Gastrointestinal Disorder Flashcards
Care of the Patient with a
Gastrointestinal Disorder
,
LABORATORY AND DIAGNOSTIC EXAMINATIONS
,
UPPER GASTROINTESTINAL STUDY (UPPER Gl SERIES, UGI)
,
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
A
Explain the importance of rectally expelling all the barium after the examination.
A)UPPER GASTROINTESTINAL STUDY (UPPER Gl SERIES, UGI)
B)ulcers
A
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
A
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
A
Give the patient milk of magnesia(constipation) (60 mL) after the examination unless contraindicated.
A)UPPER GASTROINTESTINAL STUDY (UPPER Gl SERIES, UGI)
B)ulcers
A
TUBE GASTRIC ANALYSIS
,
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
A
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
A
achlorhydria (an abnormal condition characterized by the absence of hydrochloric acid in the gastric juice)
A)true
B)false
A
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
A
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
A
The nurse or radiology personnel inserts a nasogastric (NG) tube into the stomach to aspirate gastric content.
A)TUBE GASTRIC ANALYSIS
B)GI STUDIES
A
Remove the NG tube as soon as specimens are collected. The patient may then eat if indicated.
A)TUBE GASTRIC ANALYSIS
B)GI STUDIES
A
ESOPHAGOGASTRODUODENOSCOPY (EGO, UGl ENDOSCOPY, GASTROSCOPY)
,
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
A
The patient is us ually given a preprocedure intravenous (IV) sedative such as midazolam (Versed)
A)ESOPHAGOGASTRODUODENOSCOPY (EGO, UGl ENDOSCOPY, GASTROSCOPY)
B)GI STUDIES
A
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
A
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
A
CAPSULE ENDOSCOPY
,
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
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
Withhold any medications that may interfere with the production of acid, such as antacids and analgesics.
A)ESOPHAGEAL FUNCTION STUDIES (BERNSTEIN TEST}
B)capsule
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
BARIUM ENEMA STUDY (LOWER Gl SERIES)
,
Barium sulfate assists in visualization of mucosal detail.
A)true
B)false
A
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
A
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
A
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
A
Milk of magnesia (60 mL) may be ordered after the BE to stimulate evacuation of the barium.
A)true
B)false
A
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
A
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
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
A
Explain the procedure to the patient and have him or her sign a consent form.
A)colonoscopy
B)ulcers
A
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
A
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
A
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
A
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
A
Provide warm blankets during the procedure, since many patients experience hypothermia while taking GoLYTELY.
A)true colonoscopy
B)false
A
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
A preprocedme IV sedative such as midazolam is often given.
A)colonoscopy
B)enemas
A
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
A
After the colonoscopy, . Assess for hypovo- lemic shock.
A)true
B)false
A
GoLYTELY Bowel Preparation
,
Give patient one metoclopramide (Reglan) 10-mg tablet, as prescribed, orally 30 minutes before proceeding.
A)true
B)false
A
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
A
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
A
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
A
Stool samples for O&P are obtained before barium examinations. Instruct the patient not to mix urine with feces.
A)stool culture
B)enemas
A
Ensure the specimen is taken to the laboratory within 30 minutes of collection in specified container.
A)stool culture
B)enemas
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
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
C
halitosis is termed bad breath
A)true
B)false
A
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
A
This disease appears more commonly in the new born infant, who becomes infected while passing through the birth canal.
A)Candidiasis
B)ulcer
A
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
A
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
A
patients with acquired immunodeficiency syndrome [AIDS] or those receiving chemotherapy or radiation therapy, are at risk of CANDIDIASIS
A)true
B)false
A
CANDIDIASIS appears as pearly, bluish white “ milk- curd” membranous lesions on the mucous membranes of the mouth, tongue, and larynx.
A)true
B)false
A
If the patch or plaque is removed, painful bleeding can occur. With CANDIDIASIS.
A)true
B)false
A
Use meticulous hand hygiene to prevent spread of infection.
A)candidiasis
B)ulcer
A
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
A
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
A
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
A
Give soft or pureed foods and avoid hot, cold, spicy, fried, or citrus foods. For patients with
A)candidiasis
B)ulcer
A
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
A
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
A
Tumors of the salivary glands occur primarily in the parotid gland and are usually benign.
A)true
B)false
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
Malignancy at the base of the tongue produces less obvious symptoms: slight dysphagia, sore throat, and salivation.
A)true oral cancer
B) false
A
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
A
Indirect laryngoscopy is an important diagnostic test for examination of the soft tissue.
A)oral cancer
B)false
A
Oral exfoliative cytology is used for screening intraoral lesions.
A)true
B)false
A
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
A
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
A
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
A
Patients may have drains in the incision sites that are connected to suction to aid healing and reduce hematomas.
A)true
B)false
A
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
A
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
A
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
A
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
C
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
A
The incidence of cancer of the mouth bears a high correlation to cirrhosis of the liver associated with alcohol intake
A)true
B)false
A
Early detection of oral cancer can increase the patient’s chance of survival.
A)true
B)false
A
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
A
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
A
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
A
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
A
GERD is the most common upper GI problem seen in adults
A)true
B)false
A
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
A
The second major symp-tom of GERD is regmgitation, which is not associated with either eructation or nausea.
A)true
B)false
A
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
A
In severe cases, GERD can produce dysphagia or odynophagia (painful swallowing)
A)true
B)false
A
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
A
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
A
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
A
Objective data of GERD include nocturnal cough, wheezing, and hoarseness
A)true
B)false
A
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
A
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
A
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
A
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.
A)true
B)false
A
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
A
promotility agents that increase peristalsis and therefore promote gastric emptying and reduce the risk of gastric acid reflux.
A)true
B)false
A
As a last resort, a surgical procedure called fundoplication is performed to strengthen the sphincter. For GERD
A)true
B)false
A
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
A
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
A
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
A
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
A
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
A
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
A
Environmental carcinogens, nutritional deficiencies, chronic irritation, and mucosal damage have all been considered as causes of esophageal cancer.
A)true
B)false
A
Another risk factor is Barrett’s esophagus. For esophageal cancer
A)true
B)false
A
The prevalent age-group for esophageal cancer is 55 to 70 years. It occurs more commonly in men.
A)true
B)false
A
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
A
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
A
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
A
When esophageal stenosis (narrowing) is severe, regurgitation of blood-flecked esophageal contents is common.
A)esophageal cancer
B)false
A
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
A
Endoscopic ultrasonography is an important tool used to stage esophageal cancer
A)true
B)false
A
In advanced cases, surgery is palliative to relieve dysphagia and restore continuity of the alimentary tract.
A)esophageal cancer
B)ulcer
A
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
A
Radiation therapy may be curative or palliative. In esophageal cancer
A)true
B) false
A
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
A
The following four types of surgical procedures can be performed:
- Esophagogastrectomy:
- Esophagogastrostomy:
- Esophagoenterostomy:
- 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
A
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
A
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
D
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
A
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
A
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
A
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
A
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
A
Observe for loss of weight, poor skin turgor, and weakness for patient with achalasia
A)true
B)false
A
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
A
(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
C
(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
A
Discuss methods of avoiding constipation by using high-fiber foods (if tolerated) and natural laxatives.
A)true
B) false
A
Nursing Interventions for the Patient Experiencing Esophageal Surgery
,
PREOPERATIVE NURSING INTERVENTIONS
- 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. - Give meticulous oral hygiene; breath may be malodorous.
- Give preoperative preparation appropriate for thoracic surgery.
- Give prescribed antibiotics before esophageal resection or bypass, as ordered.
True
POSTOPERATIVE NURSING INTERVENTIONS
- Promote good pulmonary ventilation.
- Maintain chest drainage system as prescribed.
- 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). - 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
A
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
A
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
A
If the condition results from ingestion of contaminated food, the intestines are usually affected and diarrhea may occur.
A)gastritis
B)ulcer
A
Collection of subjective data of gastritis includes observing for anorexia, nausea, discomfort after eating, and pain.
A)true
B)false
A
Collection of objective data of gastritis includes observing for vomiting, hematemesis, and melena caused by gastric bleeding.
A)true
B)false
A
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
A
Patients who experience GI bleeding from hemorrhagic gastritis require fluid and blood replacement and NG lavage.
A)true
B)false
A
Patient with gastritis Clear liquids are increased to diet as tolerated.
A)true
B)false
A
(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
A
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
A
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
A
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
A
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
A
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
A
GASTRIC ULCERS
,
The most common site of a gastric ulcer is in the distal half of the stomach.
A)true
B)false
A
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
A
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
A
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
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
A
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
A
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
A
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
A
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
A
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
A
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
A
Duodenal ulcers are more likely to have chronic bleeding and are more prone to perforation than gastric ulcers.
A)true
B)false
A
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
A
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
A
Both salicylates and alcohol aggravate bleeding in patients with a history of pep tic ulcers.
A)true
B)false
A
Bleeding from a gastric ulcer is more difficult to control than bleeding from a duodenal ulcer.
A)true
B)false
A
Hemorrhage, with accompanying symptoms of shock, occurs when the ulcer erodes into a blood vessel.
A)true
B)false
A
Surgical intervention is indicated if the patient remains unstable after receiving blood over several hours.
A)true
B)false
A
Perforation occurs when the ulcer crater penetrates the entire thickness of the wall of the stomach or duodenum.
A)true
B)false
A
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
A
Perforation is considered the most lethal complication of peptic ulcer.
A)true
B)false
A
Bacterial peritonitis may occur within 6 to 12 hours.
A)true
B)false
A
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
A
Fiberoptic endoscopy can detect both gastric and duodenal ulcers.
A)true
B)false
A
The physician may order insertion of an NG tube to remove gastric content and blood.
A)true
B)false
A
Surgery is indicated usually for complications: perforation, penetration,obstruction, or intractability (no longer responding to medical managem ent).
A)true
B)false
A
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
A
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
A
Histamine (H2) receptor blockers: Decrease acid secretions by blocking histamine (H2) receptors
A)true
B)false
A
Proton pump inhibitors: Antisecretory agents that inhibit secretion of gastrin by the parietal cells of the stomach.
A)true
B)false
A
Mucosal healing agent: Heals ulcers without antisecretory properties. Sucralfate is a cytoprotective drug.
A)true
B)false
A
Antisecretory and cytoprotective agent: Inhibits gastric acid secretion and protects gastric mucosa.
A)true
B)false
A
Antibiotic therapy eradicates H. pylori. The drugs used include metronidazole (Flagyl), tetracycline, amoxicillin, and clarithromycin (Biaxin).
A)true
B)false
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
Total gastrectomy is removal of the stomach.
A)true
B)false
A
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
A
Pyloroplasty: Surgical enlargement of the pyloric sphincter to facilitate passage of contents from the stomach;
A)true
B)false
A
Bleeding may occur up to 7 days after gastric surgery.
A)duodenal ulcer
B)ulcer
A
