GI Assessment Class Questions Flashcards
What are key health history questions for abdominal pain and vomiting?
Point to location of your pain
When did the pain start?
3 days ago
Tell me how has the pain been over these 3 days
It would come and go, but today it won’t stop
What does the pain feel like?
It was crampy, but now it is very squeezy and uncomfortable
What were you doing when pain started?
Nothing
On a scale of 1-10, where 10 is the worse pain ever how would you rate your pain?
9
What makes it worse? What makes it better?
I don’t know. I tried some Tylenol I threw it up.
When was your last bowel movement?
Last thursday
What have you eaten since Friday?
Threw up everything eaten
When was your last period?
Menopause started early for me, have not had in 4 years
Describe your vomit
Threw up meal from thursday night went from normal to green to yellow to clear, nothing coming out now just clear. no blood
How often do you vomit?
Every hour
Does the pain get worse or better after vomiting?
No
Do you have any fever?
No
Are you thirsty?
Yes
How often are you urinating?
Every hour
What is her circulation like?
Pale, diaphoretic
What are her vitals? What kind of drop are we looking for in systolic to call this orthostatic hypotension? HR?
Orthostatic vital sings (have her lie down) then sit her up legs dangling and do her blood pressure. 20mmHg. Change of 10 bpm
When would you treat pain? Why?
Once a diagnosis is made. Pattern of pain can provide a lot of information
What is the shape of her abdomen? Where would you stand? What do you want to know about how her stomach looks now?
Foot of bed and look u. Protuberant and large. Symmetrical. Might ask about her normal
Is umbilicus midline?
Yes
Which part of stethescope do you listen with?
Diaphragm
What does it sound like in all quadrants?
No sounds
How ling do you listen for to determine sound as silent?
5 minutes
Why is a nasogastric tube needed for decompression?
Allows bowel to relax or rest and unkink
What would you put suction setting at?
80mmHg, low suction, remove anything sitting in stomach
Anytime an intervention is going to happen what should we always be asking?
Have you had this before?
How do you determine what nostril to insert NG tube in?
Less congestion, trauma
Who would you not put an NG tube in?
Facial, head injury, basilar skull fracture, cerebral spinal fluid leakage suspected (tells you there is skull fracture)
How do you know tube is where it should be?
Once at carina stop and check if there is airflow at end of tube and then you can continue if there is not. If there is you are in the trachea. Then you aspirate once in stomach and check pH for less than 5. Then xray.
If you aspirate and nothing comes out what should you do?
Remove it and try again.
What should you be checking hourly for a patient with an NG tube? How?
Placement (use the mark point to make sure it hasn’t migrated, how much of NG tube comes out of nares), every x hours you should aspirate (depends on policy). Hourly you can mark how much bile is coming out and add to fluid balance sheet. Auscultate bowel sounds and lung sounds hourly.
What kinds of health teaching post operatively would you give for PCA use?
PCA is used to help her control her pain. Reinforce it is a narcotic/ Side effect of narcotics is it slows down your breathing, but I will be here to monitor.
How do you answer questions about addiction?
will give you enough to control your pain, but over a few days it will be reduced slowly and eventually you will be switched to lower does to ween nyou as your pain decreases. Therapeutic dose based on her weight
What is the difference between a demand and a basal rate mean?
basal rate is continuously administered, on demand means they get it when they push the pump
What assessments do you want to do on a patient on PCA?
Pain, respiratory, ABCD, IV site, BP, HR, how much of narcotic in previous hour, pushes of button she did
What is the benefit of TPN?
To rest bowel. We have ingestion and digestion food and fluids. Need capability to do both
Client comes back from surgery with central line, what do you want to assess?
Is dressing dry and intact, any bleeding?
What kind of lines can you have?
Single, double, triple lumens. How many lines do we have and what are we going to do with them?
With diagnosis of cancer obstructing bowel and entry into palliative care. What does palliative care mean and what is involved in it?
Symptom, pain, nausea, vomiting management. Prevent complications like pressure ulcers. Support religious, spiritual needs, hypodermoclysis for hydration. MAID discussion. Emotional support (fear, depression, anxiety)
What are the benefits of Subcutaneous pain injection?
May take longer to be absorbed if there is even less circulation to the area and medication may stay there longer too
What would you do if family wants to give her soup?
She cannot swallow and could possibly end up in lungs further complicating things
Family in room, call you with call bell and say patient is not breathing anymore. What do you do?
Take your stethescope, place it on apex and listen for a full minute for a heartbeat. Check for spontaneous breathing, check the time and note it at that point. Don’t need physician to pronounce death just certify it. If family is there, could leave them, give them sometime before cleaning and prepping patient.
Family in room, call you with call bell and say patient is not breathing anymore. What do you do?
Take your stethescope, place it on apex and listen for a full minute for a heartbeat. Check for spontaneous breathing, check the time and note it at that point. Don’t need physician to pronounce death just certify it. If family is there, could leave them, give them sometime before cleaning and prepping patient. Can also allow family to be involved in cleaning as well.
Would you clean if it was trauma or violent act?
No
