhea. The anorexia that accompanies inflammation also results in decreases in food intake. Blood loss leads to iron deficiency anemia. A)true ulcerative colitis B)IBS

Patients receiving sulfasalazine should receive 1 mg of folate (folic acid) daily, and those receiving corticosteroids need calcium supplements. A)true B) false

A food diary helps them identify problem foods to avoid. A)true B)false

High-fat foods also tend to trigger diarrhea. Cold foods and high-fiber foods (cereal with bran, nuts, raw fruit) may increase GI transit. A)true B)false

Smoking stimulates the GI tract (increases motility and secretion) and should be avoided. A)true B)false

Patients with significant fluid and electrolyte losses or malabsorption may need parenteral nutrition or enteral feedings, such as elemental diets. A)true B)false

A ulcerative colitis

Elemental diets are high in calories and nutrients, lactose free, and absorbed in the proximal small intestine, which allows the more distal bowel to rest. A)true B)false

Ulcerative colitis is aggravated by stress. A)true B)false

Mos t surgeons prefer a conservative approach, removing only the diseased portion of the colon A) true B)false

Today some patients view a permanent ileostomy as worse than the disease itself. A)true B)false

Nursing interventions include a thorough assessment of the patient's bowel elimination, support systems, coping abilities, nutritional status, pain, and under-standing of the disease process and treatment required. A)true B) false

A | Ulcerative colitis

Preoperative care for these patients includes (1) selecting a stoma site, (2) performing additional diagnostic tests if cancer is suspected , (3) helping the patient accept that previous treatments were unsuccessful in curing the disease, and (4) preparing the bowel for surgery.

True

The bowel is prepared 2 or 3 days preoperatively. A bland to clear liquid diet is ordered, along with a bowel prep of laxatives, GoLYTELY (an oral or NG colonic lavage-electrolyte solution), and enemas. A)true B) false

A | Ulcerative colitis surgery

Antibiotics, such an erythromycin and neomycin, are given to decrease the number of bacteria in the bowel. A) true B) false

Postoperative nursing interventions, Areas of concern are bowel and urinary elimination; fluid and electrolyte balance; tissue perfusion; comfort and pain; nutrition; gas exchange; infection; and, in the case of ostomy construction, assessment of the ileostomy and peristomal skin integrity. A)true B)false

A | Ulcerative colitis

Providing reading material and demonstrating the care of an ostomy pouch when the patient seems ready will reduce anxiety. A visitor from the United Ostomy Association can provide hope, as a recovered and productive role model. A) true,Nursing diagnoses for the surgical patient include risk for ineffective coping, situational low self-esteem, and disturbed body image B)false

Imbalanced nutrition: Jess than bod y requirements, related to: • bowel hypermotility • decreased absorption a nursing intervention would be A)Provide small frequent meals, which will help patient with poor appetite or intolerance to consume larger amounts. B)Eliminate foods that aggravate condition. C)both a and b

Powerlessness, related to loss of control of body function. A nursing intervention would be A)Assist weakened patient with activities of daily living (bathing, oral hygiene, shaving, and other grooming needs). B) Offer choices to patient, when possible, to provide a sense of control. C)both a and b

Also, before discharge, give the patient a list of resource people, phone numbers, supplies, and where to obtain them . A)true B)false

Peristomal Area Integrity

Four primary factors contributing to loss of peristomal skin integrity are allergies, mechanical trauma, chemical reactions, and infection. A)true B)false

Allergies to pouches, adhesives, skin barriers, powders and paste, or belts are evident at areas of contact. The skin may app ear erythematous, eroded, weeping, and bleeding . Changing the type of pouch, tape, or adhesive may resolve the problem. A)true B)false

Mechanical trauma caused by pressure, friction, or stripping of adhesives and s kin barriers can be avoided by changing the pouch less frequently, using adhesive tape sparingly, and wearing a belt only when the patient feels it is necessary. The skin must be protected when the pouch is removed. A)true B) false

The most common chemical irritant is the stool from the stoma. Protect the skin from these digestive enzymes by using skin barriers before applying the pouch . Skin barriers include adhesives (Stomahesive), powders (Stomahesive power), liquids kin barrie rs (Skin Prep), and caulking p aste (Stomahesive paste). A)true B)false

A common cause of infection of the peristomal skin is Candida albicans. People who have been taking antibiotics for 5 or more days may be prone to this problem . Treatment is application of nystatin powder or cream, by physician order. A)true B)false

Surgical Interventions for Ulcerative Colitis

``` Colon resection: Ileostomy: lleoanal anastomosis Proctocolectomy: Kock pouch (Kock continent ileostomy):Surgical removal of the rectum and colon (proctocolectomy) with formation of a reservoir by suturing loops of adjacent ileum together to form a pouchlike structure, nipple valve, and stoma ```

True

Unknown; autoimmune; genetic and environment play a role; various bacteria have been proposed Teenage years and early adulthood; second peak in sixth decade Confined to mucosa or submucosa of the colon inflammation in the Mucosa and submucosa Tends to be continuous, starting at the rectum and extending proxi- mally; limited to the mucosal lining Blood present No fat 15-20 liquid stools daily Toxic megacolon, fistulas, and ab- scesses (rare) Rectal bleeding, abdominal cramping Poor response to medical therapy Removal of the colon cures the intestinal disease, but not extraintestinal symptoms, such as inflammation of joints and liver disease Increased risk after 10 years of disease Architectural changes consistent with chronic inflammation Rare Minimal incidence This condition is

Ulcerative colitis

A hernia is a protrusion of a viscus through an abnormal opening or a weakened area in th e wall of the cavity in which it is normally contained A)true B)false

Most her- nias result from congenital or acquired weakness of the abdominal wall or a postoperative defect, coupled with increased intraabdominal pressure from coughing, straining, or an enlarging lesion within the abdomen A)true B)false

Ventral, or incisional, hernia is due to weakness of the abdominal wall at the site of a previous incision . It is found most commonly in patients who are obese, who have had multiple surgical procedures in the same area, and who have inadequate wound healing because of poor nutrition or infection A)true B)false

A femoral, or inguinal, hernia is caused by a weakness in the lower abdominal wall opening through which the spermatic cord emerges in men and the round ligament emerges in women. A)true B)false

Factors such as age, wound infection, malnutrition, obesity, increased intraabdominal pressure, or abdominal distention affect formation of hernias after surgical incisions A)true B)false

Fewer hernias occur with transverse incisions than with longitudinal incisions. Also, upper abdominal incisions are associated with fewer hernias than lower abdominal incisions. A)true B)false

Never attempt to reduce the sac in the ring because this can lead to complications such as rupture of the strangulated contents. A)true B)false

Objective data include a visible protruding mass or bulge.If complications such as incarceration or strangulation follow, the p atient may have bowel obstruction, vomiting, and abdominal distention. A)hernia B)false

Hernias that cause no discomfort can be left unrepaired unless strangulation or obstruction follows. A)true B)false

Teach the patient to seek medical advice promptly if abdominal pain, distention, chan ging bowel habits, temperature elevation, nausea, or vomiting occurs A)true B)false

If the hernia can be reduced manually, a truss or firm pad placed over the patient's hernia si te and held in place with a belt prevents the hernia from protruding and holds the abdomina l contents in place. A)true B)false

Open abdominal surgery may be necessary for the patient with a strangulated hernia. Prepare the patient for a long hospitalization, which may include NG suctioning, IV antibiotics, fluid and electrolyte replacement, and parenteral analgesics until peristalsis returns. A)true B)false

Postoperatively monitor the patient for urinary retention; wound infection at the incision site; and, with inguinal hemia repair, scrotal edema. A)true B)false

If scrotal edema is present, elevate the scrotum on a rolled pad, apply an ice pack, and provide a supportive garment (jock- strap or briefs). A)true B)false

The patient should deep breathe every 2 hours, but many physicians discourage coughing. A)true B)false

Teach the patient how to support the incision by splinting the area with pillow or pad. This support, along with analgesics, will help relieve pain. A)true B)false

Deficient knowledge, related to disease process a nursing intervention would be? Select all that will apply A)Instruct patient to observe and report hernias that become irreducible or edematous. B)Instruct patient to report increased pain, abdominal distention, or change in bowel habits. C)Explain reason to avoid prolonged standing, lifting, or straining. D)Instruct patient to support weakened area by use of truss or manually as needed (as when coughing).

A B C D

Ineffective tissue perfusion, related to strangulation or incarceration of hernia. A nursing intervention would be A)Monitor patient for increased pain, distention, changing bowel habits, abnormal bowel sounds, temperature elevation, nausea, and vomiting. B)Report changes in appearance and signs and symptoms to physician. C)both a and b

Follow-up care includes teaching the patient to limit activities and avoid lifting heavy objects or strain- ing with bowel movements for 5 to 6 weeks A)true B)false

Also the patient should immediately report to the physician any erythema or edema of the surgical area or increased pain or drainage. A)true B)false

HIATAL HERNIA

Hiatal hernia is a protrusion of the stomach and other abdominal viscera. A)true B)false

A hiatal hernia (esophageal hernia or diaphragmatic hernia) results from a weakness of the diaphragm. A)true B)false

A hiatal hernia is the most common problem of the diaphragm that affects the alimentary tract A)true B)false

The major difficulty in symptomatic patients is gastroesophageal reflux, m a nifested as pyrosis (heart- burn) after overeating

Hi tail hernia

Life Span Considerations Older Adults Gastrointestinal Disorders

Loss of teeth and resultant use of dentures can interfere with chewing and lead to digestive complaints. * Dysphagia is commonly seen in the older adult population and may be caused by changes in the esophageal musculature or by neurologic conditions. * Hiatal hernias and esophageal diverticuli are significantly increased with aging because of changes in musculature of the diaphragm and esophagus

Older adults have decreased secretion of hydrochloric acid (hypochlorhydria and achlorhydria) from the parietal cells of the stomach. This results in an increased incidence of pernicious anemia and gastritis in the older adult population.

Peptic ulcers are common, but often the symptoms are vague and go unrecognized until there is a bleeding episode. Medications such as aspirin, nonsteroidal antiinflammatory drugs , and steroids that are taken for the chronic degenerative joint conditions common with aging should be used with caution because they can contribute to ulcer formation.

Frequency of diverticulosis and diverticulitis increases dramatically with aging and can contribute to malabsorption of nutrients. • Constipation is a problem for many older adults. Inactivity, changes in diet and fiuid intake, and medications can contribute to this problem. Monitor bowel elimination and establish a bowel regimen to prevent impaction.

INTESTINAL OBSTRUCTION

Intestinal obstruction occurs when intestinal contents cannot pass through the GI tract; it requires prompt trea tment A)true B)false

Mechanical obstruction may be caused by an occlusion of the lumen of the intestinal tract. Most obstructions occur in the ileum, which is the narrowest segment of the small intestine. Mechanical obstructions accoun t for 90% of all intestinal obstructions. A)true B)false

Nonmechanical obstruction may result from a neuromuscular or vascular disorder. The cause is something that decreases the muscle action of the bowel and affects the ability of fecal matter and fluid to move through the intestines A)true B)false

Paralytic (adynamic) ileus (lack of intestinal peristalsis and bowel sounds) is the most common form of nonmechanical obstruction . lt occurs to some degree after any abdominal surgery A)true B)false

Edema, congestion, and necrosis from impaired blood supply and possible rupture of the bowel may occur.The retention of fluid in the intestine and peritoneal cavity can lead to a severe reduction in circulating blood volume and result in hypotension and hypovolemic shock. A)intestinal obstruction B)false

Subjective data Nausea and the inability to pass flatus are common symptoms. Early complaints of obstruction of the small intestine include spasms of cramping abdominal pain as peristaltic activity increases proximal to the obstruction. A)true B)false

objective data begins with assessing the abdominal surface for evidence of distention, hernias, scars indicating previous surgeries, or visible peristaltic waves A)true B)false

Treatment is directed toward decompression of the intestine by removal of gas and fluid, correction and ma intenance of fluid and electrolyte balance, and relief or removal of the obstruction. A)true B)false

For the patient with intestinal obstruction undergoing surgery, preoperative preparation includes explaining the procedure at a level the patient can understand. Provide emotional support for the patient because he or she is experiencing the stressors of pain and vomiting plus the added stressor of emergency surgery. A)true B)false

Postoperative nursing interventions::: Place the patient in a Fowler 's position for greater diaphragm expansion. Encourage the patient to breathe through the nose and not swallow air, which would increase distention and discomfort. Encourage deep breathing and coughing. Continue nasointestinal suctioning until bowel activity returns. Assess for bowel sounds and abdominal girth and expulsion of flatus and stool to help determine the return of peristalsis. When the patient is ready to eat, usually within 24 to 48 hours after surgery or at the first sounds of peristalsis, provide a progressive diet as tolera ted

True

Acute pain, related to increased peristalsis. A nursing intervention would be? Select all that apply A)Reposition patient frequently to help intestinal tube advance. B)Irrigate suction tubing with 30 mL sterile saline to keep tube patent. C)Explain purpose of all procedures. Provide comfort measures. D)Administer analgesics as ordered.

A B C D

Deficient fluid volume, related to:increased losses from and decrease in intestinal fluid absorption. A nursing intervention would be, select all that apply A)Monitor for signs of dehydration, decreased blood pressure, change in laboratory values, and decreased urinary output. B) Monitor serum electrolyte levels closely C)Record and report frequency, amount, and nature of emesis. D)Maintain strict I&O records.

A B C D

COLORECTALCANCER

These factors have led to diet changes; decreased animal fat, reduced red meat, and increased high dietary fiber found in fruits, vegetables, and bran may have a protective effect and act as a primary preventive measure. A)to prevent colorectal cancer B)false

Cruciferous vegetables such as cauliflower, broccoli, brussels sprouts, and cabbage may help protect against the malignancy. NSAIDs (e.g., aspirin) also seem to reduce the risk. A)colorectal cancer B)false

Subjective data include changes in bowel habits alternating between constipation and diarrhea, excessive flatus, and cramps. A)colorectal cancer B)false

``` rectal bleeding (the most common sign of colorectal cancer), with the color varying from dark to bright red, depending on the location of the neoplasm . Later stages of colon cancer may involve subjective symptoms of abdominal pain, nausea, and cachexia (weakness and emaciation associated with general ill health and malnutrition). A)true colorectal bleeding B)false ```

objective data includes observing for vomiting, weight Loss, abdominal distention or ascites, and test results that are compatible with the diagnosis. The most common clinical manifestations are chronic blood loss and anemia. A)colorectal cancer B)false

``` carcinoembryonic antigen (CEA) (an oncofetal glycoprotein found in colonic adenocarcinoma and other cancers and in nonmalignant conditions) when cancer and metastasis are suspected. A)true B)false ```

Chemotherapy is given (1) to patients with systemic d isease tha t is incu rable by surgery or radiation alone; (2) to patients in whom metastasis is suspected (e.g., when a patient has positive lymph node involvement at the time of surgery); or (3) for palliative therapy to reduce tumor size or relieve symptoms of the disease,such as obstruction or pain. A)true B)false

Nursing interventions include assessment of bowel and urinary elimination, fluid and electrolyte balance, tissue perfusion, nutrition, pain, gas exchange, infection, and peristomal skin integrity. A)patient with colorectal cancer B)false

Preoperative Care colorectal cancer

The patient has some type of bowel preparation, which usually includes 2 or 3 days of liquid diets; a combination of laxatives, GoLYTELY, or enemas; and oral antibiotics to sterilize the bowel. The antibiotic of choice may be neomycin, kanamycin, or erythromycin; each suppresses anaerobic and aerobic organisms in the colon.Before surgery, provide instruction in turning, coughing, and deep breathing; use of incentive spirometer; wound splinting; and leg exercises. A)true B)false

Postoperative Care colorectal cancer

Paralytic ileus, a conunon complication of abdominal surgery, produces the classic signs of increased abdominal girth, distention, nausea, and vomiting. Interventions include decompression of the bowel with an NG tube connected to wall suction, NPO s tatus, and increased patient activity. A)true B)false

Long-term complications of abdominal resection with permanent colostomy are urinary retention or incontinence, pelvic abscess, failure of perineal wound healing or wound infection, and sexual dysfunction. A)true B)false

Necrosis results from a compromised blood flow to the stoma; the stoma appears pale and dusky to black. Abscess caused by stoma placement too close to the wound, retention sutures, and drains must be assessed promptly. Report all complications promptly to the surgeon and document them in the medical record. A)true B)false

The patient with a permanent end colostomy can be taught two forms of colostomy management: {1) emptying and cleansing the pouch as needed and (2) managing colostomy irrigation. In patient teaching, consider past bowel habits; location of the colostomy; and the patient's age, general health, and personal preference. A)true B)false

When a large amount of tissue is removed, as in the abdominoperineal resection, the cavity left is a sanctuary for bacteria, increasing the risk of infection. Monitor the drain site for increased pain, erythema, and purulent drainage, and monitor for elevated body temperature. A)true B)false

Sexual dysfunction of both men and women is related to removal of the rectum. Contributing factors may be partial to complete disruption of the nerve's supply to the genital organs, psychological factors, or decreased activity associated with age. A)true B)false

Support groups are available to the cancer patient in most communities. Above all, the nurse's silent communication of touch and eye contact can give the patient a message that he or she is accepted and valued. A)true B)false

Imbalanced nutrition: less than body requirements, related to: • vomiting or anorexia • surgical intervention • depression nursing intervention would be?select all that apply A)Maintain NPO status as ordered. B)Monitor parenteral fluids. C)Monitor patency and function of NG tube. D)Measure I&O. E)Monitor vital signs and serum electrolytes, hematocrit, and hemoglobin. F)Provide high-protein, high-carbohydrate, high- calorie, low-residue diet as allowed and tolerated.

A B C D E F

Disturbed body image, related to loss of normal body function (colostomy) a nursing intervention would be A)Observe for signs of denial, grief, or anger. B)false

HEMORRHOIDS

Hemorrhoids are varicosities (dilated veins) that may occur outside the anal sphincter as external hemorrhoids or inside the sphincter as internal hemorrhoids. This is one of the most common health problems seen in humans, with the grea test incidence from ages 20 to 50 years. A)true B)false

The most common symptoms associated with enlarged, abnormal hemorrhoids are prolapse and bleeding. The bright red bleeding and prolapse usually occur at time of defecation. A)true B)false

Assessment Subjective data include complaints of constipation, pruritus, severe pain when dilated veins become thrombosed, and bleeding from the rectum that is not mixed with feces. A)hemorrhoids B)false

objective data includes observing external hemorrhoids and palpating internal hemorrhoids. Because bleeding and constipation are signs of cancer of the rectum, all patients with these symptoms should have a thorough examination to rule out cancer. A)true B)false

A high-fiber diet and increased fluid intake prevent constipation and reduce straining, which allows engorgement of the veins to subside. A)true, hemorrhoids B)false

Conservative interventions include the use of bulk stool softeners-such as Metamucil, bran, and natural food fibers-to relieve straining. Topical creams with hydrocortisone relieve pruritus and inflammation, and analgesic ointments, s uch as dibucaine (Nupercainal), relieve pain. Sitz baths are usually given to relieve pain and edema and promote healing. A)hemorrhoids B)false

Sclerotherapy (with a sclerosing agent injected at the apex of the hemorrhoid column), cryotherapy (tissue destruction by freezing), infrared photocoagulation (destruction of tissue by creation of a small burn), laser excision, and operative hemorrhoidectomy are additional interventions. A)hemorrhoids B)false

Surgery is indicated for patients with prolapse, excessive pain or bleeding, or large hemorrhoids. A)true B)false

After removal of the hemorrhoid, wounds can be left open or closed,closed wounds are reported to heal faster. A)true B) false

For the surgical patient, take vital signs frequently for the first 24 hours to rule out internal bleeding. A)true B)false

Sitz baths are given several times daily. Early ambulation and a soft diet facilita te bowel elimination A)hemorrhoids B)false

The patient may have a great deal of anxiety concerning the first defecation; open a discussion on this and provide an analgesic before the bowel movement to reduce discomfort. A s tool softener such as docusate (Colace) is us ually ordered for the first few postoperative days. A)hemorrhoids B)false

Pain, related to edema, prolapse, and surgical interventions nursing intervention would be?select all that apply A)Instruct patient to wash anal area after defecation and pat dry. B)Use of local anesthetics (dibucaine ointment or Tucks pads) may give relief. C)Reinforce need for high- residue diet. D)Apply ice packs to hemorrhoids if thrombosed to prevent edema and pain. E)Use cushion for sitting postoperatively.

A B C D E F

Anxiety, related to: • previous experiences • fear of first bowel movement postoperatively • lack of knowledge regarding diet a nursing intervention would be? Select all that apply. A)Establish a supportive relationship with patient. B)Explain need for high-residue diet. C)Administer laxatives and oil-retentionen ema as ordered. D)Give an algesics before first bowel movement and a sitz bath for pain relief.

A B C D

Advise the patient to include bulk-forming foods in the diet, such as fresh fruits, vegetables, and bran cereals, as well as 8 to 10 glasses of fluid a day unless contraindicated A)true, hemmodrids B)false

If the patient is anemic, discuss foods high in iron, such as red meats, liver, and dark green leafy vegetables. Sitz baths are recommended for 1 to 2 weeks postoperatively. Emphasize the need for moderate exercise and a routine time for a daily bowel movement A)hemorrhoids B)false

ANAL FISSURE AND FISTULA

Anal fissure is a linear ulceration or laceration of the skin of the anus. Usually it is the result of trauma caused by hard stool that overstretches the anal lining. The fissure is aggravated by defecation, which initiates spasm of the anal sphincter; pain; and, at times, slight bleeding. If the lesion does no t heal spontaneously, the tract is excised surgically. A)true B)false

An anal fistula is an abnormal opening on the cutaneous surface near the anus. Usually this is from a local crypt abscess; it is also common in Crohn's disease. A)true B)false

A perianal fistula may or may not communicate with the rectum. It results from rupture or drainage of an anal abscess. This chronic condition is treated by a fistulectomy (removal) or fistulotomy (opening of the fistula tract). A)true B)false

FECAL INCONTINENCE

The external anal sphincter may be relaxed, the voluntary control of defecation may be interrupted in the central nervous system, or messages may not be transmitted to the brain because of a lesion within or external pressure on the spinal cord. A)fecal incontince B)false

The disorders that cause breakdown of conscious control of defecation include cortical clouding or lesions, spinal cord lesions or trauma, and trauma to the anal sphincter (e.g., from fistula, abscess, or surgery). A)fecal incontince B)false

Perineal relaxation and actual damage to the anal sphincter are often caused by injury from perineal surgery, childbirth, or anal intercourse. A)fecal incontincnce B)false

The normal changes that occur with aging are usually not significant enough to cause incontinence. A)true B)false

Any physical, mental, or social problem that disrupts any aspect of this complex learned beh avior can result in incontinence. A)true B)false

Biofeedback training is the cornerstone of therapy for patients who have motility disorders or sphincter damage that causes fecal incontinence A)true B)false

Bowel training is the major approach used with patients who have cognitive and neurologic problems resulting from stroke or other chronic diseases.If a person can sit on a toilet, he or she may be able to defecate automatically given a pattern of consistent timing, familiar surroundings, and controlled diet and fluid intake. A)true B)false

Incontinence is a major issue in home care and frequently is cited as the most common reason for older adults to be admitted to nursing homes. A)true B)false

Cultural Considerations | Gastrointestinal Disorders

Inflammatory bowel disease (Crohn's disease and ulcerative colitis) is more common among whites than blacks and Asian Americans. * Inflammatory bowel disease is more common among Jewish people and those of Central European origin. * The incidence of colorectal cancer is higher in the United States and Canada than in Japan, Finland, or Africa. * The incidence of colorectal cancer is declining in the United States except among black men.

True

.NCLEX

Which organ manufactures heparin, prothrombin, and fibrinogen? 1. Gallbladder 2. Liver 3. Pancreas 4. Salivary gland

Paralytic (adynamic) ileus is a functional intestinal obstruction that may result from: 1. impacted feces, tumor of the colon, or pancreatitis. 2. electrolyte Imbalance, postabdominal surgery, or acute Inflammatory reactions. 3. adhesions or a strangulated hernia. 4. volwlus, lntussusceptions, or electrolyte imbalances.

To prepare the patient for .endoscopic examination of the upper Gl tract, the patient's pharynx is anesthetized with lidocaine (Xylocaine). Nursing Interventions for postendoscopic examination include: A)allowing fluids up to 4 hours before examination. B)withholding anticholinergic medications. C)prohibiting smoking· before the test. D)keeping the patient NPO until the gag reflex returns.

``` A 35-year-old man has been admitted with a diagnosis of peptic ulcers. Which drugs are most commonly used in the.patients to decrease acid secretions? A)Maalox and Kayexalate B)Tagamet and Zantac C)Erythromycin and Flagyl D)Dyazide and Carafate ```

A patient is scheduled In the morning for a hemicolectomy for removal of a cancerous tumor of the ascending colon. The physician has ordered intestinal: antibiotics for her preoperatively to: A)decrease the bulk of colon contents. B)reduce the bacteria content of the colon. C)soften the stool. D)prevent pneumonia.

``` A 78-year-old woman was admitted during the evening shift with a tentative diagnosis of cancer of the esophagus. The nurse in her initial assessment finds the patient's major complaint is: A)dysphagia. B)malnutrition. C)pain. D)regurgitation of food. ```

Deficient knowledge is a commonly used nursing diagnosis when patients need information regarding their conditions. and diagnostic tests. Before a gastroscopy, the nurse should inform the patient that: 1. fasting for 6 to 8 hours is necessary before the examination. 2. a general anesthetic will be used. 3. after gastroscopy, the patient may eat or drink immediately. 4. admission to the hospital is necessary.

In evaluating the care of a young executive admitted with bleeding peptic ulcer, the nurse focuses on nursing interventions. A nursing intervention associated with this type of patient is: A)observing vomitus for color, consistency, and volume. 4. checking the patient's low-residue diet.

The staff nurse on the surgical floor Is aware of pulmonary complications that frequently follow upper abdominal incisions. These are most frequently related to: A)aspiration. B)pneumothorax if the chest cavity has been entered. C)shallow respirations to minimize pain. D)not forcing fluids.

Which tests can distinguish between peptic ulcer disease and gastric malignancy? A)Serum test for H. pylori antibodies B)Endoscopy with biopsy

A recently approved medication for the treatment of Crohn's disease, infliximab (Remicade), is ·classified as which type of drug? A)Alkylating agent B)Monoclonal antibody

During assessment of the patient with esophageal achalasia, the nurse would expect the patient to report: A)dysphagia, especially with liquids. B)relief of pyrosis with the use of antacids.

A nursing intervention that is most appropriate to.decrease postoperative edema and pain in the male patient following an inguinal herniorrhaphy is: A)elevating the scrotum with a support or small pillow. B) supporting the incision during routine coughing and deep breathing.

The use of nonabsorbable antibiotics a preparation for bowel surgery is done primarily to: A)reduce bacterial flora in the colon. B)prevent additional formation of ammonia.

In planning care for the patient with ulcerative colitis, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that ulcerative colitis: A)Is curable with a colectomy, whereas Crohn's disease often recurs after surgery. B)is more highly associated with a familial relationship than is Crohn's disease.

Which group of medications should be avoided in pa- tients with E. coli 0157:H7? A)Antimotility drugs B)Antilipidemic agents

What should a patient be taught after a hemorrhoidectomy? A)Administer an oil-retention enema to empty the colon. B)Use a prescribed analgesic before a bowel movement.

The medication of choice to treat Clostridium difficile intestinal infection is: 1. neomycin 2. Flagyl 3. Ancef 4. erythromycin....

It is believed that the gastric mucosa of the body of the stomach undergoes a period of transient ischemia in association with hypotension, severe injury, extensive burns, or complicated surgery. This results in the development of what disorder? A)Volvulus B)Stress ulcers

In Crohn's disease, major complications that develop due to the granulomatous cobblestone lesions of the small intestine include: A)malabsorption of nutrients. B)severe diarrhea of 15 to 20 stools per day.

A severe intestinal infection caused by contaminated undercooked beef such as hamburger from a specific pathogenic bacteria present in some cattle is called: A)Escherichia coli 0157:H7 intestinal infection. B)Clostridium difficile intestinal infection.

After a transverse loop colostomy, the nurse inspects the patient's stoma. The stoma appears mostly pink with some dusky discoloration at the lower border. An appropriate action would be to: A)cover the stoma with a petroleum gauze dressing to prevent any further irritation to the stoma. B)clean the area around the stoma, apply a clean pouch, and notify the physician about the discoloration.

The nurse is teaching a postgastrectomy patient about dumping syndrome. The patient would indicate the need for further instruction if she made which statement? A)I will not drink liquids when I eat. B) I will avoid fats and increase carbohydrates.

The primary medical management for a patient with duodenal ulcers is: A)gastric resection. B) antacids, histamine (H2) receptor blockers, proton pump inhibitors, mucosal healing agents, antibiotic therapy

An 84-year-old patient has a history of a large ventral hernia. He is complaining of nausea, vomiting, abdominal distention, and abdominal pain. A serious complication of a hernia in which the blood supply to the tissue becomes occluded is called a(n): A)strangulated hernia. B)hiatal hernia.

Peptic ulcers result from (Select all that apply.): A)excess of gastric acid or a decrease in the natural ability of the Gl mucosa to protect itself from acid and pepsin. B) invasion of the stomach and/ or duodenum by Helicobacter pylori. C)taking certain drugs, including corticosteroids and antiinflammatory medications. D)all the above

For adequate visualization, ensure that this study is scheduled before any barium studies. A)OBSTRUCTION SERIES (FLAT PLATE OF THE ABDOMEN) B)stool culture