Week 3 Upper Gastrointestinal

Question 1

A detailed NURSING ASSESSMENT is essential in determining an appropriate nursing care plan for conditions affecting the digestive system.

Some elements include:

Answer 1

• Vital signs including pain score
• Patient’s medical, surgical and social history - pre-existing conditions, family history, smoking, alcohol, recent travel, occupation
• General appearance
  Skin- dehydration, pallor, jaundice, bruising, itching
  eyes- sunken, yellow sclera, pale conjunctivae
  mouth- halitosis; lips (dry, chapped, pale, sores); tongue (dry and coated, ulcerations); condition of gums and teeth
  Weight- fluctuations
• Diet- any changes in appetite, altered bowel pattern, food intolerances
• Medication history- usual medications, drug allergies
• SYMPTOMS
  Nausea and vomitting- note the onset, duration and triggers of vomitting in addition to characteristic of vomitus eg/haematemesis (blood in vomit)
  Dyspepsia (indigestion)
  Dysphagia (difficulty swallowing)
  Abdominal pain- note site, onset, nature
  Bowel sounds- present or absent
  Diarrhoea OR Constipation- onset, duration, frequency, characterisitcs of stool eg/melena- black tarry stool resulting from bleeding in upper GI tract
  Palpaple lump(s)- site, onset, characteristcs.

Question 2

A systematic approach to planning and implementing nursing care will ensure that an individual’s needs are comprehensively addressed. Elements include:

Answer 2

COMMUNICATION
OBSERVATIONS
NUTRITION/HYDRATION
ELIMINATION
PAIN RELIEF
MOBILISATION
PSYCHOSOCIAL SUPPORT

Question 3

A variety of INVESTIGATIONS may be be necessary to make a diagnosis. Specific examples include:

Answer 3

• x-ray, ultrasound, CT
• Gastroscopy/Endoscopy- a procedure where a thin, flexibile tube with a light and camera on one end, called an endoscope, is used to look inside the oesophagus, stomach and small intestine (duodenum).
• Barium Swallow- a test that uses barium swallowed and x-ray to create images of the upper GI tract including throat (pharynx) and oesophagus.
• Colonoscopy- a procedure where a thin, flexible tube with a light and camera attached is used to look inside your large intestine (colon) and rectum.
• Laparoscopy- performed under anaesthetic involving a small incision (keyhole) through the abdominal wall to allow the injection of carbon dioxide into the peritoneal cavity to move organs and structures away from each other to be better visualised. It helps in obtaining tissue and fluid samples as well as detecting inflamattion, masses and other abnormalities.

Question 4

Nausea is

Answer 4

is a feeling of discomfort in the epigastrium with a conscious desire to vomit

Question 5

Vomiting is

Answer 5

is the forceful ejection of partially digested food and secretions from the upper GI tract

Question 6

Nursing assessment for nausea and vomiting:

Answer 6

Vital signs- to help detect fluid volume deficit

General observation- appearance, skin colour and turgor

Collect patient history- Duration, frequency, severity, precipating factors, medications, measures used to alleviate.

Question 7

Nursing care and interventions for nausea and vomiting:

Answer 7

Emesis bag, postion patient close to a bathroom
Strict fluid balance chart
NBM, or if not prohibited- ice chips to suck on.
Postion patient upright
NGT and suction to decompress the stomach
IVT
Medication thearpy as ordered- antiemetics
Other non-pharmacological therapy- acupuncture, ginger, relaxation, change in body position

Question 8

Lifespan considerations nausea and vomiting

Answer 8

Older patients are more likely to have cardiac or renal insufficiency that places them at a great risk for life-threatening fluid and electrylite imbalances.
The older adult with a decreased level of consciousness may be at a high risk for aspiration of vomitus.

Question 9

Gastro-oesophageal reflux disease (GORD) is

Answer 9

a chronic symptom of mucosal damage caused by reflux of stomach acid into the lower oesphagus. In fact, GORD is not a disease, but a syndrome.

Question 10

GORD is one of the most common gastrointestinal conditions in Australia. It is estimated to occur in

Answer 10

10–15% of the population, with a rising prevalence, most likely due to obesity. In addition to obesity, risk factors include advanced age, male gender, Caucasian ethnicity, diets high in fats, sugars and salt, and smoking

Question 11

GORD is usually caused by

Answer 11

the ring of muscle at the bottom of the oesophagus becoming weakened.

Question 12

It is not always clear what causes this but people at risk of developing GORD are:

Answer 12

Obesity- increased pressure on the stomach can weaken muscles in the oesophagus
smoking, alcohol, coffee or chocolate- these may relax the muscles at the bottom of the oesphagus.
pregnancy- temporary changes in hormone levels and increased pressure on stomach
hiatus hernia- when part of your stomach pushes up through the diaphragm
Stress

Question 13

Gastritis is

Answer 13

inflammation of the stomach lining and is one of the most common problems affecting the stomach. There are two types of gastritis, acute and chronic.

Question 14

Causes of gastritis

Answer 14

Medications- aspirin, corticosteroids, NSAIDs- these medications inhibit the synthesis of prostaglandins that are protective to the gastric mucosa.

Diet- alcohol, spicy food

Helicobacter pylori infection- prolonged inflammation leads to changes in the stomach and can lead to cancer.

Environmental- radiation, smoking

Pathophysiological conditions- burns, large hiatus hernia, reflux of bile/pancreatic secretions, renal failure, sepsis, shock.

Other factors- endoscopic procedures, NG tube, psychological stress.

Question 15

GORD Signs and Symptoms- these vary from person to person.

Answer 15

heartburn is the most common symptom. It is a burning, tight sensation felt intermittently beneath the lower sternum and spreading upwards to the throat or Jaw
dyspepsia- pain or discomfort in the upper abdomen
regurgitation- described as hot, bitter or sour liquid coming into the throat or mouth.
respiratory symptoms such as; wheezing, coughing, and dyspnoea
GORD-related chest pain can mimic angina and is described as burning, squeezing or radiating to the back, neck, jaw or arms. Assessment is vital!

Question 16

GORD Complications

Answer 16

oesophagitis- inflammation of the oesophagus and this can potentially lead to oesophageal ulcers that can bleed, cause pain and make swallowing difficult.
Barrett’s oesphagus- repeated episodes of GORD can damage the cells lining in the lower oesphagus
dental erosion- due to acid reflux into the mouth
Oesophageal cancer

Question 17

GASTRITIS Signs and Symptoms

Answer 17

Nausea and Vomiting
Abdominal bloating
Abdominal pain
Indigestion
Burning feeling
Loss of appetite

Question 18

Nursing care and management GORD:

Answer 18

elevate bed to 30 degrees

patient should not lay supine for 2 - 3 hours after a meal

Medication therapy
- Protein pump inhibitors (PPIs) block the acid secretory pathway eg/omeprazole
- PPIs have a short plasma half-life thereofre the TIMING of administration is important with the greatest efficacy seen when given a meal time.
- PPIs should be given approximately 30 minutes before a meal.
- Long term use of PPIs may increase the risk of falls and fractures.
- PPis are associated with increased risk of C.difficile infection in hospitalised patient’s.

education - avoid late night eating and identified activites that causes reflux for them, weight reduction, avoiding alcohol and smoking

Question 19

Nursing care and management- GASTRITIS

Answer 19

Supportive treatment such as IV fluids and NBM status if vomiting and dehydration accompanies acute gastritis.
Administration of medication therapy- focuses on reducing irritation of the gastric mucosa and providing symptomatic relief eg/ antiemetics, H2 repetor blockers or PPIs to reduce gastric HC1 secretion, antibiotic combinations used to eradicate H.pylori if a cause.
In severe of acute gastritis- NG tube may be used to monitor for bleeding, lavage the precipating agent from the stomach, keep the stomach empty.
Involvement of mulitidisciplanary team- eg/dietician

Question 20

A peptic ulcer is

Answer 20

a break or ulceration in the mucosal lining of the lower oesophgus, stomach or duodenum.

Question 21

Peptic ulcer disease (PUD) damages the

Answer 21

lining, usually by increased acid secretion leading to inflammation and ulceration. Helicbacter pylori infection and the use of no-steroidal anti-inflammatory drugs (NSAIDs) are the primary causes of both gastric and duodenal ulcers.

Question 22

PUD Signs and symptoms

Answer 22

Epigastric pain- Gnawing or burning pain in the middle to upper stomach between meals or at night

Pain that temporarily disappears if you eat something like food milk or antacids

Bloating

Heartburn

Nausea or vomiting

• Bleeding, performation and gastric obstruction are the major complications of PUD

Question 23

Nursing care and management PUD

Answer 23

Administration of prescribed medication
- PPI’s eg/omeprazole
- H2 blockers eg/rantididine
- Antibiotics eg/amoxicillin, clarithromycin and metroniadole
- Protective medications eg/sucralfate
- Antimetic eg/ Stemetil, ondansetron or metoclopramide to relieve nausea and vomiting.

If complications occur such as haemorrage, performation or pyloric stenosis, intravenous access will need to be established and fluid replacement initiated to correct hypovolemia.

Insertion of a NG tube may be indicated to allow aspiration to decompress and empty the stomach.

Commencement of a fluid balance chart and regular vital signs

A urinary catheter may be required to monitor input/output.

Nutritional therapy- avoid caffeine-containing beverages and foods. Eliminating alcohol as it can delay healing. Avoid foods that cause gastric irritation including hot (spicy) foods, peppper and carbonated beverages.

Question 24

Gingivitis

Answer 24

The gingiva are the gums, the visible mucosa around teeth. Gingivitis refers to inflammation of the gingiva, and is common. It is a mild form of periodontitis, which means inflammation of all the tissues surrounding the teeth, and is less common

Question 25

Gingivitis Signs and symptoms:

Answer 25

Patients with gingivitis present with: Puffy, dusky red, swollen gums Gums which are tender and bleed easily Foul breath Bleeding when brushing teeth Development of pus Formation of abscess with loosening of teeth

Question 26

Gingivitis Risk Factors:

Answer 26

Poor oral hygiene, which leads to the build-up of plaque. If teeth are not cared for properly, plaque hardens into tartar and irritates the gingiva Systemic disorders like diabetes or leukaemia, exposure to heavy metals, pellagra (niacin deficiency) and scurvy (Vitamin C deficiency) Skin disease, particularly erosive lichen planus Hereditary factors Poor or inadequate oral hygiene practices Tobacco use Immune compromise Viral and yeast infections Dry mouth Hormonal changes associated with menses and pregnancy Poor nutrition Substance abuse Ill-fitting dental restoration Type 1 diabetes, leukaemia, Down syndrome, Papillon-Lefevre syndrome and Crohn disease.

Question 27

Gingivitis Treatment:

Answer 27

Prevention through health teaching Dental care Gingival massage Regular dental checkups - including professional cleaning of teeth Treatment of underlying conditions

Question 28

Candidiasis

Answer 28

is an infection caused by a yeast (a type of fungus) called Candida. Candida normally lives on the skin and inside the body, in places such as the mouth, throat, gut, and vagina, without causing any problems. Sometimes, Candida can multiply and cause an infection if the environment inside the mouth, throat, or esophagus changes in a way that encourages fungal growth. Candidiasis in the mouth and throat is also called thrush or oropharyngeal candidiasis. Candidiasis in the esophagus (the tube that connects the throat to the stomach) is called esophageal candidiasis or Candida esophagitis.

Question 29

Oral Candidiasis Signs and Symptoms

Answer 29

White patches on the inner cheeks, tongue, roof of the mouth, and throat Redness or soreness Halitosis Cotton-like feeling in the mouth Loss of taste Pain while eating or swallowing

Question 30

Oral Candidiasis Risk Factors

Answer 30

Taking antibiotics, including inhaled corticosteroids Wearing dentures Having cancer, HIV/AIDS Smoking

Question 31

Oral Candidiasis Treatment

Answer 31

Miconazole oral gel Good oral hygiene Rinising mouth after using inhaled corticosteroids

Question 32

HSV -1

Answer 32

HSV-1 is mainly transmitted by oral-to-oral contact to cause infection in or around the mouth. HSV-1 affects most people on one or more occasions during their lives and is the herpes simplex virus that will be discussed here. Both variants of the herpes simplex virus present with localised blistering.

Question 33

HSV 2

Answer 33

HSV-2 on the other hand is almost exclusively transmitted through genital-to-genital contact during sex. Both variants of the herpes simplex virus present with localised blistering.

Question 34

HSV Cold sores

Answer 34

Herpes simplex is commonly referred to as cold sores or fever blisters, as recurrences are often triggered by a febrile illness, such as a cold.

Question 35

HSV Signs and Symptoms

Answer 35

Lip lesions Mouth lesions Vesicle formation (single or clustered) Shallow painful ulcers Blisters

Question 36

HSV Risk Factors

Answer 36

Upper respiratory infections Excessive exposure to sunlight Food allergies Emotional tension Onset of menstruration

Question 37

HSV Treatment

Answer 37

Topical creams - corticosteroids Mild antiseptic mouthwash Viscous lignocaine Removal or control of predisposing factors Antiviral agents.

Question 38

There are two types of oral cancer:

Answer 38

1) oral cavity cancer- which starts in the mouth 2) oropharyngeal cancer- which starts in the part of the throat behind the mouth. Oral cancer is more common over the age of 40, but is becoming more commonly diagnosied in younger people which is attributed to the human papillomavirus (HPV) which is sexually transmitted.

Question 39

Oral cancer Nursing assessment

Answer 39

Subjective data- health history including recurrent oral herpatic lesions, HPV infection or vaccinitation, syphilis, exposure to sunlight, medications (immunosuppressants), past surgery Functional heatlh patterns- use of alcohol and tobacco, oral hygiene, oral intake, weight loss, mouth or tongue soreness, dysphagia, difficulty speaking. Objective data- ulcer/s on lip, palpable neck mass, limited movement of tongue, increased salivation, drooling, slurred speech, foul breath odour, smear cytology, biopsy, positive toluidine blue test

Question 40

Oral Cancer Nursing management

Answer 40

identify patient's at risk and education of patients eg/smoking cessation Pain management- non pharmacological/pharmacological Provide oral hygiene for patient reasurrance and anxiety management, especially pre and post op surgery

Question 41

The World Health Organisation (2016) defines overweight and obesity as

Answer 41

excessive fat accumulation that presents health risks and arises from a sustained energy imbalance.

Question 42

Nursing care and management Obesity:

Answer 42

Gathering a health history is vital to determing whether any physical conditions are present that may be causing or contributing to obesity eg/family history, previous attempts of weight loss, any underlying conditions such as hypertension, cardiovascular problems, stroke, cancer, diabetes, any medications, previous surgery (eg/bariatric surgery). Calculate a BMI and document on admission form Working within the multidisciplinary team- referal for nutritional therapy, exercise, behaviour modfication, support groups, meciation therapy such as appetite-supressing medications

Question 43

Nursing care and management Malnutrition:

Answer 43

Determine contributing factors eg/ socioeconomoic factors, physical illnesses, incomplete diets, history of eating disorders Calculate a malnutrition score and document on admission Referral to multidiscioplinary team For acute intervention- spcialised nutritional support such as oral supplements, enteral nutrition, parenteral nutrition.

Question 44

Enteral feeding is

Answer 44

a method of supplying nutrients directly into the gastrointestinal tract. Enteral feeding is used for patients who still have a functioning GI tract but for some reason may be unable to take any or enough oral nutrition or it may be unsafe to do so.

Question 45

Parenteral Nutrition is

Answer 45

intravenous feeding, or feeding into your bloodstream. Parenteral nutrition is used for patient who cannot ingest, digest or absorb nutrients via the GI tract.

Question 46

Nasogatric tube (NGT)

Answer 46

This is a thin soft, flexible tube that passess through the nostril and down the back of their throat, through the oesophagus and into the stomach. NGT's can be either fine bore or large bore depending on the need. Fine bore tubes are usually indicated for patient's who require short term enteral feeding, removal or replacement of tube should be considered at the 4 week mark, but will depend on local hospital policy. Large bore tubes, or commonly known as salem sump tubes are double lumen with an air vent, this type of tube is more commonly used in patients who not only require nutritional support but also gastric drainage and aspiration. A salem sump tube should be changes every 10-14 days or as per local hospital policy.

Question 47

Nasojejunal tube (NJT)

Answer 47

Jejunal feeding is the method of feeding directly into the small bowel. The feeding tube is still inserted via the nose but extends into the small bowel via the stomach and pyloric sphincter into the jejunum. This type of tube is used when gastric feeding is poorly tolerated or contraindicated.

Question 48

Percutaneous endoscopic gastrostomy (PEG)

Answer 48

This type of tube is inserted surgically or endoscopically through the abdominal wall into the stomach. PEGs are inserted when a patient has difficulty swallowing (dysphagia) or is unable to obtain adequate nutrition via the mouth. Depending on local hospital policy, a PEG tube can be used after insertion in as little as 4 hours or within 24 hours. A PEG tube only requires to be changed every 12 months.

Question 49

Jejunostomy tube (J-tube)

Answer 49

A jejunostomy tube or J-tube is also a tube that is place through the abdominal wall into the midsection of the small intestine via either a endoscopic or laproscopic procedure. Feeding usually commences within 24-48 hours post placement.

Question 50

Refeeding syndrome

Answer 50

This is a potentially leathal condition that can occur in acutely ill and severly malnourished patients. It occurs when enteral or parenteral nutrition is given too fast. It is characterised by fluid retention and electrolyte imbalances. Electrolyte imblances occur and can cause cardiac, respiratory, hepatic or neuromuscular disorders. Whilst the electrolyte imbalance is able to be corrected, if not identifed it can lead to clinical complications and death. To avoid this, nutritional support is introduced slowly and cautiously with the amount provided titrated upward slowly as the patient tolerates the feed

Question 51

Drug administration Administering medications via tubes can bring its own complications if the medication is not adminstered properly and following the guidelines.

Answer 51

Some medications are not able to be administered via a tube and this is where it is important to be referring to the "Don't Rush to Crush" book for guidance. It is also important to ensure that a pre and post flush with water is provided to avoid occlusions.

Question 52

Aspiration and tube dislodgement are the two most common safety risks when providing nutrition to your patient via a feeding tube. To manage this consider the following

Answer 52

Patient position Aspiration risk Tube position

Question 53

Patient position

Answer 53

correct positions decreases aspiration risk elevate the head of the bed to a minimum of 30 degrees, preferable is 45 degrees. if you need to perform a procedure, stop the feed, lower the bed and then return the bed to the position before recommencing the feed. if patient is on intermittent feeds, remain upright for 30-60 minutes post feed. Always check local policy and procedure.

Question 54

Aspiration risk

Answer 54

prior to using the tube for either feeding or medication administration, proper tube positions should always be checked. aspirate tube to check for position, you should see gastric contents.

Question 55

Tube position

Answer 55

on insertion, an x-ray needs to be completed to confirm placement. (GOLD STANDARD!) aspiratate as above, and use a pH strip to confirm placement. recheck length of tube, at each shift change, pre and post using the tube

Question 56

Which of the following gastrointestinal organs is in the thoracic cavity? Mouth Oesophagus Stomach Duodenum

Answer 56

Oesophagus

Question 57

Which of the following is NOT a region of the small intestine? Duodenum Jejunum IIeum Plasmodium

Answer 57

Plasmodium

Question 58

Which of the following organs acidifies food for digestion? Stomach Small Intestine Pancreas Liver

Answer 58

Stomach

Question 59

Which of the following does NOT connect with the duodenum Stomach Pancreas Liver Ileum

Answer 59

Ileum

Question 60

Which of the following organs produces bile? Duodenum Pancreas gall bladder liver

Answer 60

liver

Question 61

The process of moving food from the oesophagus to the stomach is called: deglutition peristalsis bulk movement churning

Answer 61

peristalsis

Question 62

Which of the following organs contains and oblique smooth muscle layer, as well as a circular and longitudinal Oesophagus Stomach Small intestine Colon

Answer 62

Stomach

Question 63

What is the taenia coli? A nasty fungal infection A layer of fat in the colon A single layer of smooth muscle in the colon A fat tag hanging from the colon

Answer 63

A single layer of smooth muscle in the colon

Question 64

Which of the following cell types secretes acid in the stomach The enteroendocrine cell The chief cell The suface mucous cell the parietal cell

Answer 64

the parietal cell

Question 65

In which region of the gastrointestinal tract does protein digestion begin? mouth stomach duodenum pancreas

Answer 65

stomach

Question 66

In lipid digestion, in which region of the gastrointestinal tract are most micelles formed? Mouth Stomach Small intestine Colon

Answer 66

Small intestine

Question 67

Gastric acid breaks proteins into: Peptides Amino acids Proteins Saccharides

Answer 67

Peptides

Question 68

Which of the following enzymes DOES NOT digest peptides Pepsin Trypsin Amylase Carboxypeptidase

Answer 68

Amylase

Question 69

Which of the following enzymes digests complex polysaccharides such as starch maltase lactase sucrase amylase

Answer 69

amylase

Question 70

How is glucose absorbed into epithelial cells in the small intestine By diffusion By carrier mediated passive transport By primary active transport By secondary active transport

Answer 70

By secondary active transport

Question 71

To be absorbed into cells, triglycerides must be: Converted to amino acids Converted to fatty acids Transported into cells with glucose Attached to bananas

Answer 71

Converted to fatty acids

Question 72

Which of the following macronutrients is transported from the intestines in the lymphatic system? Carbohydrates triglycerides Amino acids

Answer 72

triglycerides

Question 73

Which of the following defines gastritis? Ulcer formation in the stomach or duodenum reflux of gastric content into the oesophagus inflammation in the lining of the stomach

Answer 73

inflammation in the lining of the stomach

Question 74

Which of the following is unlikely to lead to gastritis? smoking alcohol consumption sugary food consumption H pylori infection

Answer 74

sugary food consumption

Question 75

which of the following is TRUE? PUD often leads to GORD Gastritis often causes GORD Gastritis can cause PUD GORD very often leads to PUD

Answer 75

Gastritis can cause PUD

Question 76

Which of the following would provide immediate relief from discomfort in PUD and GORD antiacids histamine receptor antagonists proton pump inhibitors NSAID's

Answer 76

antiacids

Question 77

Which region of the GI tract is PUD least likely to affect? the oesophagus the stomach the small intestines

Answer 77

the oesophagus

Question 78

Which of the following is not a component of the mucosal protection barrier Tight junctions between epithelial cells acid secretion by parietal cells Alkaline mucus on the gastric surface Rapid turnover of gastric epuithelial cells

Answer 78

acid secretion by parietal cells

Question 79

Carbohydrates

Answer 79

For metabolism (and some structures in cells)

Question 80

Proteins

Answer 80

Structural and functional elements of the body such as excess amino acids used as an energy source

Question 81

Lipids

Answer 81

Structural components such as myelin sheaths, cell membranes

Question 82

The mechanism of action of Maxalon (metoclopramide) is: 1st generation antihistamine. Acts on vestibular apparatus and vomiting centre Serotonin receptor antagonist. Acts on the vagal feedback from intestines and the chemical trigger zone Dopamine receptor antagonist. Acts on chemical trigger zone to inhibit vomiting Serotonin receptor antagonist. Acts on vestibular apparatus and vagal feedback

Answer 82

Dopamine receptor antagonist. Acts on chemical trigger zone to inhibit vomiting

Question 83

Peptic ulcer disease is commonly caused by: Show answer choices smoking and alcohol abuse helicobacter pylori and the use of NSAIDs excessive intake of acidic foods and alcohol genetic predisposition

Answer 83

helicobacter pylori and the use of NSAIDs

Question 84

Pain from Peptic ulcer disease is often located in: Show answer choices mucosa in the stomach X The duodenum X small intestine Epigastrium

Question 85

A patient who has gastroesophageal reflux disease (GORD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GORD is needed? Show answer choices "I take antacids between meals and at bedtime each night" "I sleep with the head of the bed elevated on 4-inch blocks" "I eat small meals during the day and have a bedtime snack" "I quite smoking several years ago, but I still chew a lot of gum"

Answer 85

"I eat small meals during the day and have a bedtime snack"

Question 86

This is scenario 2 from your Tutorial worksheet. Marissa is a 40-year-old female, recently diagnosed with Peptic Ulcer Disease (PUD) who has been admitted with a potential Upper GI bleed and on the endoscopy list. You observe she is clammy and pale. She presents with melena, concentrated urine and states she has not been able to tolerate food and only small sips of fluid. You conduct an abdominal assessment and she has hyperactive bowel sounds with tenderness in the upper left quadrant. She states prior to this she has had occasions of epigastric pain, reduced appetite and weight loss over the last few weeks. Her vital signs are: HR- 123, BP 98/61, O2 sats 99%, RR- 24, Pain score 5/10, Weight 51kg, Height 175cm. Identify 2 (two) appropriate problem statements below: Show answer choices Marissa is experiencing deficient fluid volume related to acute loss of blood as evidenced by hypotension, concentrated urine and melena. Marissa is experiencing moderate pain related to PUD and potential bleed as evidenced by upper abdominal tenderness and pain score of 5/10. Marissa is experiencing hypervolemia related to acute loss of blood as evidenced by hypertension, concentrated urine and melena. Marissa is experiencing minimal pain related to PUD and potential bleed as evidenced by lower abdominal tenderness and pain score on 5/10.

Answer 86

Marissa is experiencing deficient fluid volume related to acute loss of blood as evidenced by hypotension, concentrated urine and melena. Marissa is experiencing moderate pain related to PUD and potential bleed as evidenced by upper abdominal tenderness and pain score of 5/10.

Question 87

On observing Janice's mouth, you notice creaming white lesions on the tongue and her inner cheeks. You determine it could be oral thrush. What is the name of the fungus responsible? Show answer choices Histoplasmosis Aspergillosis Cryptococcus neoformans Candida albicans

Answer 87

Candida albicans

Question 88

T/F Is this statement true or false? A Proton Pump Inhibitor (PPI) blocks the Histamine H2 receptor on the basal surface of the gastric parietal cell and hence prevents sequence of reactions that eventually prevents the phosphorylates of the proton pump to stop pumping H+ into the gastric lumen.

Answer 88

True