GI Disorders

Question 1

Crohn’s disease can affect what part of the GI tract?

Answer 1

any part!

mouth to the anus

Question 2

ulcerative colitis can affect what part of the GI tract?

Answer 2

only affects the large
intestine.

Question 3

In both Crohn’s disease and ulcerative colitis a).. and b).. are quite common

Answer 3

a) diarrhea and b) cramping

Question 4

is rectal bleeding more common in ulcerative colitis or crohns?

Answer 4

ulcerative colitis,

Question 5

is weight loss and nutritional deficiencies more common in ulcerative colitis or crohns disease?

Answer 5

Crohns!

Question 6

If ulcerative colitis is bad enough what treatment can be preformed?

Answer 6

removal of the large intestine

Question 7

**Brenda asks the nurse, “Does my ulcerative colitis increase my risk for developing cancer?” What is the
nurse’s best response? **
 “Yes, people who have had UC for more than 15 years have an increased risk for pancreatic cancer”
 “Yes, people who have had UC for more than 10 years have an increased risk for colorectal cancer”
 “No, there is no evidence that UC increases your risk for cancer”
 “Although UC does not cause cancer, some of the drugs used to treat this disease may increase your
risk for cancer”

Answer 7

 “Yes, people who have had UC for more than 10 years have an increased risk for colorectal cancer”

Question 8

Is there a cure for Crohns disease?

Answer 8

no, because it can effect the entire GI tract.

Question 9

in UC, inflammation starts where? and spreads where?.

Answer 9

starts in the rectum and spreads upwards through the large intestine in a continuous manner.

Question 10

What are “skip lesions” in Crohns disease?

Answer 10

where there’s an area of inflammation in two
or more separate locations, that are separated by normal sections of the GI tract.

Question 11

What part of the GI tract is MOST commonly affected by Crohn’s disease?
 Duodenum
 Jejunum
 Terminal ileum and colon
 Rectum

Answer 11

 Terminal ileum and colon

most commonly affects where the
small and large intestines meet.

Question 12

• name three negative acute phase proteins, AND do they decrease on increase during states of inflammation?

Answer 12

• albumin, prealbumin, and transferrin.
• **decrease **during states of inflammation

Question 13

• Name one positive acute phase protein, and does it decrease or increase during inflammation?

Answer 13

• C-reactive protein
  –** increases** by 25% or more during states of inflammation

Question 14

what information is gathered by erythrocyte sedimentation rate (or ESR) results?

Answer 14

It reflects the viscosity of the blood plasma and
how fast red blood cells will settle over time.

Question 15

What blood test result could indicate that a malnourished client is experiencing a negative nitrogen balance?
 Decreased serum creatinine
 Elevated serum urea
 Decreased alkaline phosphatase
 Elevated troponin

Answer 15

 Elevated serum urea

Question 16

Nitrogen is a product of muscle break down in the body, what is the waste product of nitrogen?

Answer 16

Urea

Question 17

what does a negative nitrogen balance tell us?

Answer 17

that more nitrogen is being excreted than is being taken in through a person’s diet.

Question 18

5 complications that can occur with crohns disease?

Answer 18

inflammation, stenosis or strictures, abscesses, perianal disease, fistulas

Question 19

in management for people who have **mild-to-moderate ** IBD, what approach is usually preferred?

Answer 19

“bottom-up approach”

Question 20

in people who have severe or debilitating IBD, what approach would we use for management

Answer 20

“top-down
approach”

biologics or immune modulators

Question 21

what is one of the first treatments that is used when treating IBD?

Answer 21

5-ASA agents

sulfasalazine and mesalamine

Question 22

where do 5-ASA agents primarily work?

Answer 22

They work primarily in the large
intestine

Question 23

what medication is used as a short-term, “rescue” treatment for when people with IBD experience a disease flare-up.

Answer 23

corticosteriods

Question 24

what antibiotic is used most commonly in individuals with IBD, specifically Crohns disease?

Answer 24

metronidazole

Question 25

What drug class is used to induce remission in IBD and then prevent flare-ups?

Answer 25

immmune modulators | azathioprine, methotrexate, and cyclosporine

Question 26

what is the onset for immune modulators?

Answer 26

6 months to achieve their effects.

Question 27

what is the big risk with taking immune modulators?

Answer 27

immune suppression

Question 28

**What are the characteristics of Crohn’s disease?** a. Can be cured with a total proctocolectomy with permanent ileostomy b. Inflammation always begins in the rectum and then proceeds up the colon in a continuous manner c. Ulcers may present anywhere in the gastrointestinal tract but are most common in the terminal ileum d. Frequently presents with cramping abdominal pain, bloating, and constipation

Answer 28

c. Ulcers may present anywhere in the gastrointestinal tract but are most common in the terminal ileum

Question 29

**A client with Crohn's disease has a prescription for a low-residue diet. An appropriate lunch would include:** a. Stir-fried vegetables (beans, peas, carrots, and corn) over rice b. Homemade chicken noodle soup and 2 soda crackers c. BLT (bacon, lettuce, and tomato) sandwich on multigrain bread d. Caesar salad with whole wheat croutons and garlic toast

Answer 29

b. Homemade chicken noodle soup and 2 soda crackers

Question 30

**A nurse is caring for a client with Crohn’s disease who has a permanent ileostomy. During the abdominal assessment, what should the nurse expect to see?** a. A stoma in the upper left quadrant of the abdomen continuously drains liquid stool b. A stoma in the lower left quadrant of the abdomen drains semi-formed stool c. A stoma in the upper right quadrant of the abdomen drains semi-formed stool d. A stoma in the lower right quadrant of the abdomen continuously drains liquid stool

Answer 30

d. A stoma in the lower right quadrant of the abdomen continuously drains liquid stool

Question 31

A nurse teaches a client with inflammatory bowel disease (IBD) that a newly prescribed medication is a targeted treatment that will bind to, and block, specific proteins in the body that are involved in the disease process. The nurse explains that the drug is administered as an injection and the goal of treatment is to induce remission. What drug is the nurse describing? a. Sulfasalazine b. Prednisone c. Methotrexate d. Adalimumab

Answer 31

d. Adalimumab

Question 32

Biologics used to achieve and maintain remission in IBD are not the same as other drugs as they are actrually?

Answer 32

antibodies! :)

Question 33

What is the drug class name ending for biologics? and what is their route of administration?

Answer 33

" –mab," Injection or IV

Question 34

biologics can increase the risk for?

Answer 34

infections and for certain types of cancer.

Question 35

a total proctocolectomy with the creation of an ileostomy removes what portion of the bowels?

Answer 35

In this procedure, the entire large intestine will be removed (including the rectum and anus), and the anal opening will be sutured shut.

Question 36

in clients who have a severe exacerbation of IBD – bad enough to need hospitalization – what protocol are they usually placed on to help the gut heal?

Answer 36

they’re usually made NPO, which is called “bowel rest”.

Question 37

An elemental diet is composed of ?

Answer 37

simple nutrients that are easy to digest (amino acids, fatty acids, sugar, vitamins, and minerals). | do not need pancreatic enzymes for digestion

Question 38

if a client cannot tolerate oral intake at all, what will be reccomended?

Answer 38

enteral or parenteral nutrition may be required.

Question 39

total parenteral nutrition (or TPN) provides what % of a patients required nutrition

Answer 39

100% of a client’s required nutrition

Question 40

TPN needs to be administered through what type of catheter?

Answer 40

central venous catheter

Question 41

**A client is admitted to hospital with a severe exacerbation of ulcerative colitis. The client is made NPO, and the healthcare team anticipates that the client will be unable to tolerate food for at least two weeks. What nutritional intervention should the nurse anticipate being ordered for this client?** a. Insertion of a nasogastric tube by the nurse, and initiation of enteral feeding b. Initiation of total parenteral nutrition (TPN) c. Surgical insertion of a gastric tube, and initiation of enteral feeding d. Oral administration of an elemental feed

Answer 41

b. Initiation of total parenteral nutrition (TPN)

Question 42

when a patient isn’t able to take in, or tolerate, nutrition that’s provided through the GI tract what is the order in which managment is provided?

Answer 42

1. oral nutrition 2. Enteral nutrition 3. parenteral nutrition

Question 43

parenteral nutrition is reserved for a a)... GI tract.

Answer 43

a)... non-functioning

Question 44

# 4 things TPN is typically only used in certain circumstances, such as?

Answer 44

1. impaired absorption of nutrients, 2. bowel rest, 3. GI motility disorders, 4. inability to maintain enteral access.

Question 45

nurses can add any medications or ingredients to a parenteral nutrition bag after it’s been prepared. **True or false?**

Answer 45

FALSE!!!! TPN is sterile, bag should not be tampered with outside of pharmacy

Question 46

A 2-in-1 formula of TPN contains ?

Answer 46

amino acids and dextrose | protein and carb

Question 47

a 3-in-1 formula of TPN contains?

Answer 47

amino acids and dextrose and lipids | protein, carb and fat

Question 48

If a TPN bag contains “heavy creaming”, what should the nurse do?

Answer 48

Return to sender. Depending on how much has separated will determine if bag is useable)

Question 49

"Marbling" in a TPN bag means?

Answer 49

triglycerides aren’t just separating from the rest of the mixture… now they’re starting to clump together. | return to sender

Question 50

how often should BG be checked in patients who are begun on TPN?

Answer 50

every 4 hours.

Question 51

When a severely malnourished person starts TPN (or other nutritional intervention), the highest risk for re feeding syndrome usually occurs within the next a)... days ?

Answer 51

1-3 days.

Question 52

In refeeding syndrome, the body begins breaking down a).. for energy which produces b).. This causes blood pH to c).. In order to resist pH change d).. shift into the cells and force e).. into the blood which is then peed out.

Answer 52

a) fats b) ketones c) decrease d) hydrogen ions e) potassium and magnesium

Question 53

What ions are lost in refeeding syndrome?

Answer 53

magnesium, potassium, and phosphate

Question 54

in critically ill patients who are receiving TPN, if triglyceride levels get too high, that can sometimes lead to ?

Answer 54

acute pancreatitis or fat overload syndrome

Question 55

in order to catch a infection in patients with TPN, how often should temperature be checked?

Answer 55

every 6 hours.

Question 56

Are NG tubes used for short term or long term use?

Answer 56

short term.

Question 57

If we know that the tube will only be used for feeding, and not for suction, we can use a?

Answer 57

small-bore feeding tube

Question 58

What rate is it reccomended to start enteral at? and then how much should you increase it?

Answer 58

10-40 mL/hr and then increase by 10-20 ml/ 8-12 hours

Question 59

tube feeding tubes getting clogged can be prevented by?

Answer 59

routinely flushing the tube with water.

Question 60

# 5 things Reason a person may get diarrhea from tube feeding?

Answer 60

1. The rate is too fast 2. the solution is too cold 3. not enough fiber in solution 4. solution is hypertonic 5. medications

Question 61

symptoms of dumping syndrome include GI (6 things) Vasomotor (6 things)

Answer 61

GI: abdominal pain and cramping, nausea and vomiting, bloating, and diarrhea VASOMOTOR: diaphoresis, flushing, dizziness, hypotension, syncope, and palpitations.

Question 62

what causes dumping syndrome?

Answer 62

caused by osmotic fluid shifts INTO the GI tract (caused by too fast administration of a hyperosmolar tube feed solution)

Question 63

* What is “cachexia”?

Answer 63

= wasting syndrome that causes weakness + loss of weight, fat, and muscle

Question 64

what layers of the GI tract are affected in ulcerative colitis

Answer 64

* Mucosa, submucosa

Question 65

* What diet is recommended for a client with ulcerative colitis: o During acute phase (an acute exacerbation)?

Answer 65

 NPO

Question 66

* What layers of the GI tract are affected by Crohn’s disease?

Answer 66

* All layers of bowel wall – transmural

Question 67

* What type of feeding tube should be inserted if the client displays symptoms of delayed gastric emptying/motility?

Answer 67

* Nasoduodenal or nasojejunal tube

Question 68

* What does it mean if a medication has a physical incompatibility with an enteral formula?

Answer 68

* It will cause mixture to thicken and clog feeding tube

Question 69

* Are fat emulsions hypo-, hyper-, or isotonic?

Answer 69

* Isotonic = can infused through peripheral or central line