Module 3 Gastrointestinal System

Question 1

Trace the pathway of food through the digestive system.

Answer 1

Mouth, esophagus, lower esophageal sphincter, stomach, pyloric sphincter, duodenum, jejunum, ileum, large intestine, rectum, and anus. Remember that the duodenum, jejunum, and ileum are all parts of the small intestine.

Question 2

The pyloric sphincter is between the stomach and the duodenum. True or false?

Answer 2

True

Question 3

The nurse understands that the gallbladder is located in this quadrant of the abdomen?

Answer 3

Right upper quadrant

Question 4

The nurse understands that the liver is located in this quadrant of the abdomen?

Answer 4

Right upper quadrant

Question 5

The nurse understands that the pancreas is located predominately in this quadrant of the abdomen.

Answer 5

Left upper quadrant

Question 6

The spleen is located predominately in this quadrant of the abdomen?

Answer 6

Left upper quadrant

Question 7

The appendix is located in this quadrant of the abdomen?

Answer 7

Right lower quadrant

Question 8

The rectum is located in this quadrant of the abdomen?

Answer 8

Left lower quadrant

Question 9

The nurse understands that breakdown of food begins in the mouth with this enzyme present in a person’s saliva?

Answer 9

Amylase

Question 10

State the three functions of the saliva.

Answer 10

• Buffer to protect the oral mucosa
• Saliva contains ptyalin and amylase, which initiate the digestion of dietary starches.
• Antibacterial action to help keep the mouth clean

Question 11

List the major gastrointestinal hormones.

Answer 11

Cholecystokinin (CCK), Secretin, and Gastrin

Question 12

Describe the function of Cholecystokinin (CCK). How would the patient be affected if CCK is deficient?

Answer 12

CCK stimulates contraction of the gall bladder, stimulates secretion of pancreatic enzymes, slows gastric emptying, and inhibits food intake. Therefore if CCK is deficient or not being released appropriately then the person would have a larger appetite and less control over their food intake.

Question 13

Describe the function of secretin. How would the patient be affected if secretin is deficient?

Answer 13

Secretin stimulates secretion of bicarbonate-containing solution by the pancreas and liver. Remember bicarb is a buffer so if secretin is deficient the person will have ulcers form from the increased acid levels not being reduced appropriately.

Question 14

Describe the function of gastrin. How would the patient be affected if gastrin is deficient?

Answer 14

Gastrin stimulates secretion of gastric aid and pepsinogen, increases gastric blood flow, stimulates gastric smooth muscle contraction, and stimulates growth of the gastric, small intestine, and colon mucosa. Therefore if gastrin is deficient then the absorption of nutrients will be significantly reduced because acid levels will be decreased, blood flow for absorption will be decreased, and food will not move through the GI tract efficiently.

Question 15

The nurse is assigned to care for a client with c-diff during her shift. Prior to entering the clients room the nurse understands that all clients with c-diff have these two things in common?

Answer 15

These patients all have copious amounts of foul smelling, watery diarrhea and a history of broad spectrum antibiotic usage.

Question 16

The nurse understands that c-diff is highly contagious and is easily transferred from patient to patient. The nurse understands that hand hygiene can prevent infections from spreading. How should the nurse perform hand hygiene after caring for a patient with c-diff?

Answer 16

The nurse should only** wash her hands with soap and water. The nurse should **never use alcohol based hand sanitizer since this will not kill the c-diff spores.

Question 17

List common symptoms associated with appendicitis.

Answer 17

Abrupt onset with pain originally at the epigastric or periumbilical that then localizes to the lower right quadrant. Nausea, vomiting, RLQ tenderness, rebound tenderness, elevated WBC count, and fever.

Question 18

List potential complications of appendicitis?

Answer 18

Perforation (rupture), peritonitis, sepsis, localized periappendiceal abscess formation

Question 19

What is the treatment for appendicitis?

Answer 19

Treatment for appendicitis is surgery.

Question 20

The nurse is caring for a patient with appendicitis. The patient reports that the right lower quadrant pain has suddenly been relieved. What should the nurse suspect has happened?

Answer 20

The nurse should expect the appendix has ruptured.

Question 21

A client has symptoms of belching, nausea, burning pain in the chest, dry cough, and heartburn. The physician has dx with client with GERD. What medication treatment should should the nurse anticipate in this patient?

Answer 21

The nurse should anticipate antacids and proton pump inhibitors (PPI’s).

Question 22

The nurse understands that this sphincter is weak in patients with a diagnosis of GERD?

Answer 22

Lower esophageal sphincter

Question 23

The nurse is caring for an infant with severe projectile vomiting, weight loss, constipation, fatigue, excessive hunger, and a lump in abdomen. The physician tells the patient’s parents that the child has pyloric stenosis and failure to thrive. The parents begin to cry after the physician leaves and asks what they did wrong and why their infant is not gaining weight? The nurse says …

Answer 23

The nurse says that pyloric stenosis is a condition in which the opening between the stomach and small intestine (duodenum) thickens. This thickening will prevent food from entering the small intestine where most of the nutrients are absorbed. This means that no matter how much you feed your child the child will vomit the food up because it cannot move through the intestines. This is not your fault. You did nothing wrong, the cause of this disorder is unknown. Your child will need surgical correction of the problem.

Question 24

The nurse understands that peptic ulcer disease (PUD) is an ulceration that develops in the stomach lining or duodenum from exposure to the acidic stomach acid. What medications place patient’s at a higher risk of PUD?

Answer 24

Aspirin and NSAIDs. Particularly susceptible when NSAIDs are taken with warfarin and/or corticosteroid medications.

Question 25

What are the primary complications of peptic ulcer disease (PUD) and what is the preferred treatment of PUD?

Answer 25

Hemorrhage and perforation are the primary complications of PUD. The preferred treatment is PPI's (proton pump inhibitors).

Question 26

The nurse understands that PUD can be the result of H. pylori gastritis. How is H. pylori gastritis contracted and what is the preferred treatment?

Answer 26

H. pylori are small, curved, or spiral shaped, gram-negative rods (proteobacteria) that can colonize the mucus-secreting epithelial cells of the stomach. Exact cause is unknown. May be passed by saliva, fecal matter, and contaminated food / water. Treatment is **antibiotics** or bismuth salts in combination with **PPI’s**.

Question 27

The nurse recognizes that understanding Crohn's disease is very important in the education of the new graduate nurse who is working on the gastroenterology floor. When assessing for understanding the new graduate should state that Crohn's disease is defined as ______ and the characteristic features include \_\_\_\_\_\_.

Answer 27

Crohn's disease causes recurrent, **granulomatous type of inflammatory** response that can affect **_any_** area of the GI tract. The characteristic feature of this disease is the sharply demarcated, **granulomatous lesions surrounded by normal-appearing mucosal tissue.** Symptoms will depend on the lesion location. Most common symptoms include: diarrhea, abdominal pain, weight loss, fluid / electrolyte disorders, malaise, and low-grade fever which can be confused with other disorders. Symptoms specific to Crohn's disease include a client experiencing **tender red bumps on the shins,** ankles, and occasionally arms and the client may complain of pain or **stiffness in joints** related to arthritis or arthralgia.

Question 28

There is a cure for Crohn's disease. (True or False)

Answer 28

False

Question 29

The nurse would describe ulcerative colitis as the following to a group of nursing students?

Answer 29

Ulcerative colitis is a nonspecific inflammatory condition of the colon that leads to the **formation of pinpoint hemorrhages which in time develop into crypt abscesses.** These lesions may become **necrotic and ulcerate. _Limited_** to the mucosa and submucosa and is confined to the rectum and colon. Inflammatory process is **continuous** rather than skipping areas

Question 30

List common symptoms of ulcerative colitis.

Answer 30

Ulcerative colitis is a relapsing disorder with periods of diarrhea. Stool will frequently appear **with blood** and/or mucus. Other symptoms include: abdominal cramping, fecal incontinence, anorexia, weakness, dehydration, tachycardia, abdominal distention/tenderness, and fatigue.

Question 31

Irritable bowel disease (irritable bowel syndrome) is a functional GI disorder characterized by a variable combination of chronic and recurrent intestinal symptoms not explained by structural or biochemical abnormalities which affect the large intestine. The nurse understands that symptoms of this disorder will include?

Answer 31

Abdominal pain, bloating, abdominal distention, constipation, diarrhea, or alterations between periods of diarrhea and constipation. Frequent stools (**more than 3x a day**), stool can be hard, lumpy, loose, or watery. May strain, experience **urgency**, or feeling of **incomplete evacuation.**

Question 32

What would the nurse anticipate as symptoms and causes of malabsorption?

Answer 32

The nurse understands that causes of malabsorption include infection, medications, small intestine surgery, and disorders like celiac disease. Symptoms of malabsorption include diarrhea, flatulence, distension, abdominal pain, ascites, weakness, muscle wasting, weight loss**_, steatorrhea stools (fatty, bulky, yellow-gray, malodorous stools)_**, easy bruising, bleeding, vitamin K deficiency, vitamin deficiencies, bone pain, fractures, tetany, macrocytic anemia, and glossitis.

Question 33

A 22 year old male patient reports diarrhea with small amounts of blood and large amounts of mucus present. The episodes of diarrhea are intermittent and includes abdominal cramping with some incontinence of stool. What disease do you suspect?

Answer 33

Ulcerative colitis would be expected. When assessing this question you will notice that many of the symptoms are non-specific and could be associate with multiple GI disorders. The condition is noted as intermittent so it is relapsing which is a clue. Another clue is the blood and mucus in the stools which is characteristic of ulcerative colitis because remember that UC results in pinpoint hemorrhages which may ulcerate in time.

Question 34

Describe the disease process of cholelithiasis and cholecystitis as if you are describing it to a patient.

Answer 34

Cholelithiasis means that you have gallstones in your gallbladder. The gallbladder's job is to store and concentrate bile which is used to digest fats in the diet as the food moves through the small intestine. Cholecystitis means that your gallbladder is inflamed most often as a result of a gallstone blocking the tube that leads from the gallbladder to the small intestine. Gallstones are most often made of cholesterol that you intake in your diet.

Question 35

Explain what diet modifications the nurse would recommend to a patient with cholecystitis before and after surgery is completed.

Answer 35

The nurse should recommend a diet that is **low fat**, low cholesterol, and low triglyceride to a client dx with cholecystitis. After surgery many patients will want to eat high fat meals again. The nurse should advise that pain will occur after gallbladder removal when the patient eats high fat meals because the bile is needed to breakdown lipids (fats). Now that the gallbladder is removed bile which is normally concentrated and held in the gallbladder will drain more continuously and produce a laxative like effect when the client eat high fat meals. So the client will still have symptoms of pain, gas, and diarrhea post surgery with the ingestion of high fat meals.

Question 36

What is the normal level of total bilirubin for an adult client?

Answer 36

0.3 to 1.2 mg/dL this level may vary slightly depending on what ranges your lab utilizes. Remember that a high level of bilirubin would make the nurse anticipate the patient will have jaundice.

Question 37

Describe pancreatitis.

Answer 37

Pancreatitis is an inflammation of the pancreas. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. In acute pancreatitis the inflammation is brought on by premature activation of pancreatic enzymes and is reversible.

Question 38

List potential causes of pancreatitis.

Answer 38

Potential causes of pancreatitis include **gallstones**, **ETOH**, hyperlipidemia, infections, cystic fibrosis, diabetes, medications, abdominal trauma or surgery.

Question 39

The nurse is caring for a client with acute pancreatitis and knows that lab testing can be utilized as a part of the diagnosis of pancreatitis. What lab results would indicate acute pancreatitis?

Answer 39

**Elevated serum amylase and lipase three or more times the upper limit of normal**,

Question 40

The nurse anticipates what treatment plan to be ordered by the physician in acute pancreatitis?

Answer 40

Acute pancreatitis treatment includes IV fluids, nasogastric tube insertion, and NPO (nothing by mouth). The patient will also require pain relief and electrolyte replacement.

Question 41

It is appropriate to give a patient with symptoms of nausea, vomiting, diarrhea, fever, and jaundice who has a diagnosis of hepatitis A an antibiotic for treatment of their condition. (True or false).

Answer 41

False. Hepatitis A is a viral infection and therefore an antibiotic will not treat the infection.

Question 42

You know a patient with a recent diagnosis of hepatitis A understands their disease process when they say "I should have stopped using IV drugs and I would not have contracted this disease." (True or false)

Answer 42

False. Hepatitis A is contracted by the fecal oral route.

Question 43

Medications, toxins, alcohol, drugs, and the hepatitis viruses are all possible causes of hepatitis. TRUE False

Answer 43

True

Question 44

The nurse is explaining cirrhosis to a patient and states that this diagnosis best described as?

Answer 44

Cirrhosis is the end-stage of chronic liver disease, in which much of the functional liver tissue has been replaced by fibrous tissue. Common causes include alcohol, viral hepatitis, toxic reactions to drugs/chemicals, biliary obstruction, hemochromatosis, Wilson disease, and NAFLD (Nonalcoholic fatty liver disease).

Question 45

The nurse understands that portal hypertension is an elevated pressure in the portal venous system. The portal vein is a major vein that leads to the liver. Symptoms of portal hypertension the nurse should anticipate would include?

Answer 45

Symptoms of portal hypertension include GI bleeding with black, tarry stools or blood in the stools. Vomiting blood. Ascites and confusion. Remember portal hypertension is the result of many different disease processes so all symptoms of underlying cause may be present in these patients as well.

Question 46

What treatment would the nurse anticipate in a client dx with portal hypertension?

Answer 46

Treatment would include treating any underlying condition. Treat bleeding. Medications may include beta blockers (propranolol) and lactulose to reduce ammonia. A low sodium diet would be recommended. Surgical treatment would include transjugular intrahepatic portosystemic shunt, distal splenorenal shunt, liver transplant, and ascites fluid drainage (paracentesis).

Question 47

The nurse understands that liver failure is the most severe consequence of liver disease. This occurs either suddenly or gradually depending on cause. The nurse knows possible causes of liver failure include?

Answer 47

Causes include a reaction to a medication, **high doses of acetaminophen** or paracetamol, **hepatitis infection, alcohol abuse,** and advanced fatty liver. Sudden **fulminant hepatitis** which is a sudden damage to the liver such as with overdoses of medications like Tylenol.

Question 48

In a client diagnosed with liver failure the nurse would anticipate symptoms to include:

Answer 48

Sweet odor on breath, jaundice, RUQ pain, ascites, nausea, vomiting, malaise, confusion, sleepiness, deficiency in fat-soluble vitamins, fatty stools, gynecomastia, menstrual irregularities, spider angiomas, and tremors. **_Fulminant hepatitis_** - symptoms include elevated ammonia levels, **convulsions**, **confusion**, a **flapping tremor,** and **coma**.

Question 49

List potential complications of liver failure.

Answer 49

Potential complications of liver failure include liver cirrhosis, cancer of liver, liver failure, hepatic encephalopathy, portal hypertension, glomerulonephritis, and death.