new flashcard deck made with SG topic info from powerpoints and textbook - day before exam highlights
what is important when someone has acute abdomen
determining cause
what is dumping syndrome - s/s
uncontrolled gastric emptying of chyme into the small intestine (WEAKNESS, SWEATING, PALPITATIONS, DIZZINESS) symptoms occur 15-30 minutes after eating
what is postprandial hypoglycemia - s/s
uncontrolled gastric emptying of fluid high in carbohydrate into the small intestine resulting in excess insulin and reflex hypoglycemia (SWEATING, WEAKNESS, CONFUSION, PALPITATIONS) symptoms occur 2 hours after eating
A patient has a vagotomy with antrectomy to treat a duodenal ulcer. Postoperatively, the patient develops dumping syndrome. Which of the following statements, if made by the patient, should indicate to the nurse that further dietary teaching is needed?
I should eat bread with each meal - dumping syndrome is excacerbated by carbs and sugar
- At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. The nurse will teach the patient to
this is dumping syndrome - the pt should lie down after eating and also eat small meals
priorirty intervention for vomiting
NPO and IV access for fluids
for an ED, pt is at risk for what
malnutrition causes hyperkalemia so dysrhtymias and electrolyte imbalances
how to give meds with enteral feedings
no meds WITH formula, should dissolve tabs in water
Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube?
change tubing every 24 hours
drainage for NG tube
small amount of blood drainage is normal
A 61-year-old patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times?
every 4 hours
A patient returns to the surgical unit with a nasogastric (NG) tube to low intermittent suction,
IV fluids, and a Jackson-Pratt drain at the surgical site following an exploratory laparotomy and repair of a bowel
perforation. Four hours after admission, the patient experiences nausea and vomiting. What is a priority nursing
intervention for the patient?
Check the amount and character of gastric drainage and the patency of the NG tube.
An important nursing intervention for a patient with a small intestinal obstruction who has an NG tube is to
a. offer ice chips to suck PRN.
b. provide mouth care every 1 to 2 hours.
c. irrigate the tube with normal saline every 8 hours.
d. keep the patient supine with the head of the bed elevated 30 degrees.
mouth care
Following bowel resection, a patient has a nasogastric (NG) tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse?
reposition check placement notify HCP if continues
what to monitor for pt with parenteral nutrition
BG - goal is <140-180
complication of parenteral nutrition and what are s/s
muscle weakness and pain = hypophosphatemia called refeeding syndrome
5 education for GERD
- Lifestyle Modifications – sleeping/resting with HOB elevated, not supine for 2-3 hours after eating, avoiding constrictive clothing, cigarette cessation
- Dietary Modifications – avoiding foods that increase lower esophageal sphincter (LES) pressure like alcohol, chocolate, mints, caffeine, and fatty foods – LOW FAT FOODS
A 46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement indicates that additional teaching about GERD is needed?
I can eat a bedtime snack
A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patient’s
BREATH sounds - think respiratory
dx test for GERD
barium swallow
The nurse is planning to teach a client with GERD about substances that will increase the LES pressure.Which item shoud the nurse include on this list.
inc pressure means lessGERD - nonfat milk good
When obtaining a nursing history from the patient with colorectal cancer, the nurse should specifically ask the patient about
diet
When evaluating the patient’s understanding about the care of the ileostomy, what statement by the patient indicates the patient needs more teaching?
I can regulate my stool
71-yr-old patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery?
drainage and infection - choose this over output from stoma etc
A patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should
document as NORMAL
Which nursing action will be included in the plan of care for a 25-yr-old male patient with a
new diagnosis of irritable bowel syndrome (IBS)?
build rapport, talk about problems
when someone is malnourished what is priority
monitor for dyrhtymias like hyperkalemia and they are at higher risk for infection
Which action should the nurse in the emergency department anticipate for a 23-year-old patient who has had several episodes of bloody diarrhea?
stool culture
A 57-year-old man with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which order will the nurse question?
loperamide
A 25-yr-old male patient calls the clinic complaining of diarrhea for 24 hours. Which action
should the nurse take first?
ask patient to describe stool
After several days of antibiotic therapy, an older hospitalized patient develops watery
diarrhea. Which action should the nurse take first?
contact precautions
A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times?
bedtime
- The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient’s peptic ulcer. The nurse will teach the patient to take
antacids after meals and sucralfate 30 minutes before meals.
A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid?
“It is best for me to take my antacid 1 to 3 hours after meals.”
- The nurse will anticipate teaching a patient experiencing frequent heartburn about
PPI’s - prazoles
- Upper gastro-intestinal endoscopy (EGD)
NPO AND test gag reflex after test before giving anything
barium swallow
give patient fluids and fiber after test to prevent constipation
s/s of peritonitis
rebound tenderness and MORE pain with movement
priority intervention for peritonitis
IV access for fluids
A patient in the emergency department has just been diagnosed with peritonitis caused by a ruptured diverticulum. Which prescribed intervention will the nurse implement first?
IV access, fluids and antibiotics
A patient is awaiting surgery for acute peritonitis. Which action will the nurse include in the
plan of care for patient position?
knees flexed
someone with UC should be provided what education
frequent colon cancer screening
for acute UC attack, priority is
NPO
A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy
abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to
NPO
The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement?
monitor fluids
patient taking adalimumab, teaching is
increased risk for infection
teaching for diverticulosis
increase fiber intake
The nurse admitting a patient with acute diverticulitis explains that the INITIAL plan of care is to
fluids
What should the nurse teach the patient with diverticulosis to do?
high fiber diet
high risk factors for PUD
hpylori and NSAID use
gastric vs duodenal ulcer
- Gastric ulcers – burning or gaseous pressure in the epigastrium, pain 1-2 hours after eating, if penetrating, increased discomfort with food
- Duodenal ulcers – burning, cramping, pressure-like pain across mid-epigastrium and upper abdomen or back, 2-5 hours after eating, midmorning, midafternoon, and during the night. Pain relieved with food and antiacids – pain at night
most common complication of PUD
hemoorhage - hypovolemia
A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following? and what should nurse do?
ulcer perforated - check vital signs
Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)?
eat ANY foods you can tolerate
big lifestyle changes for diet for peptic ulcer
ELIMINATE alcohol and smoking
When assessing the client with the diagnosis of peptic ulcer disease, which physical examination should the nurse implement first?
auscultate bowel sounds
The nurse is teaching the patient a client with a peptic ulcer discharge instructions. The client asks the nurse which type of analgesic he may take. Which of the following responses by the
nurse would be most accurate?
acetaminophen
what to give pt before apendectomy
antibiotics
A young adult patient is admitted to the hospital for evaluation of right lower quadrant
abdominal pain with nausea and vomiting. Which action should the nurse take?
have pt lie on side flexing right leg
10 interventions for after bariatric surgery
- NPO
- No straws
- Clear liquids after 48 hours
- Frequent post-operative vital signs and pulse oximetry, with comparison to baseline
- Assessment of incision for drainage/bleeding initially and for infection after 3 days
- Assess pain and administer pain medication as ordered (excessive pain or pain that does not respond to medication may indicate leaking of suture line)
- Teach patient importance of deep breathing, coughing, splinting incision, and incentive spirometry use
- Keep HOB 45 degrees or higher
- Institute VTE prevention measures –EARLY MOBILITY!
- Maintain IV infusions as ordered, monitor I & O
if someone is vomiting bright red blood
priority is NPO and IV access to prevent hypovolemic shock
Which assessment should the nurse perform first for a patient who just vomited bright red blood?
take BP and pulse and NPO
The nurse will anticipate preparing a 71-year-old female patient who is vomiting “coffee-ground” emesis for
endoscopy
- Which order from the health care provider will the nurse implement first for a patient who has vomited 1200 mL of blood?
give LR’s
