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NRSE-3540 Adult Care 1 > Module 4 > Flashcards

Module 4 Flashcards

1
Q

what are the functions of the gi tract

A

secretion, digestion, absorption, motility, and elimination

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2
Q

Function of the oral cavity

A

mastication, secreting saliva and enzymes, swallowign

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3
Q

primary function of the esophagus

A

move food and fluids from the pharynx to the stomach

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4
Q

Upper esophageal sphincter function

A

UES opens and closes to prevent movement of air into the esophagus during respiration

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5
Q

what is the function of lower esophageal sphincter

A

prevent reflux of gastric acid

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6
Q

smooth muscles that line the stomach are responsible for

A

gastric motility

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7
Q

What is dysphagia?

A

difficulty swallowing

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8
Q

What is dyspepsia

A

heartburn (acid reflux)

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9
Q

Why should we ask our patients if they have experienced weight loss in our assessment of the gi system

A

some gi cancers can cause weight loss

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10
Q

What order do we perform an abdominal assessment

A

inspection, auscultation, light palpation

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11
Q

Questions to ask during GI history and assessment

A

last bowel movement, diet recall, pain w/eating, nauseated? diarrhea? constipation? vomiting? , dyspepsia, alcohol consumption, caffeine assumption

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12
Q

If appendicitis is suspected, do we perform palpation?

A

no

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13
Q

Do we auscultate or palpate any abdominal mass?

A

no ; this can be a life-threatening aneurysm

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14
Q

What order do we inspect the abdomen

A

RUQ, LUQ, LLQ, RLQ

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15
Q

areas of pain are assessed first or last during assessment?

A

last

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16
Q

If peristaltic waves are noticed in our patient, what can this indicate? What do we do?

A

may indicate intestinal obstruction. notify the provider

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17
Q

what do normal bowel sounds sound like

A

high-pitched, irregular gurgles

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18
Q

what does borborygmus sound like?

A

increased high-pitched sounds, very loud and gurgling noises

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19
Q

when is borborygmus usually noted

A

when pt is experiencing diarrhea, gastroenteritis, over a complete intestinal obstruction

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20
Q

When may bowel sounds be diminished or absent

A

after surgery, peritonitis, paralytic ileus

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21
Q

What order do we auscultate bowel sounds

A

RLQ, RUQ, LUQ, LLQ

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22
Q

During auscultation, if we hear a bruit (swooshing noise), this can indicate

A

presence of an aneurysm

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23
Q

If a bruit is heard during auscultation, what should we do?

A

notify provider immediately

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24
Q

Rigidity, felt during light palpation, may indicate

A

peritoneal inflammation

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25
Q

What are tympanic percussion sound s

A

high-pitched, musical sounds heard over air

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26
Q

What are dull percussion sounds

A

medium-pitched thud sounds heard over fluid

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27
Q

Why do we monitor CBC?

A

diagnosis of anemia, GI bleeding, and infection

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28
Q

What are AST and ALT

A

liver enzymes

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29
Q

Elevations in liver enzymes (AST and ALT) can indicate

A

liver disorder (hepatitis, cirrhosis)

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30
Q

normal range for ALT

A

4-36 units/L

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31
Q

normal range for AST

A

0-35 units/L

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32
Q

ammonia levels can be used to detect

A

liver function

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33
Q

an elevated ammonia level by indicate

A

hepatic dysfunction/injury (cirrhosis)

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34
Q

Normal range for ammonia

A

10-80 mg/dL

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35
Q

elevations in serum lipase and amylase may indicate

A

acute pancreatitis

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36
Q

range for normal amylase

A

60-120 somogyi units/dL

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37
Q

range for normal lipase

A

0-160 units/L

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38
Q

Elevation in bilirubin (total) may indicate

A

liver impairment

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39
Q

normal range for bilirubin

A

0.3-1.0 mg/dL

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40
Q

what are CA and CEA tests used to identify

A

cancer (reoccurrence, efficacy of cancer treatment, can also be elevated by benign tumors)

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41
Q

Normal range for CA (cancer antigen)

A

0-37 units/mL

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42
Q

Normal range for CEA (carcinoembryonic antigen range)

A

< 5 ng/mL

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43
Q

what is an FOBT

A

fecal occult blood test

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44
Q

what does the FOBT test for

A

presence of blood from hemorrhage/gi bleeds

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45
Q

Patient prep for FOBT

A

no NSAIDs 7 days prior, no red meat or vitamin C (more than 250 mg/day) for 3 days prior

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46
Q

what is a FIT test

A

fecal immunochemical test (may replace colonoscopy if they are low risk for cancer)

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47
Q

what does a FIT test screen for

A

looking at stool (look up the thing about the false positives and negatives)

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48
Q

Do drugs or food alter a FIT test

A

no, so patient adherence is higher

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49
Q

are FIT and FOBT tests taken at home

A

yes; however, false positives and false negatives are more likely

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50
Q

If a patient receives a positive FIT or FOBT, even if false, what must happen

A

a colonoscopy

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51
Q

To aid in diagnosis for parasitic infection, stool samples may be used to test for

A

ova and parasites

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52
Q

stool samples can also be used to test for this disease, which is a potentially dangerous superinfection caused by prolonged antibiotic use

A

clostridium difficile

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53
Q

X-rays of the abdomen can be used to look for

A

masses, tumors, obstructions, gas

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54
Q

what is an acute abd series

A

chest xray, supine abd film, upright abd film

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55
Q

what is an acute ABD series good to look for

A

hernias because they can be visualized as patient moves

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56
Q

what special considerations should we make for someone receiving a CT with contrast

A

stop metformin 48 h before to reduce AKI

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57
Q

Patient education for x-ray

A

no jewelry, belts, zippers, buttons, telemetry leads, medication patches

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58
Q

Patient prep for MRI

A

remove all metal (includes medication patches and ekg/telemetr leads)

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59
Q

patient education for MRI

A

MRI machine typically very loud, can cause you to feel claustrophobic

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60
Q

What is an endoscopy

A

direct visualization of gI tract using a flexible fiberoptic endoscope

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61
Q

An endoscopy evaluates for

A

ulcerations, bleeding ,inflammation, tumors, cancer

-looks at esophagus, stomach, biliary system, and bowel

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62
Q

During an endoscopy, biopsies may be taken to evaluate for

A

helicobacter pylori

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63
Q

What is an esophaogastroduodenoscopy (EGD)

A

visual examination of the esophagus, stomach, and duodenum using endoscope

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64
Q

if gi bleed is found during EGD, the prodder can

A

cauterize or clip the bleed

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65
Q

if EGD shows esophageal stricture (narrowing of esophageal opening), the provider can

A

dilate the esophagus

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66
Q

Patient prep for EGD

A

-avoidance of NSAIDs, anticoagulants, and aspirin for several days (to one week) before
-NPO 6-8 h before
-remove dentures
-client receives moderate sedation from propofol, midazolam, or fentanyl
-atropine to dry secretions
-local anesthetic inactivates gag reflex

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67
Q

After medications are given, positioning for EGD is

A

head of bed elevated, bite block inserted

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68
Q

Nursing interventions during EGD

A

monitor respiration, oxygen saturation

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69
Q

Post-op interventions for EGD

A

-monitor vs q 15-30 mins (side rails of the bed are raised until aesthetic wears off)
-NPO until gag reflex returns
-make sure someone is able to drive them home

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70
Q

Patient education for post-op interventions for EGD

A

-do not drive for 12-18 hours after procedure
-hoarse voice and sore throat can persist for several days

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71
Q

what is an endoscopic retrograde cholangiopancreatography (ERCP)?

A

a visual and radiographic examination of the liver, gallbladder, bile ducts, and pancreas to identify obstructions

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72
Q

What are different procedures that can be done during ERCP?

A

x-ray images with radiopaque dye, papillotomy to remove gall stones, stents inserted to fix biliary duct stricture, biopsy samples

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73
Q

Pre-op preparation for ERCP

A

-same as EGD
-obtain IV access
-medication reconciliation
-ask about implantable medical devices

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74
Q

Post- op interventions for ERCP

A

-assess VS q 15-30 min
-gag reflex check
-discontinue IV fluids
-colicky pain, flatulence can occur

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75
Q

Post-op education for ERCP

A

-do not drive 12-18 hours
-report abdominal pain, fever, nausea, vomiting that fails to resolve

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76
Q

an abdominal ultrasound is used to evaluate

A

liver, spleen, pancreas, biliary system

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77
Q

patient prep for abdominal ultrasound

A

-may have to be NPO
-supine position
-explain patient will have to lie still

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78
Q

what is an endoscopic ultrasonography

A

ultrasound with endoscope to look at lymph nodes and mucosal tumors

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79
Q

Patient prep and follow-up care for endoscopic ultrasound

A

same as endoscopy

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80
Q

In older adults, does peristalsis decrease or increase

A

decrease

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81
Q

Decreased peristalsis in the older adult can lead to

A

decreased sensation to defecate -> constipation and impaction

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82
Q

Because of the distention and dilation of pancreatic ducts , older adults are more likely to have

A

decreased lipase levels –> steatorrhea

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83
Q

Because older adults have decreased hydrochloric acidlevels, they are at risk of

A

decreased absorption of iron and vitamin B12, and increased bacteria

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84
Q

Decreased liver enzyme activity in the older adult leads to

A

accumulation of drugs –> toxicity

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85
Q

What is GERD

A

gastroesophageal reflux disease

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86
Q

What happens to the body during GERD

A

backward flow of stomach contents into the esophagus, known as regurgitation

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87
Q

What puts someone at risk for GERD

A

overweight, pregnancy, helicobacter pylori infection

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88
Q

GERD can be caused by relaxation of the

A

lower esophageal sphincter

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89
Q

What can cause the lower esophageal sphincter to relax

A

caffeine, tea, cola, chocolate, nitrates, citrus fruits, tomatoes, alcohol, smoking, peppermint/spearmint, smoking, calcium channel blockers, anticholinergics, high estrogen, high progesterone, nasogastric tube placement

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90
Q

what do patients report regurgitation tastes like

A

sour and bitter

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91
Q

Symptoms of GERD

A

dyspepsia, regurgitation, water brash, dental caries, dysphagia, globus, odynophagia, pyrosis, belching

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92
Q

What are dysphagia, globus, odynophagia

A

trouble swallowing, feeling something in back of throat, painful swallowing

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93
Q

Symptoms of GERD typically worsen when

A

patient bends over, strains, or lies down. Pain may radiate to chest, neck, jaw, and back

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94
Q

During the process of healing, the body may substitute normal epithelium with

A

squamous cell epithelium (known as Barrett’s esophagus)

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95
Q

Barrett’s esophagus:

A

more resistant to acid but is precancerous

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96
Q

During the healing process and Barrett’s esophagus ______ can occur, which leads to difficulty swallowing

A

esophageal stricture

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97
Q

How is GERD diagnosed

A

symptoms, EGD, pH monitoring esophageal manometry

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98
Q

what is pH monitoring in GERD

A

transnasal catheter placed in esophagus mucosa, monitors pH changes for 24-48 hours

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99
Q

Treatment for GERD consists of

A

changes in diet and lifestyle, drug therapy

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100
Q

Patient education for GERD

A

-eliminate foods that affect LES
-encourage small, frequent meals
-avoid eating 3 hours before bed
-sleep propped up
-avoid alcohol and tobacco
-avoid heavy lifting, straining, bending
-avoid restrictive clothing

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101
Q

Drugs used to treat GERD

A

PPIs (-zole), antacids, H2 blockers (-dine)

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102
Q

What drugs can increase risk for GERD by lowering LES

A

NSAIDs, oral contraceptives, anticholinergics, sedatives, CCBs

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103
Q

PPIs such as esomeprazole and pantoprazole can be given IV to prevent

A

prevent stress ulcers

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104
Q

Surgical management for GERD includes

A

laparoscopic Nissen fundoplication (LNF)

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105
Q

What is a hiatal hernia?

A

protrusion of the stomach (in part of total) above the diaphragm into the thoracic cavity through the hiatus.

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106
Q

What are the two types of hiatal hernias?

A

sliding and paraesophageal

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107
Q

What is a sliding hiatal hernia?

A

portion of stomach and gastroesophageal junction move above the diaphragm.

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108
Q

When do sliding hiatal hernias occur?

A

usually when patient is in supine position or with increased intra-abdominal pressure

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109
Q

What is a paraesophageal (rolling) hiatal hernia?

A

when part of the fundus of stomach moves above diaphragm, but the gastroesophageal junction remains below the diaphragm.

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110
Q

symptoms and assessment findings of a sliding hiatal hernia?

A

Heartburn, reflux, chest pain, dysphagia, belching.

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111
Q

symptoms and assessment findings of a paraesophageal hiatal hernia?

A

fullness after eating, sense of suffocation, chest pain, worsening of manifestations when reclining.

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112
Q

Assessment findings of hiatal hernia?

A

FOR BOTH MAYBE
pharyngitis, insrpiatory and expiratory wheeze

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113
Q

Diagnostics for hiatal hernia?

A

barium swallow with fluroscopy
EGD
Ct of chest with contrast

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114
Q

What does the barium swallow with fluroscopy do?

A

Allows visualization of the esophagus

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115
Q

Nursing actions for a barium swallow

A

instruct client to use cathartics to evacuate the barium from the gi tract following the procedure

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116
Q

What happens if a client does not eliminate the barium?

A

places them at risk for fecal impaction.

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117
Q

What does a egd do?

A

allows visualization of the esophagus and gastric lining

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118
Q

nursing actions after a egd

A

verify gag response has returned prior to providing oral fluids or food following the procedure

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119
Q

Ct of chest with contrast does what?

A

allows visualization of the esophagus and stomach

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120
Q

Nursing actions for ct of chest with contrast

A

pre: assess for iodine allergy for iv contrast
Post: encourage fluids to promote dye exretion and minimize risk of remal injury
MONITOR BUN/ CREATININE

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121
Q

Treatment for hiatal hernia?

A

Medications
fundoplication
Laproscopic nissen fundoplication

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122
Q

nuring education for hiatal hernia?

A
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123
Q

medications for hiatal hernia?

A

PPI, Antacids

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124
Q

What are the proton pump inhibitors?

A

end in azole

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125
Q

What do ppi do?

A

reduce gastric secretion by inhiiting the cellular pump of the gastric parietal cells necessary for gastric acid secretion

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126
Q

nursing actions for PPI

A

monitor for electrolyte imbalances, and hypoglycemia for clients that have DM

Long term use can result in c.diff, and cap

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127
Q

Client education for PPI

A

long term use increases risk of fractures, especially in older adults

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128
Q

What are the antacids?

A

aluminum hydroxide, magnesium hydroxide, calcium carbonate, and sodium bicarbonate

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129
Q

How do antacids work?

A

neutralize excess acid and increase LES pressure

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130
Q

Nursing actions for antacids

A

ensure no contraindications with other medications (levothyroxine).
Monitor kidney function for clients taking magnesium hyroxide

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131
Q

Client education for antacids

A

Take when acid secretion is the highest (1-3 hr after eating) and at bed time. Separate from other medications by 1 hour minimum.

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132
Q

Nutrition education for clients with hiatal hernia?

A

avoid eating immediately prior before bed, maintain healthy weight, exercise regularly, elevate bed.

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133
Q

What food should patients avoid eating to prevent hiatal hernias?

A

fatty foods, caffi.ene, fried foods, chocolate, peppermint, spicy foods, tomatoes, citrus fruits and alcohol

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134
Q

What should patients avoid doing to prevent hiatal hernias?

A

straining, or vigorous exercise. Avoid tight clothing around abdomen.

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135
Q

what does a fundoplication do?

A

reinforces the LES by wrapping a portion of the fundus of stomach around the distal esophagus.

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136
Q

Laproscopic Nissen Fundoplication

A

minimally invasive

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137
Q

LNF nursing actions

A

elevate hob to promote lung expansion
Instruct client to support incision during movement and coughing to minimize strain on suture lines

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138
Q

Client education for LNF

A

Consume a soft diet for the first week postop.
Avoid carbonated beverages, ambulate early but avoid heavy lifting.

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139
Q

Complications of LNF

A

Temporary dysphagia, gas bloat syndrome(difficulty burping and distention)
atelectasis and pneumonia

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140
Q

Complications from hiatal hernias?

A

Volvulus, obstructions, strangulation, iron deficiency anemia.

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141
Q

What is a volvulus?

A

twisting of the esophagus and or stomach

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142
Q

Obstruction (paraesophageal hernia)

A

blockage of food in the herniated portion of the stomach

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143
Q

Strangulation (paraesophageal hernia)

A

Compression of the blood vessels to the herniated portion of the stomach.

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144
Q

Iron deficiency anemia (paraesophageal hernia)

A

resulting from bleeding into the gastric mucosa due to obstruction

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145
Q

Safety considerations of hiatal hernia?

A
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146
Q

What is the primary concern for sliding hernias?

A

esophageal reflux, and associated complication. (1140)

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147
Q

Esophageal tumors are usually

A

epithelial tissue.

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148
Q

Where are squamous cell carcinomas located in the esophagus?

A

upper 2/3

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149
Q

What is the most common esophageal cancer?

A

Adenocarcinomas

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150
Q

Where are adenocarcinomas located in esophagus?

A

distal end of the esophagus and upper portion of the stomach.

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151
Q

Risk factors for esophageal tumors?

A

alcohol, diets chronically deficient in fruits and veggies, diets high in nitrites (pickled and fermented foods), obeseity, malnutrition smoking, g.e.r.d

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152
Q

Symptoms of esophageal tumors

A

dysphagia, weight loss, feeling of food stuck in their throat, hoarseness, changes in bowel habits, Odynophagia

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153
Q

When signs are present for esophageal tumors (usually cancerous) what does this mean?

A

signs usually only start when the cancer has spread.

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154
Q

What are esophageal tumors referred as?

A

silent tumors because they will not have symptoms until it is too late.

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155
Q

Assessment for esophageal tumors?

A

lack of pleasure in eating, anxiety,.

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156
Q

What diagnostics are used for esophageal tumors?

A

EGD, PET, ct scan,

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157
Q

Treatment for esophageal tumors

A

nutrition and swallowing therapy
Chemo and radiation.

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158
Q

surgical management of esophageal tumors

A

Esophagectomy

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159
Q

Pre procedure for esophagectomy

A

stop smoking 2-4 weeks prior
nutritional and pulmonary strengthening.

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160
Q

post esophagectomy

A

Stay in semi-fowlers position or high fowlers to support ventilation and prevent reflux.
Ensure patency of chest tube drainage system and monitor for changes in volume or color of the drainage. Placement of NG tube

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161
Q

What is the highest priority for esophagectomy?

A

respiratory care. Traditional surgery means they need ventilation and intubation fr first 16-24 hours.

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162
Q

What are complications of being intubated for esophagectomy?

A

atelectasis, and pneumonia.
after extubation, deep breathing, coughing, turning q1-2 hr.
Assess breath sounds and sob q1-2h
Provide inscional support and analgesics to enhance effective coughing.

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163
Q

Nursing interventions for esophagectomy

A

-monitor ng tube for patency.
Secure ng tube to prevent dislodgement to prevent disturbance at incision anastomosis.
-nutrition
-wound care ( prevent dehiscence)

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164
Q

Why are ng tubes placed after esophagectomy?

A

decompress stomach to prevent tension on suture line.

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165
Q

when do we resume initial feedings with J tube ?

A

second day post op.

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166
Q

Do we aspirate for residual in J tube?

A

NO, this will increase risk for mucosal tearing.

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167
Q

How are feedings introduced?

A

slowly until the fifth post op day?

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168
Q

What day of post op do we do a barium swallow to assess for anastomotic leaks?

A

7th.

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169
Q

When can we discontinue the ng tube?

A

if no anastomotic leaks are seen.

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170
Q

How long are patients on a liquid diet after surgery with no complications?

A

2 weeks.

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171
Q

NG tube nursing interventions after esophagectomy

A

check placement 48 hrs.
ensure patent and drainage correct color
provide meticulous oral care and nasal hygiene q2-4 hr
do not irrigate or reposition tube
Observe for leak at anastomosis site

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172
Q

What color should the drainage of the ng tube be by the end of the first post-op day?

A

YELLOWISH GREEN
will be bloody after insertion

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173
Q

What are signs and symptoms of an anastomosis leak?

A

fever, fluid accumulation, tachycardia, tachypnea, ams

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174
Q

Patient education for post-surgical esophagectomy

A

dysphagia and odynophagia may recur because of stricture, reflux, or cancer recurrence.
High protein, soft meals.
Sit up right after eating, and remain up right
Monitor weight.

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175
Q

When should patients report a weight loss to the provider?

A

if they have a 5lb weight loss or more in one month

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176
Q

What is gastritis?

A

Inflammation of gastric mucosa (stomach lining).

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177
Q

Do mucosal changes heal after several months with acute gastritis

A

Yes but not with chronic.

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178
Q

Acute gastritis

A

exposure to local irritants or other causes.

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179
Q

what is a high risk factor for acute gastritis

A

long term use of NSAIDS
alcohol, caffiene, coffee.

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180
Q

chronic gastritis appears how

A

patchy, spread out inflammation of the mucosal lining in stomach.

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181
Q

As chronic gastritis progresses what happens to the lining in the stomach?

A

thins, and atrophy occurs

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182
Q

with progressive gastric atrophy…

A

acid-secreting function decreases and the source of the intrinsic factor is lost.

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183
Q

What is an intrinsic factor?

A

critical for the absorption of vitamin b12. When there is a decrease of this vitamin, pernicious anemia may result.

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184
Q

what is the most common form of chronic gastritis?

A

h.pylori

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185
Q

Nutrition for gastritis

A

avoid alcohol

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186
Q

symptoms of acute gastritis

A

rapid onset of epigastric pain and dyspepsia. Hematemesis melena, nv, gastric hemorrhaging can occur

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187
Q

is gastric hemorrhage an emergency?

A

yes

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188
Q

what is dyspepsia

A

epigastric burning sensation.

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189
Q

Chronic gastritis symptoms

A

n/v upper abdominal discomfort. Periodic epigastric pain may occur after meals and anorexia.

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190
Q

with chronic gastritis has few symptoms except when?

A

ulceration occurs.

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191
Q

Acute gastritis nursing interventions

A

blood transfusion and fluid replacement. surgery

192
Q

partial gastroectomy, pyloroplasty and or vagotomy may be needed when?

A

patients with major bleeding or ulceration.

193
Q

chronic gastritis nursing interventions and treatment

A

elimination of the causative factor, tx of underlying disease, and avoidance of toxic substances
b-12 injections

194
Q

Medications for gastritis

A

ppi, h2 receptor antagonist (famotidine), sucralfate (mucosal barrier fortifier), antacids,

195
Q

Peptic ulcer disease

A

results when GI mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsid

196
Q

What causes most ulcers?

A

h.pylori (oral-oral)

197
Q

3 types of ulcers

A

duodenal, gastric, and stress

198
Q

Where are duodenal ulcers located?

A

upper portion of the duodenum. They are deep, sharply demarcated lesions that penetrate through the mucosa and submucosa–muscle layer).

199
Q

What is a main feature of a duodenal ulcer?

A

high gastric secretion.
patients with these ulcers have low ph levels (excess acid) in the duodenum for long periods.

200
Q

gastric ulcers develop where?

A

antrum of stomach near acid-secreting mucosa.

patients can have delayed gastric emptying.

201
Q

stress ulcers occur when

A

after trauma or an acute medial crisis like sepsis or a head trauma. Patients who are npo can often get them.

202
Q

stress ulcers cause

A

prolonged stay in hospital and increased mortality rates.

203
Q

Manifestations of stress ulcer

A

bleeding. MASSIVE HEMORRHAGE

204
Q

Complications of PUD

A

hemorrhage, perforation, pyloric obstruction, intractable disease.

205
Q

hemorrhage most often occurs in which type of ulcers?

A

stress and gastric.

206
Q

signs and symptoms of PUD

A

dyspepsia, epigastric pain and tenderness, at midline between the umbilicus and xiphoid process.

207
Q

what will we see if a patient has perforation into the peritoneal cavity?

A

rigid, boardlike abdomen accompanies by rebound tenderness and intense pain.
Initial auscultation of bowel sounds could be hyperactive but will diminish with prolonged infection.

208
Q

how to test for h.pylori?

A

stool, blood, breath

209
Q

diagnostic for pud

A

EGD,, rapid urease test,

210
Q

How do we check for gi bleeding?

A

nuclear medicine scan: injected with contrast media then scanned for bleeding after waiting period. Scan 1-2 days after to check if interventions were effective.

211
Q

Treatment for PUD

A

drug therapy, nutritional therapy, procedures, surgical management

212
Q

drug therapy for PUD

A

ppi based triple therapy. PPI plus 2 abx for 10-14 days.
Bismoth subsalicylate

213
Q

Bismuth subsalitcylate teaching

A

inhibits h-pylori from binding to mucosal lining and stimulates mucosal protection.

NO ASPIRIN.
This medication can cause stool or tongue to be discolored black, this is temp and harmless.

214
Q

nursing interventions of PUD

A

management of bleeding, perforation and gastric outlet obstruction

Fluid and electrolyte balance.
prevent hypovolemia: LR, NS, Isotonic fluids. Ng tube placement

215
Q

gastric cancer

A

most common type is adenocarcinoma

216
Q

symptoms of gastric cancer early

A

chronic dyspepsia
abdominal discomfort, initally relieved with antacids
feeling of fullness
epigastric back, or retrosternal pain

217
Q

symptoms of gastric cancer advanced

A

n/v
iron deficiency anemia
palpable epigastric mass
enlarged lymph nodes
weakness/fatigue
progressive weight loss

218
Q

interventions for gastric cancer

A

chemo and radiation, drug therapy, and surgery.

219
Q

drug therapy for gastric cancer

A

oxaliplatin, fluoruracil, cisplatin, epirubicin. before and after surgery.

220
Q

common adverse effects of drug therapy for gastric cancer

A

bone marrow suppression, nausea, vomiting,

221
Q

Gastrectomy

A

total or partial.

222
Q

pre, post procedure

A

pre: ng tube for suctioning of secretions,

223
Q

patient teaching regarding gastric cancer

A
224
Q

complications of gastrectomy

A

delayed gastric emptying:

225
Q

is delayed gastric emptying temporarily resulting from edema at the anastomosis site

A

yes, resolves within one week with ng suction, fluid/ electrolyte balance.

226
Q
A
227
Q
A
228
Q
A
229
Q

What is dumping syndrome?

A

a group of vasomotor symptoms that occur in a patient who eats after gastroectomy.

230
Q

early signs of dumping syndrome

A

occurs within 20 minutes of eating, vertigo, tachycardia, syncope, sweating, pallor/ash gray skin, palpitations, desire to lay down.

231
Q

late dumping syndrome symptoms

A

1-3 hours after eating, caused by a release of excessive insulin.. Follows by an increase in blood sugar. Dizziness, light-headedness, palpitations, confusion, diaphoresis

232
Q

nutrition education for dumping syndrome

A

eliminate liquids at meal times,
decrease the amount of food at mealtime
high protein, low-moderate carb

233
Q

drug therapy for dumping syndrome

A

acarbose, somatostain analog.

234
Q

what does Acarbose do for dumping syndrome?

A

decrease carb absorption

235
Q

What do somatostain analogs do for treatment for dumping syndrome?

A

decreases gastric and intestinal hormone secretion and slows stomach and intestinal transit time
can be prescribed in severe cases.

236
Q

Delayed gastric emptying goes away how long after gastric surgery?

A

1 week

237
Q

what can cause mechanical blockages?

A

edema at anastomosis and adhesions(obstructions) in the distal loop.

238
Q

What are the metabolic causes?

A

hypokalemia, hypoproteinemia, or hyponatremia.

239
Q

how does edema at the anastomosis resolve?

A

ng suctioning, maintenance of fluid and electrolyte balance, and proper nutrition.

240
Q

Intrinsic factor can cause a decrease in which vitamins and minerals?

A

b12, folic acid, iroin, calcium and vitamin d absorption, impaired calcium metabolism.

241
Q

How do deficiencies from intrinsic factor occur?

A

resection and inadequate absorption because of food rapidly entering the bowel.

242
Q

What happens with Atrophic glossitis

A

occurs from a vitamin b12 deficiency, causing the tongue to have a shiny, smooth, and beefy appearance.

243
Q

why do we need to monitor cbc in patients with dumping syndrome?

A

monitor cbcmegloblastic anemia (low rbc and leukopenia)

244
Q

How do we fix low rbc and leukopenia in patients with dumping syndrome?

A

admin b12

245
Q

Patients can develop anemia in dumping syndrome so what can be given to fix this?

A

folic acid, or iron.

246
Q

What are symptoms of incisional infection?

A

fever, redness, hyperpigmentation, and drainage).

247
Q

nursing intervention for gastric cancer and gastroectomy

A

assess ability to cope with disease and possible need for end of life care
symptom management
enlisting family resources and health care resources.
monitor for incisional site infection.

248
Q

patient education for preventing dumping syndrome (caused by gastrectomy)

A

eat small frequent meals
avoid drinking liquids with meals
avoid foods that cause discomfort
eliminate caffeine and alcohol
smoke cessation
b12 injections
lie flat for a short amount of time after eating.

249
Q

gastrectomy interventions

A

pre: ng placed with suction to remove secretions,

250
Q

what is a mechanical obstruction

A

bowel physically blocked by problems outside of the intestine. (adhesions) in the bowel wall (chrons) or intestinal lumen (tumors).

251
Q

What is a nonmechanical obstruction?

A

paralyetic illeus, or functional obstruction does not involve a physical obstruction in or outside the intestine. INSTEAD
peristalysis is decreased or absent. Resulting in slowing of the movement or a backup of intestinal contents.

252
Q

what is ibs?

A

functional gi disorder that causes chronic or recurrent diarrhea, constipation, and or abdominal pain and bloating.

253
Q

Different types if ibs?

A

ibs-d: diarrhea
ibs-c: constipation
or mixed

254
Q

Medications are different between ibs-d and ibs-c. Do we give laxatives to patients with ibs-d?

A

no

255
Q

symptoms of ibs

A

malaise, fatigue, and changes in bowel patterns, the patient will not lose weight so they will appear well
lower left quadrant of the abdomen intensity and pain.
organ hypersensitivity and nausea.

256
Q

Big assessment finding in ibs?

A

mucus in stool

257
Q

Nursing intervention for ibs

A

health teaching, drug therapy, stress reduction

258
Q

treatment for ibs

A

stress management, diet, medications

259
Q

ibs dx

A

hydrogen breath test.
lab work should still be normal(cbc, fobt, ERS alumin)

260
Q

Hydrogen breath test

A

environment influence gut bacteria

lots of bacteria will produce a lot of hydrogen.
pre: npo 12h
give small amounts of sugar, take samples over the course of hours.

261
Q

drug therapy for ibs

A

Ibs d: loperamide (can cause drowsiness), psyllium (rectal bleeding and vomiting.. monitor electrolyte imbalances) alosetron (use caution in females and only as a last resort)

IBS C: lubiprostone, linaclotide

262
Q

Linaclotide does what?

A

tx for ibs-c, by stimulating guanylate cyclase receptors in intestines to increase fluid and promote bowel transit times.
also relieves pain and cramping with ibs.

patients:take once a day 30 minutes before breakfast.

263
Q

who can take lubiprostone?

A

women with ibs-c

264
Q

amitriptyline(tricyclic antidepressant) treat what in ibs?

A

pain after eating

265
Q

Alosetron is a ss receptor antagonist can be used?

A

cautiously in women with ibs-d as a last resort if they do not respond to loperamide, and psyllium.

266
Q

what do patients taking alosetron need to report?

A

agree to report sx of colitis or constipation early because this could be a life-threatening bowel complication including ischemic colitis.

267
Q

nutrition for ibs

A

probiotics, fiber, increase water, pepprmint oil capsules can reduce sx in patients with ibs.

268
Q

patient education for ibs

A

consume 30-40mg of fiber a day
eat regular meals
drink 8-10 glasses of water
chew food slow
relaxation techniques, meditation.

269
Q

What is a herniation?

A

weakness in abdomial wall through which a segment of the bowel or other abdominal structure protrudes.

270
Q

can hernias also penetrate through other areas of the abdominal wall?

A

yes,

271
Q

types of hernias

A

indirect inguinal hernia
direct inguinal hernia
femoral hernia
umbilic hernia
incisional or ventral hernia

272
Q

what is an indirect inguinal hernia?

A

Hernia of intestines through the opening of the inguinal cancal

273
Q

What happens when males have indirect inguinal hernia?

A

can become large and often descend into the scrotum

274
Q

What is direct inguinal hernia

A

pass through a weak point in the abdominal wall

275
Q

Femoral hernias

A

protrude through the femoral ring. A plug of fat in the femoral canal enlarges and eventually pulls the peritoneum and often the urinary bladder into the sac.

276
Q

umbilical hernias

A

congenital or acquired. Congenital appear in infancy. Acquired directly result from increased intraabdominal pressure. Most common in obeseity

277
Q

Incisional hernia

A

occur at site of a previous surgical incision. Those hernias result from inadequate healing of the incision. (most often from postop wound infection, inadequate nutrition and obesity.

278
Q

Symptoms of hernias

A

patients report lump or protrusion at involved site. (straining or lifting).
assessment of abdomen laying and standing. If it is reducible it may disappear when patient is laying flat.

279
Q

Strangulated hernia

A

comes through the bowels and twists

279
Q

irreducible hernia

A

(incarcerated) no matter the position, hernia is still there

279
Q

reducible hernia

A

bowel contents can slip back into normal spot

280
Q

A provider may have them strain or preform the valsalva maneuver to observe for

A

bulging.

281
Q

what do absent bowel sounds indicate?

A

obstruction and strangulation which are medical emergencies.

282
Q

What is a truss?

A

a pad made from firm material that is held in place over a hernia to help keep the abdominal contents from protruding into the herinal sac.

283
Q

Patient education for a truss

A

assess skin under the truss and apply when waking up in the morning. Protect skin under truss with powder

284
Q

Herrniorrphay pre-op

A

npo,

285
Q

post op hernia repair

A

avoid coughing, but promote lung expansion by deep breathing, and ambulation
scrotal support and ice bags to prevent swelling. (men)
elevate scrotum with a soft pillow.

286
Q

men who have gone under an inguinal hernia repair may have

A

issues voiding, during postop period.
need to stand for a more natural position, allowing gravity to help
urine output less than 30 should be reported.
fluids 1500-2000ml a day (maintain urinary function and prevent constipation and dehydration).

287
Q

what should patients be educated on at discharge?

A

symptoms to report: fever, chills, wound drainage, redness/hyperpigmentation
separation of incision, increased pain in the incision.
keep the wound dry, and clean. Showers are permitted within a few days.

288
Q

strangulation sx

A

abdominald distention n/v pain, tachycardia, fever

289
Q

What happens when colorectal cancers expand?

A

they can perforrate a bowel

290
Q

Most common areas for metasticies to spread?

A

liver, lung, brain and bone

291
Q

What is seeding?

A

when we open the patient to remove a tumor. Surgeons will cut above and below the cancer site. When this happens, some cancer cells will displace from the portion of the bowel and enters the abdominal cavity.

292
Q

CRC risk factors?

A

> 50, genetics, family history, FAP, chrones, ulcerative colitis, smoking, obeseity, inactivity, and alcohol

293
Q

What is FAP

A

Familia adenomas polyps. It is a genetic condition where a lot of polyps will form and are almost always malignant.

294
Q

Patients who have FAP will need surgical interventions when?

A

before the age of 20.

295
Q

Signs and symptoms of CRC

A

change in bowel habits, rectal bleeding, anemia, fatigue, abdominal fullness, pain, unintentional weight loss.

296
Q

Right sided RCR signs and symptoms

A

May not have symptoms until they have weight loss that triggers them going to the doctor.

297
Q

Transverse CRC symptoms

A

dark red blood mixed in stool, feel like they are going to the bathroom more frequently and abdominal pain

298
Q

Rectosigmoid CRC symptoms

A

Bright red blood with stool, narrowing of stool, change in shape, feel like struggling to pass stool.

299
Q

Screening tools for CRC

A

colonoscopy, fobt, sigmoidoscopy.

300
Q

What lab will be elevated in patients with cancer?

A

CEA

301
Q

Colonoscopy pre, and post-procedure

A

Pre: bowel prep, mightnight npo, avoid red, orange, and purple dye, and will have moderate sedation.

Post: ensure gag reflux returns, vitals, assess bowels and abdomen, and assess for fever.

302
Q

Treatment and medications for CRC

A

chemo and radiation. Pain management.

303
Q

Intestinal obstructions (mechanical)

A

something outside of intestine , scar tissue(adhesions), tumor, intesicion (bowel folds in on itself), swelling, edema, hernia and volvulus.

304
Q

Nonmechanical obstructions happen because there

A

is a decreased or absent peristalsis of the bowel.

305
Q

When do non-mechanical obstructions occur?

A

happens with gastro surgery because the bowel does not like to be touched. There is always a risk for paraltyic ileus.

306
Q

How long does a paralytic ileus last?

A

function may be lost for a few hours to a few days. This can happen for longer.

307
Q

What can cause paralytic ileus?

A

Anasthesia

308
Q

What is important to do post op from gastro surgery?

A

assess bowel sounds

309
Q

What will bowel sounds sound like after gastro surgery?

A

hypoactive at first and they should return to normal within a few hours.

310
Q

What type of obstructions are more common?

A

small bowel obstructions

311
Q

Small bowel obstruction signs and symptoms

A

mid abdominal pain, cramping, peristaltic wave, distention higher up, upper gastric pain, n,v

312
Q

What contents are in the emesis with patients that have small bowel obstructions?

A

Bile, mucus, orange or brown in color, with foul odor. They will have perfuse vomiting for prolonged times.

313
Q

Partial obstruction signs and symptoms

A

early diarrhea at first because bowel is not completely closed so bowels will increase secretion trying to move the blockage out.

314
Q

Complete bowel obstruction

A

no stool or gas

315
Q

Large bowel obstruction symptoms

A

Intermediate lower abdominal cramping. Mild distention in lower abdomen, little to no vomiting and no major fluid or electrolyte imbalances.

316
Q

Partial obstruction stool will look?

A

ribbon like

317
Q

What is a major complication from small bowel obstructions?

A

fluid and electrolyte imbalances.

318
Q

What are the symptoms of hypovolemia?

A

tachycardia and hypotension.
These symptoms can be mild or severe, which can lead to hypovolemic shock.

319
Q

Acid-base imbalances for Bowel obstructions

A

These are related to fluid.
High obstruction: loss of gastric hydrochloric acid can lead to METBOLIC ALKOLOSIS

320
Q

Obstruction at the end of the small intestine…

A

alkaline fluids are effects so we have metabolic acidosis.

321
Q

How does sepsis occur with intestinal obstructions?

A

gut has normal flora. When we have a blockage, food will accumulate at or above the obstruction. When this happens, bacteria will feed on the content.

Abdomen swells and can perf the bowel leading to peritonitis—-sepsis.

322
Q

What is venous compression?

A

ischemia, no blood flow, and bowel will die. Necrotic bowel and can lead to sepsis.

323
Q

Types of ostomies

A

right sided: ascending
Transverse: emergent bowel, double barrel
Left side: descending
Rectal: sigmoid

324
Q

Stoma care

A

Snug but not touching the stomach
thorough skin assessment
red and moist
minimal amount of blood
swelling: measure weekly for 6-8 weeks
Function of ostomy in 2-3 days
Empty 1/3-1/2
stool will be liquid then be more formed
s/s of infection

325
Q

Exploratory laparotomy

A

pre: npo, abx in holding. Right labs, pt teach

Post: ambulate, bowel sounds,

326
Q

If a patient as an open exploratory lap will they have ng tube?

A

yes

327
Q

what is appendicitis?

A

inflammation of the appendix
-happens when the opening gets blocked. (hard fecal matter)

328
Q

Symptoms for Appendicitis

A

main symptom, lower right abdominal pain that radiates towards the belly button. This pain is sudden and intense followed by n,v

329
Q

It is important to ask which symptom occurred first with appendicitis why?

A

because there is another condition that is similar but sx appear opposite

330
Q

Risk factors for appendicitis?

A
331
Q

Assessment findings for appendicitis

A

-thorough pain assessment (assess abdomen and flanks)
-assess McBurney point (pain in RLA between the anterior iliac crest and the umbilicus)
-provider assess for muscle rigidity and guarding

332
Q

What assessment findings would indicate appendicitis has turned into perforation or peritonitis

A

abdominal pain that increases with cough or movement and is relieved by bending the right hip or the knees

333
Q

labs and procedures for Appendicitis

A

-elevation of WBC count
-Ultrasound may show enlarged appendix
-CT scan can diagnose fecaloma

334
Q

Treatment for appendicits

A

Appendectomy
-laparoscopy : home same day
-laparotomy (open): hospital 3-5 days, restriction on activity for 4-6 weeks

335
Q

Nursing care for appendicitis

A

-keep patient NPO upon arrival incase emergency surgery is needed
-help patient out of bed evening of surgery
-if patient has peritonitis or abscesses wound drains and NG tube monitoring

336
Q

Medication for appendicitis and patient education

A

-opioids
-IV antibiotics for peritonitis

337
Q

Nutrition education for appendicitis

A

none

338
Q

Safety considerations for appendicitis

A

-appendicitis can become peritonitis
-peritonitis complications include gangrene, sepsis, and perforation

339
Q

What are the contraindications with appendicitis?

A

No enemas or laxatives: can cause the appendix to rupture because of increased peristalsis of the bowel

no heating pads: increased blood flow can perf it

340
Q

What is peritonitis?

A

Inflammation of the peritoneum from infection of peritoneum from punctures, traumas, and etc

341
Q

What are examples of complications that can happen that can lead to periotonitis?

A

diverticulitis, PUD, appendicitis, bowel obstruction, or infection from continuous ambulatory peritoneal dialysis

342
Q

risk factors of peritonitis?

A

any type of infection in the gastrointestinal system or any punctures that may occur.

343
Q

Assessment findings and symptoms of peritonitis

A

rigid, board-like abdomen (hallmark symptom) n/v, rebound tenderness, tachy, fever
Older adult: decreased mental status, and confusion

344
Q

surgical treatment for peritonitis and interventions

A

exploratory laparotomy: open,
Surgery may be done if super severe
Nursing actions for surgery
-monitor post-op vital signs
-monitor i/o every q1h immediately after surgery
-monitor surgical dressing for bleeding
-if they need wound irrigation, keep a sterile technique and monitor irrigation input and output to prevent fluid retention.

345
Q

After surgery, patients have many jp drains because?

A

we have irrigated solution into the patient so they have an increased fluid volume

346
Q

Labs for peritonitis

A

increased wbc
BNP
Potassium, sodium,
bun and creatinin: hydration status: increased
h/h: increased
3rd spacing: hypovolemia,
tachy, hypotension, fever, decreased urinary output: shock

347
Q

Nonsurgical treatment for peritonitis

A

vital signs, hypotension, tachy’s, fever, LOC, broad spectrum abx, respiratory status.

348
Q

Diagnostics

A

abdominal x-ray, and ultrasound

349
Q

Nursing care for peritonitis

A

Client in fowlers or semi-fowlers to promote drainage of peritoneal fluid and improve lung expansion

monitor fluid and electrolyte imbalances.
keep client npo
maintain and monitor ng suction
collaborate with case management and wound care for management needs

350
Q

Patient education for peritonitis

A

Maintain adequate rest and resume home activity slowly and as tolerated
no heavy lifting for 6 weeks
Monitor for evidence of return infections and notify provider immediately.

351
Q

Why do we keep patients in semi-fowlers?

A

lung expansion
localize drainage to lower abdominal region to decreased spread of infection
decrease abdominal pressure

352
Q

Medications and nutrition for peritonitis

A

hypertonic iv fluids and broad-spectrum antibiotics.

353
Q

Complications and safety complications for peritonitis

A

literally dont know??? its a complication already?

354
Q

what is gastroenteritis

A

inflammation of the stomach and small intestine

-triggered by infection (b/v)

355
Q

symptoms of gastroenteritis and assessment findings

A

vomiting and frequent watery stools, nausea, then Abdominal pain!!!!

356
Q

What question should we put in our assessment for gastroenteritis?

A

Travel! especially if they have been to Asia, Africa, Mexico, South America, and Central America

What local restaurants have they eaten at? 24-36 hours?

357
Q

risk factors for gastroenteritis

A

-immunocompromised, older adult
-cruise vacation, college dormitories, prisons, nursing homes

358
Q

diagnostics and treatments for gastroenteritis

A

-supportive treatment
-antibiotics

359
Q

Nursing care for gastroenteritis

A

-keep buttocks and perineal area clean dry and intact
-monitor for hypokalemia and hypovolemia

360
Q

patient education for gastroenteritis

A

-frequent wiping can irritate the skin so avoid toilet paper, use warm water and can use creams/oil
-protective barrier cream between stools
-sitz bath for ten minutes 2-3 times a day
-prevention of spreading it
-may need to wear pads and diapers for incontinence

361
Q

medications and nutrition for enteritis

A

-high amount of oral fluid intake: Gatorade,
-loperamide
-shigellosis:: ciprofloxacin, azithromycin
do not administer antidiarrheals: we want the body to shed the organism, if motility is slowed it will stay in the body.

362
Q

Complications and safety considerations for gastroenteritis

A

client at increased risk for fluid and electrolyte imbalances and impaired nutrition
-hypokalemia and hypovolemia

363
Q

What is ulcerative colitis?

A

Edema and inflammation primarily in the rectum and rectosigmoid colon

-4 types
-mild, moderate, severe, fulminant

364
Q

symptoms and assessment findings of ulcerative colitis

A

abdominal pain and cramping, often in left lower quadrant with pain. Anorexia and weight loss
-diarrhea: 15-20 liquid stool a day
-high pitched bowel sounds
rectal bleeding

365
Q

risk factors of ulcerative colitis?

A

Genetics, Caucasians, Jewish heritage, adolescents, and young adulthood, (more in males),

366
Q

diagnostics and treatment for ulcerative colitis?

A

sigmoidoscopy, colonoscopy, barium enema, ct scan, mri, stool examination

367
Q

nursing care for ulcerative colitis

A

NPO and admin tpn
instruct high protein high calorie low fiber foods
Monitor by colonoscopy since they have increased risk of cancer
-assess client in identifying foods that trigger manifestations
-monitor for potassium deficiency.
Monitor i/o

368
Q

Patient education for ulcerative colitis

A

Seek emergency care for indications of bowel obstruction or perferation (fever, abdominal pain, vomiting)
weigh 1-2 times a week
Npo and admin tpn

369
Q

medications and nutrition for ulcerative colitis

A

small frequent meals
b12 injections
avoid alcohol and caffeine
iron supplements
high protein, and low fiber (elementals, semi-elemental products).

370
Q

complications and safety considerations for ulcerative colitis

A

Bowel obstruction and perferation

371
Q

What is chrons disease?

A

Disease in the small intestine anywhere in the gi tract.

372
Q

symptoms of chrons disease and assessment findings

A

right lower quadrant pain and cramps
fever, pus and mucus in stool (x5 a day)
steatorrhea
high pitched bowel sounds

373
Q

Risk factors of Chrons

A

Genetics, Jewish heritage, adolescents and young adults, tobacco use

374
Q

Diagnostics and treatments for chrons disease

A

Endoscopy, Proctosigmoidoscopy, colonoscopy, sigmoidoscopy, ultra sound, x-ray, and ct scan, Barium enema

375
Q

Barium enema complications and nursing actions?

A

Monitor post-op for manifestations of bowel perforation (rectal bleeding, firm abdomen, tachy and hypotension)

376
Q

What are small intestine ulcerations and narrowing consistent with?

A

chrons disease

377
Q

Client education for post barium enema for Chrons

A

Remain npo, and perform bowel preperation before procedure
Cramping and distention during enema.

378
Q

Chrons nursing care

A

same for ulcerative colitis

379
Q

Medications for Chrons

A

mild to moderate
-5- ASA drugs
Moderate to severe
-azathioprine, 6-mercaptopurine
-these drugs can leadL to serious infections
Others
-BRM’s (infliximab, adalimumab)
-glucocorticoids
-ciprofloxacin, metronidazole for abscesses,infection, and fistulas

380
Q
A
381
Q

Nutrition therapy for Crohns

A

-poor nutrition can lead to inadequate fistula and would healing, muscle mass, decreass immune response
-TPN
-Ensure or Sustacal nutritional supplements
-avoid GI stimulants (alcohol and caffeine)

382
Q

Fistula management for crohns

A

-incision and drainage of abscesses
-3000 calories a day
-infection prevnetion
-skin care
-electrolyte therapy
-TPN

383
Q

What is diverticulitis?

A

Inflammation and infection of bowel mucosa are caused by bacteria, food, or fecal matter trapped in more than one diverticula.

384
Q

symptoms and assessment findings of Diverticulitis

A

acute onset of abdominal pain often in left lower quadrant, n/v
fever, chills, tachycardia, distention

385
Q

risk factors for diverticulitis

A

Occurs the most in older adults and affects males more then females
African Americans

386
Q

What types of medications are avoided in clients with diverticulitis

A

laxatives and enemas

387
Q

Medications for diverticulitis

A

Antimicrobials: ciprofloxacin, metronidazole, sulfamethoxazole-trimethoprim.

388
Q

nursing actions for antimicrobials

A

monitor kidney function and hepatic studies

389
Q

Client education for antimicrobials

A

can cause superinfection, observe for thrush, or vaginal yeast infection
urine can darken (harmless effect)
Monitor for cns effects, numbness of extremities, ataxia, and seizures, and notify the provider immediately

390
Q

Nutrition for diverticulitis

A

-slowly add fiber into diet
-bulk forming laxatives may be needed
-severe symptoms the patient is NPO
-NG tube if nausea, vomiting is severe
-

391
Q

Complications and safety considerations for diverticulitis

A

-herniation
-perforation and abscess
-

392
Q

Nursing actions for diverticulitis

A

instruct rest, and take meds as prescribed. opioid analegesics may be used for pain. Ng tube can be inserted
promote normal bowel function and consistency (AVOID laxatives and enemas)

393
Q

Patient education/nutrition for diverticulitis

A

clear liquid diet until manifestations subside
low fiber diet
avoid seeds or nuts, popcorn, alcohol
fat should only be 30% of diet.

394
Q

Complications and safety considerations of diverticulitis

A
395
Q

What is a Paralytic illeus?

A

-usually postsurgical complication where bowels are not passing flatus or stool
-bowel sounds will be absent

396
Q

What diet do patients with paralytic ileum follow

A

NPO

397
Q

Why do patients with paralytic ileum have an NG tube

A

decompress the bowel by draining fluid and air

398
Q

symptoms of paralytic Ileus

A

abdominal bloating and distention, gas, constipations, nausea and vomiting, dehydration

399
Q
A
400
Q

What is cholecystitis?

A

inflammation of the gallbladder wall.

401
Q

More risk factors for cholecystitis

A

rapid weight loss, more common in females, estrogen therapy, oral contraceptives, genetics, older adults, type 2 dm, low-calorie liquid protein diets.

402
Q

What is the main cause of cholecystitis?

A

gallstones obstructing the cystic and or common bile ducts causing bile ducts to back up and gallbladder to become inflamed.

403
Q

signs and symptoms of Cholecystitis

A

Sharp pain in upper right quadrant, radiating to shoulder
pain with deep inspiration
dyspepsia, belching, flatulence fever

404
Q

What happens when someone eats high-fat food if they have cholecystitis?

A

they will have intense pain (increased hr, diaphoresis, n/v) after ingestion caused by biliary colic

405
Q

Assessment findings in someone with cholecystitis

A

Jaundice, icterus, clay colored stool, steatorrhea dark urine,

406
Q

What symptom can be present in chronic cholecystitis and why?

A

Pruritis, accumulation of bile salts in the skin due to biliary obstruction

407
Q

Do older clients have the same manifestations for cholecystitis?

A

no, delirium is the main symptom and localized tenderness. May not have a fever or pain.

408
Q

What labs will be effected with cholecystitis?

A

wbc: Increased
Direct/indirect total blood bilirubin can be increased is there is obstruction
amalyase/lipase: increased
AST/LDH/ALP: increased, indicating bile duct is obstructed.

409
Q

Diagnostic procedures for Cholecystitis

A

ultrasound/ct/mri, HIDA, ERC, MRC

410
Q

Nursing care for cholecystitis

A

Administer analgesics as needed and perscribed

411
Q

Medications for cholecystitis

A

analgesics: Opioid as perfered for acute biliary pain
NSAIDS: ketorolac, mild, moderate pain
NSAIDS: monitor for gi bleeding
Bile acid: Chenodiol, ursodiol: graduall

412
Q

What does bile acid do?

A

Chenodiol, ursodiol: gradually dissolves cholesterol based gall stones

413
Q

Nursing actions for bile acids

A

use caution in clients who have liver conditions or disorders with varices

414
Q

Client education about bile acid

A

Report, abd pain, diarrhea, or vomitting.

Med is limited to 2 year of admin and requires a gallbladder ultrasound every 6 months during first year to determine effectiveness.

415
Q

Therapeutic procedures for cholecystitis

A

Extracorporeal shock wave lithotripsy, cholecystectomy.

416
Q

Nursing actions for shock wave lithotripsy for cholecystitis

A

assist client to lay on a fluid-filled pad for shock wave delivery.
administer analgesia
instruct client pain during the procedure.

417
Q

Complications for Cholecystitis

A

Obstruction of the bile duct, Bile peritonitis, postcholecystectomy syndrome.

418
Q

What can obstruction of the bile duct cause?

A

ischemia, gangrene, and a rupture of gallbladder wall.
rupture of gallbladder wall can cause a local abscess or peritonitis which requires surgical intervention and admin of broad spectrum abx

419
Q

Bile peritonitis

A

occurs if adequate amounts of bile are not drained from surgical site. This is a rare but fatal complication

420
Q

Nursing actions for Bile Peritonitis

A

monitor for pain, fever, jaundice
report findings immediately

421
Q

What is postcholecystectomy syndrome?

A

Manifestation of gallbladder disease can continue after surgery. The client should report findings similar to those experienced prior to surgery related to pain and nausea.

Manifestations can recur immediately or months later

422
Q

Nursing actions for postcholecystectomy syndrome?

A

Assess pain characteristics and other reported findings

423
Q

Client education for postcholecystectomy syndrome?

A

Possible further diagnostic evaluation can be needed

424
Q

What should a normal stoma look like

A

red and moist

425
Q

after a colostomy has been performed, what kind of bag is placed on the client

A

clear pouch system

426
Q

if a clear pouch system is not being used for a freshly made stoma, what should the care team do

A

petroleum gauze dressing covered by dry sterile dressing

427
Q

for 6-8 weeks following surgery, the stoma may appear

A

edematous with slight bleeding

428
Q

The nurse caring for a client with a stoma should perform routine assessments of the

A

skin

429
Q

Peristomal skin complications

A

hyperpigmentation, irritant dermatitis, skin stripping, candidiasis

430
Q

The colostomy bag should be emptied when it is

A

1/2 or 1/3 full

431
Q

Stool from the ascending colon will be

A

liquid

432
Q

stool from the transverse colon will be

A

pasty

433
Q

stool from the descending colon will be

A

more solid

434
Q

for a retracted stoma, what can we use to help the pouch fit correctly

A

stoma belt

435
Q

The largest complication of stoma (occurs immediately following post op)

A

necrosis

436
Q

During the first 6-8 weeks, why does the stoma need to be measured weekly

A

it is decreasing in size gradually

437
Q

How big of an opening should be cut on the wafer paper to ensure proper fit of the colostomy bag

A

1/8 to 1/16 in larger

438
Q

Before putting on the colostomy bag, the patient should

A

clean the skin with soap and water. do not moisturize!

439
Q

What can the patient do to eliminate odors of the colostomy pich

A

charcoal filters, pouch deodorizers, breath mint

440
Q

We should educate patients with colostomy/ileostomy NOT to do this relieve odor

A

aspirin

441
Q

What types of foods should someone with a colostomy avoid

A

foods with casings, coconuts, celery, nuts, seeds

442
Q

Which ostomy patients can use irrigation

A

sigmoid colostomy

443
Q

what is sigmoid colostomy irrigation

A

when they train to empty @ a certain time. increases quality of life

444
Q

What is an anastomotic leak

A

stool leaking into abdominal cavity instead of ostomy bag.

445
Q

In ileostomies, resection of the terminal ileum can result in

A

vitamin b12 replacement

446
Q

Can those with an ileostomy take a laxative

A

no

447
Q

Ileostomy patients should consume how much fluid a day

A

10-12 glasses

448
Q

What is a cholecystectomy

A

removal of the gallbladder with laparoscopic or open approach

449
Q

Hospitalization period for laparoscopic and open cholecystectomy

A

Laparoscopic: within 24 hours discharge
Open: 1-2 days hospitalization

450
Q

Nursing actions with laparoscopic approach

A

immediate postoperative care

451
Q

During open cholecystectomy, the surgeon can place what?

A

JP drain in gallbladder bed, T-tube in common bile duct

452
Q

Care of a Jackson Pratt tube inserted during cholecystectomy

A

-monitor and record drainage (serosanguineous stained with green-brown bile)
-antibiotics to decrease risk of infections

453
Q

Care of a T-tube inserted during cholecystectomy

A

-instruct client to report absence of drainage
-inspect the surrounding skin of infection or bile leakage
-elevate the T-tube above abdomen
-clamp tube 1 hr before and after meals
-monitor and record amount of drainage
-assess stools for color (stools clay-colored)
-document response to food
-monitor for bile peritonitis

454
Q

Client education for laparoscopic cholecystectomy

A

-ambulate frequently to minimize free air pain
-monitor incision for infection and dehiscence
-pain control
-indications of bile leak
-resume activity gradually as tolerated

455
Q

Client education for open approach cholecystectomy

A

-resume activity gradually
-begin with clear liquids and advance to solid foods
-report sudden increse in drainage, foul odor, pain, fever, jaundice
-take showers until drainage tube removed
-color of stools should be brown within one week
-diarrhea is common

456
Q

Dietary counseling for cholecystectomy

A

-adhere to a low-fat diet
-reduce dairy products and avoid fried foods, chocolates, nuts, gravies
-avoid gas-forming foods (broccoli, beans, cabbage)
-consider weight reduction
-take fat-soluble vitamins or bile salts to enhance absorption

457
Q

complications of cholecystectomy

A

-obstructions, bile peritonitis, postcholecystectomy syndrome

458
Q

Obstruction of the bile duct can cause

A

-ischemia, gangrene, and a rupture of the gallbladder wall

459
Q

what does rupture of the gallbladder wall look like? What are the interventions?

A

-local abscess or peritonitis (rigid, birdlike abdomen)
-surgical intervention and antibiotics

460
Q

What is bile peritonitis and the nursing actions

A

-bile not drained from surgical site
-pain,fever, jaundice
-report to provider

461
Q

Postcholecystectomy cause and nursing interventions

A

-gallbladder disease continues after surgery
-assess pain characteristics and other reported findings

462
Q

What is a colon resection

A

removal of part of the colon and regional lymph nodes. can occur with partial or total colectomy

463
Q

A partial colectomy may result in

A

colostomy (temporary or permanent)

464
Q

A total colectomy may result in

A

ileostomy

465
Q

Preoperative care for colon resection

A

-patient is told colostomy is a possibility
-patient is educated on the risk for sexual dysfunction (only if it is low-rectal surgery)
-some surgeons will want bowel prep
-oral or IV antibiotics before if needed
-NGT may be placed for decompression
-IV placement for fluid and electrolytes

466
Q

Postoperative care for open colon resection

A

-NG tube
-IV PCA 24-36h
-diet slowly progressed from liquids to solid foods

467
Q

Postoperative care for laparoscopic colon resection

A

-solid foods very soon after
-less pain
-fewer postoperative complications
-1-2 day hospital stay

468
Q

Patient teaching for appendectomy

A

-often limited until post procedure due to intense pain

469
Q

Laparoscopic appendectomy

A

-has few complications
-same day discharge
-usual activities in 1-2 weeks

470
Q

laparotomy appendectomy

A

-large abdominal incision
-would drains and NG tube placement if peritonitis or abscesses are found

471
Q

Nursing interventions for laparotomy appendectomy

A

-administer IV antibiotics
-help patient out of bed
-may be hospitalized 3-5 days
-usual activity in 4-6 weeks

472
Q

Preoperativce care for colectomy

A

-if stoma is planned, inform patient
-administer antibiotic bowel prep (neomycin) if prescribed
-administer cleansing enema or laxative if prescribed

473
Q
A
474
Q

if a hernia is not reducible what needs to happen?

A

surgery

475
Q

complications of strangulated hernia

A

necrosis of the bowel, ischemia and obstruction, lower bowel perf.

NRSE-3540 Adult Care 1 (5 decks)

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