gastrointestinal ngn Flashcards
the following flashcards are going to be on the gastrointestinal ngn case study
question 1 on the NGN case study talks about a patient who has an increased risk for developing colorectal cancer. Our job is to see which findings would indicated an increase, select all that apply. (5)
- presence of dark, tarry stool
- family history of polyposis
- 20-year history of ulcerative colitis
- use of caffeine or coffee
- unintentional 20-pound weight loss
- change in bowel pattern for 3 months
- long-term use of NSAIDS such as ibuprofen
- bacterial infection with h.pylori
explain how all the ones we selected can cause colorectal cancer, and how the others dont.
- presence of dark, tarry stool
( occult blood loss, no patient should be pooping blood ) - family history of polyposis
( its a precursor to CRC ). - 20-year history of ulcerative colitis
( inflammatory bowel disease that can increase the risk ) - unintentional 20-pound weight loss
( any form of unintentional weight loss can indicate any form of cancer and should be evaluated ) - change in bowel pattern for 3 months
( its literally just a change )
why it isn’t
- coffee, caffeine or alcohol is a more of a risk for gastritis
long term use of nsaids is a risk for gastritis and pepitucler disease
bacterial infection like h.pylori is a peptic ulcer disease risk factor
question 2 on the NGN case study is asking us what are the clinical manifestation of a rectosigmoid colon cancer?
remember the patient has anemia from the labs in the ngn case study
select all that apply (5)
- feeling tired
- rectal bleeidng
- inability to digest fat
-change in shape of stool
-feeling of abdominal bloating
- stools that float
- clay-colored stools
- straining to pass stools
explain how these 5 are it
and how the rest isn’t
anemia can manifest as fatigue, feeling tired and or generalized weakness.
anemia is common with rectosigmoid colon cancer from the loss of blood rectally
- passage of red blood is one of the cardinal signs of rectosigmoid colon cancer
a cancerous mass can grow into the lumen of the sigmoid colon, causing the shape of the stool to be changed, be like ribbon or pencil thin
tumors in the rectosigmoid colon can cause partial and eventually complete obstruction of the intentisal lumen, causing the patient to have gas pains- abdominal bloating, cramping and needed to strain to poop.
the inability to digest fat is not known for rectosigmoid colon cancer, so stools will not float
clay-colored stools are in indication of another gi problem
question 3 on the NGN case study is talking about a patient who got into an accident and was later diagnosed with acute pancreatitis. which clinical manifestation would the nurse associate with this diagnosis ? select all that apply (4)
- cyanosis
- acute pain
- vomiting
- weight loss
- decreased lipase
- hypertension
- hypoglycemia
- increased amylase
this is simply probably going to be based on like memory of clinical manifestation
but before anything what does acute pancreatitis mean?
acute pain
vomiting
weight loss
increased amylase
short period of time where the pancreas is inflammed, usually do to auto digestion of pancreas
nausea and vomiting are common and associated with weight loss due to the fluid loss during these actions
obstruction of the pancreatic duct leads to elevated levels of amylase
obstruction of the common bile duct by inflammation can lead to jaundice not cyanosis
lipase levels will be elevated with pancreatitis
hypotension instead of hypertension is caused by fluid shifting out of the intravascular space
decreased pancreas function causes hyperglycemia, not hypoglycemia
the following question 4 is based on a patient who has cirrhosis ( end stage liver failure ) and would like to know the clinical manifestation of the condition ?
select all that apply (6)
- ascites
- hunger
- pruritus
- jaundice
- headache
- vomiting
- bruising
- anorexia
tell me why these apply
tell me why those dont apply
ascites is a result of portal hypertension that occurs with liver cirrhosis
pruritus is common because bile pigments seep into the skin from the bloodstream
jaundice occurs because the bile duct becomes obstruction and bile enters the bloodstream
gi symptoms such as vomiting are common
brusising is a sign of poor liver function and is a cirrhosis-related complication
decrease appetite, because of the pressure on the abdominal organs from the ascites and liver is unable to metabolize food - not increases
headache is not a common manifestation
question 5 is talking about a patient who has been scheduled for a barium swallow. how would the nurse prepare the client for the test? select all that apply (4)
- ask about allergies to iodine before the procedure
- clarify procedural questions before the consent is signed
- administer cleansing enemas before the test
- suggest a light breakfast on the day of the procedure
- ensure that the laxative is prescribed after the test
- instruct to withhold prescribed opioids for 1 day before the test
- assess the clients ability to swallow
- ensure the bowel is adequately cleansed
what is the purpose of a barium swallow?
explain why the 4 is and the others not
- clarify procedural questions before the consent is signed
( its the nurse should to ensure consent is signed and clarify any questions before the procedure, this is a basic right and procedure to perform ) - ensure that the laxative is prescribed after the test
( the reason why is because barium will harden and lead to constipation, laxative will aid and promote elimination even with barium in the body ) - instruct to withhold prescribed opioids for 1 day before the test
( the same reason why we give laxatives, because opioids slow down the bowel movement ) - assess the clients ability to swallow
( its very important to assess the patients ability to even perform the test, like swallowing in order to avoid aspiration )
the things that are not it
- Iodine is not used with barium
- no need to clean out the intestine with an enema because it will not inteferce with the visualization of the upper GI tract
- the client is kept to nothing by mouth for 8-12 hours before the test in order to ensure the upper gi tract is free of food
- low residue diet may be prescribed several days before the test
- barium enema, not barium swallow visualizes the lower gi tract which requires stool to be cleaned and the nurse would ensure the bowel is adequanlty cleaned prior to testing
the purpose of the barium swallow Is to see the upper gi tract for any complications
- you should not eat prior so the body is well cleaned
question 6 on the NGN case study is talking about a patient who was diagnosed with ulcerative colitis years ago that comes into the er presenting with blood and mucus stools that she experiences about 15 times a day. It is imperative that the doctors provide her a stony bag because if you remember ulcerative colitis is the inflammation of the colon ( remember crohns is the entire gi tract ) so the best treatment for this is to provide a OSTOMY bag.
what are some information the nurse should include when teaching about the client about the bag? select all that apply (5)
- explain what an ostomy is and how it functions
- decrease fluid intake to 1500ml/day
- empty the pouch when its 1/2 full
- the stoma should be pink to red in color
- keep the area around the stoma clean and dry
- foods to avoid
- a skin barrier should be use before apply the punch
- fecal continence is possible
why did we select these 5
and why did we not select the others
- explain what an OSTOMY is and how it functions
( yes, its important for us to explain the procedure and how life managing works ) - the stoma should be pink to red in color
( yes, its literally an intestine out, you want it to be perfused with blood making it red in tone ) - keep the area around the stoma clean and dry
( yes, because you dont want to get an infection or skin breakdown ) - foods to avoid
( yes, some foods can be really irritating, especially having ulcerative colitis ) - a skin barrier should be used before applying the pouch
( yes, avoid skin breakdown )
the nots
- dont need to decrease fluid, matters it better to increase fluid because you need hydration (2-3l per day)
- want to empty pouch 1/3 full, not 1/2 to decrease risk of skin irritation and leakage
- fecal continence is not possible since the OSTOMY and intestine are out doing its own thing
question 7 on the GI NGN case study talks about the body systems and if we should select them or not.
Neurological (3)
- pain at 7-8 on a pain scale of 0 to 10
- takes ibuprofen 600 mg every 6 hours for pain
- epigastric pain sharp, burning or gnawing
gastrointestinal (2)
- reports stools are light brown color that do not float
- indigestion and bloating occurring around 30 minutes after eating
- takes two to three calcium carbonate chewable tablets after each meal at night
cardiovascular (1)
- takes non prescribed 81-mg baby aspirin daily
- 138/68 mmHg blood pressure
- 89 beat/min heart rate
why did we choose the ones that we did and why did we not choose the others one
neurological
- pain at a 7-8
- takes ibuprofen 600mg every 6 hours for pain
- epigastric pain, sharp, burning or gnawing
gastrointeisnal
- reports stool are light brown color that do not float (NO, THIS IS NORMAL)
- indigestion and bloating occurring around 30minutes after eating
( common for chronic gastritis and PUD ) - takes two to three calcium carbonate chewable tablets after each meal at night
( can cause an imbalance in acid base system by providing too much base )
Cardiovascular
- takes non prescribed 81-mg baby aspirin daily
( taking this daily can cause GI bleeding, especially since the client is also taking an NSAID, like ibuprofen on a regular basis, which is famous for GI upset and gi bleed )
- 138/68mmHG blood pressure
( within normal limits ) - 89 beats per min
( within normal limits )
question 8 on the NGN case study is still on the same patient who was diagnosed with chronic gastritis
the client is most likely experiencing
- chronic gastritis
as evidenced by the primary finding of
- dyspepsia
why was is not crohns disease?
why is it not peritonitis?
why is not ulcerative colitis ?
what is not celiac disease?
why is it not evidence by working from home?
- covid 19?
- smoking status?
- dizziness upon changing position quickly
the reason why that it that is because the patient is using many medications like ibuprofen, pairing having epigastric tenderness, pain, hyperactive bowel swords and dyspepsia ( sharping, gnawing pain ) are great cues that It is related to the upper gi tract
this can help eliminate crohns and ulceravitce colitinies since that is usually related to the lower gi, being the colon
peritonitis can develop with progression of symptoms and perforation of the GI tract but that is not present
no celiac, like inability to tolerate wheat, rye, or barely
work has nothing to with it,
client doesn’t smoke
dizzying can be from orthostatic hypotension which is not found in chronic gastritis
something to note, not much to talk about question 9 on the NGN case study, talks about what are the laboratory results that consist with impaired gastric elimination
which include
- high wbc
- positive C13 ( urea breath test)
- 48 immunoglonin anti- h.pylori
- 1.45 IGG h.pylori
this is literally something you just have to remember, these are the big picture in diagnosing someone with h.pylori
question 10 on the NGN case study is simply talking about the indicated and contradicted for patients who have h.PYLORI infection
- teach to avoid foods causing discomfort
- avoid caffeinated and carbonated beverages
- space meals interval to eating three times/day
- teach benefits of bland,nonspicy diet
- explain why antibiotics are not used for this disorder
- teach to physically limit activity when in remission
- teach about complementary and integrative therapies
- indicated
- yes you want to tell them what to avoid cause they are already in discomfort - indicated
- coffee and carbonated drinks can cause further diarrhea and speed up perstalisis - contradinciated
- no need to space meals, just eat normal, its better to even eat small meals 6 time a day - indicated
- yes its good to eat bland, so it doesn’t irritate the stomach - contraindicated
- you want to tell them why antibiotics are used, its an infection, we need to kill the bacteria and a PPI - contraindicated
- limit activity only applies if youre having an active GI bleed, other than that, you should be moving - indicated
- betert to give the full picture of everything
question 11 is basic knowledge
what is the medication class for omeprazole ?
what to teach client?
what is medication class for famotidine ?
what to teach client?
what is medication class for sucralfate?
what to teach client?
proton pump inhibitor
take 30mintes before start of the day
- it becomes ineffective if taken with food, so its better to start you day off with it in your system
h2 antagonist
take medication at bedtime
( it aids with decrease gastric acid )
mucosal barrier
take on an empty stomach
( other medications can interfere with the medication )
the last question simply is the signs of important which are
- client reports epigastric pain intenstity at a 2-3 on the scale
- ability to eat frequent meals
- has improved rest and sleep
- attenting sessions
- client states stools and tongue have very dark color
( this is due to. bismuth subsalitye meidication suspension and indicated adherence to the medication )
all of these are signed of progression good
