Ch 55 (med-surg)

A patient is diagnosed with a duodenal ulcer caused by H. pylori infection. The patient asks the nurse how this infection was contracted. How does the nurse respond?

" H. pylori infection is thought to be transmitted by consuming raw or unwashed foods." Although it is not entirely clear how H. pylori is transmitted, it is believed to be spread through contaminated food or water. Studies have also suggested that contact with stool, vomit, and sometimes saliva of an infected person can spread the infection. Human immunodeficiency virus is contracted through contact with infected blood or body fluids. Mycobacterium tuberculosis, the organism that causes tuberculosis, is typically contracted via inhaled droplets.

A patient is prescribed sucralfate to treat symptoms of peptic ulcer disease. What information does the nurse include when teaching the patient about this medication?

"Consume a high-fiber diet to minimize constipation." The main side effect of sucralfate is constipation, so the nurse should teach the patient about measures to minimize this. Meals at bedtime are not recommended with peptic ulcer disease, and patients should avoid alcohol. Sucralfate should be taken on an empty stomach.

Which statements should the nurse include when teaching patients and their families regarding prevention of gastritis? Select all that apply.

"Eating a well-balanced diet is important." "Alcoholic beverages in excessive amounts should be avoided." "Excessive intake of coffee or even decaffeinated drinks should be avoided." "Protection against exposure to toxic substances in the workplace should be practiced." A healthy lifestyle comprising a well-balanced diet helps to prevent complications. Excessive alcohol and caffeinated and decaffeinated drinks can lead to gastritis in adults, and these drinks should be avoided. A patient who is exposed to toxic substances, such as lead or nickel, at his or her workplace is also susceptible to gastric problems. Foods with strong spices such as pepper and mustard should be avoided because they can cause gastric distress. The use of proton pump inhibitors is reserved for patients who are already suffering from severe gastritis.

A patient asks the nurse how an infection such as H. pylori can cause gastric ulcers. What does the nurse tell the patient about this organism?

"It produces an enzyme that alters the pH of the gastric environment." H. pylori secretes urease, which produces ammonia, causing the gastric environment to become alkaline. This causes the release of hydrogen ions and increased acid, which causes mucosal damage. The organism does not damage the mucosa directly or secrete acid. It does not affect pyloric sphincter function.

A patient with chronic gastritis who is ordered to take vitamin B 12 asks the nurse why this vitamin is necessary. What does the nurse tell the patient about vitamin B 12?

"It will prevent a type of anemia." Patients who have chronic gastritis usually develop pernicious anemia, which may be prevented or treated with vitamin B 12. Vitamin B 12 does not affect the symptoms of gastritis, protect stomach lining, or minimize reflux.

The nurse inserts a nasogastric (NG) tube for gastric lavage in a patient who is vomiting blood. What is the appropriate practice for gastric lavage?

A large-bore NG tube is required for gastric lavage. A large-bore NG tube is required for gastric lavage to accommodate the large volumes of fluid flowing in and out of the tube. Water at room temperature is appropriate for lavage, not cold water. A sample of the gastric contents is aspirated using a 50-mL catheter-tipped syringe. There is no evidence that sterile saline is better than tap water for gastric lavage; either can be used.

The endoscopy of a patient reveals a reddened and thick mucosal membrane around the stomach with prominent rugae. What condition does the patient have?

Acute gastritis In acute gastritis, the gastric mucosa becomes red and thickened with prominent rugae due to inflammation from being exposed to local irritants. Chronic gastritis appears as a patchy, spread out inflammation of mucosal lining of the stomach. Atrophic gastritis is a type of chronic gastritis most often found in older adults. Type A chronic gastritis is also associated with inflammation of glands, whereas Type B chronic gastritis mainly involves the glands of the antrum.

Which self-management measure will the nurse teach the patient with gastritis?

Avoid exposure to lead Atrophic gastritis is a kind of chronic gastritis that is commonly seen in patients exposed to toxic substances such as lead. Therefore exposure to metals such as lead should be limited. The patient should avoid excessive intake of both caffeinated and decaffeinated coffee. The patient with gastritis should quit smoking or tobacco use entirely because it aggravates the condition. The patient may not need to completely avoid NSAIDs but should exercise caution when taking them.

Which is the most serious complication of peptic ulcer disease that a nurse should check for in an older patient?

Hemorrhage The most serious complication of peptic ulcer disease in older adults is hemorrhage. This hemorrhage can be worsened with H. pylori infection; this condition may result in tarry or dark sticky stools and bright red vomitus. Perforations can occur when the ulcer is deep enough to wear away the entire membrane of the stomach and duodenum. Pyloric obstruction occurs in a small percentage of patients. Intractable diseases can occur if there are a lot of stressors in a patient's lifestyle (such as alcoholic beverages) and if the patient is unable to adhere to long-term therapy.

The nurse is caring for a patient and is monitoring the patient regularly for acute gastritis with bleeding. Which medication class most likely causes the nurse to believe the patient is at risk for this disorder?

Nonsteroidal antiinflammatory drugs (NSAIDs) Chronic use of NSAIDs can result in gastritis and, in serious cases, bleeding or hemorrhage. ACE inhibitors have no gastric side effects. PPIs are used to treat gastritis and ulcers; they do not cause either condition. Narcotic analgesics are not implicated in gastritis.

A patient who has chronic gastritis is at increased risk for which condition?

Pernicious anemia Patients with chronic gastritis lose function of the parietal cells and thus the source of intrinsic factor leading to vitamin B 12 deficiency and pernicious anemia. It does not cause an increased risk of appendicitis, chronic constipation, or irritable bowel syndrome.

A nutritionist is asked to assist in forming a plan for a patient with peptic ulcer disease (PUD). Which recommendation is most helpful for this patient?

Reducing caffeine intake Caffeine, specifically coffee, stimulates gastrin release, which worsens PUD. Marshmallow root is recommended for PUD treatment, but marshmallows do not contain marshmallow root. Ipecac induces vomiting, which is not beneficial to the patient with PUD. Spicy foods worsen most stomach disorders and diseases.

The nurse is assessing the nature of abdominal pain in a patient with a suspected peptic ulcer. What feature of the pain points towards a diagnosis of gastric ulcer?

The pain is worsened by the ingestion of food. Pain due to a gastric ulcer usually worsens after the intake of food. Pain on the right of the epigastrium is often due to a duodenal ulcer. Pain due to a gastric ulcer is often in the upper epigastrium with localization to the left of the midline. It usually occurs 30 to 60 minutes after a meal and is rare at night. Pain associated with a duodenal ulcer occurs 90 minutes to 3 hours after a meal and the patient often wakes up between 1 and 2 AM due to pain.

Which pathologic changes can occur in a patient with gastritis? Select all that apply.

Vascular congestion Acute inflammatory cell infiltration Degenerative changes in the superficial epithelium of the stomach lining In gastritis, due to the breakdown of the gastrointestinal barrier, hydrochloric acid diffuses into the mucosa and causes injury to small vessels. This can cause vascular congestion and acute inflammatory cell infiltration. This diffusion also causes erosion of the superficial epithelium of the stomach lining. Prostaglandins provide a protective mucosal barrier that prevents the stomach from digesting itself. Histamine release and vagus nerve stimulation are aggravating factors that may cause pathological changes in gastritis, but these are not changes caused by gastritis.

Which organ is usually affected in chronic atrophic gastritis?

deeply located glands Chronic atrophic gastritis causes inflammation and destruction of deeply located glands and affects all layers of the stomach. Type B chronic gastritis usually affects the glands of the antrum and can also involve the entire stomach. Type A (nonerosive) chronic gastritis leads to inflammation of the fundus and body of the stomach.

A patient with peptic ulcer disease (PUD) asks the nurse whether a maternal history of gastric cancer will cause the patient to develop gastric cancer. What is the nurse's best response?

"If you are concerned that you are at high risk, I recommend speaking to your provider about the possibility of genetic testing." Genetic counseling will help the patient determine whether he or she is at exceptionally high risk to develop gastric cancer. The patient cannot know for certain whether family history places him or her at exceptionally high risk to develop gastric cancer unless specific testing is done. Asking the patient what the provider has said is an evasive answer by the nurse and does not help answer the patient's question. Although a diet high in pickled, salted, and processed foods does increase the risk for gastric cancer, a family history of specific types of cancer can also increase the risk.

A patient who currently takes phenytoin has been started on a multidrug regimen for treatment of peptic ulcer disease. What does the nurse tell this patient about taking these medications?

"Take the phenytoin 1 to 2 hours before or after the antacid." Antacids may interfere with the effectiveness of phenytoin, so patients should be taught to take them 1 to 2 hours apart. It is not necessary to discontinue the phenytoin; phenytoin does not increase the effects of the antacid.

A patient with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response?

"These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." Although licorice and slippery elm may be helpful in managing PUD, the patient should consult his or her health care provider before making a change in the treatment regimen. Alternative therapies may or may not be helpful in managing PUD. The patient should not use over-the-counter medications without first discussing it with his or her provider.

A patient tells the nurse that calcium carbonate has been effective in treating the discomfort associated with peptic ulcer disease. What does the nurse tell this patient?

"Tums will cause rebound acid secretion, which will make symptoms worse." Calcium carbonate is a potent antacid, but it triggers gastrin release, which causes rebound acid secretion. Therefore it is not recommended for a patient with peptic ulcer disease. Calcium carbonate does not affect ulcer healing.

The nurse is teaching a patient about self-management of gastritis. Which piece of education is appropriate?

"Use complementary and alternative therapies." Using complementary and alternative therapies such as relaxation and meditation can help manage stress and discomfort, both of which can cause gastritis to worsen. Drinking coffee, whether it is caffeinated or decaffeinated, should be avoided because coffee contains peptides that stimulate gastrin release. Tomato products and onions are common irritating foods and should be avoided. Aspirin and other NSAIDs should be avoided because they may enhance acid production and further agitate gastritis.

The nurse finds a patient vomiting coffee ground-type emesis. On assessment, the patient has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority?

Administering intravenous (IV) fluids Administering IV fluids is necessary to treat the hypovolemia caused by acute gastrointestinal (GI) bleeding. Administration of an H 2 antagonist will not treat the basic problem, which is upper GI bleeding. Enteral nutrition will not be part of the treatment plan for acute GI bleeding. Administration of antianxiety medication will not treat the basic problem causing the patient's change in mental status, which is hypovolemia.

The nurse is caring for a patient who has just returned from an endoscopic procedure. His wife verbalizes that the patient must be hungry. Which initial action by the nurse is correct?

Assess for a gag reflex Following an endoscopic procedure, the patient should not be allowed any foods or fluids until the gag reflex has been assessed for prevention of aspiration. The patient's wife should be instructed to refrain from providing foods or fluids. It is not necessary to obtain a dietitian consult or an order for nasogastric tube insertion.

Which disorder in older adults may have a direct association with mucosa-associated lymphoid tissue (MALT) lymphoma?

Atrophic gastritis

A patient with extensive burns reports severe abdominal pain and blood-tinged vomitus. Which ulcers might be the reason behind the patient's condition?

Curling's ulcer Curling's ulcers occur due to excessive stress hormones in the body. A patient suffering from extensive burns would be under extreme stress and would be susceptible to Curling's ulcers. Peptic ulcers occur when the mucosal barrier is disrupted due to gastrointestinal problems. Ischemic ulcers are associated with patients suffering from sepsis. Cushing's ulcers are found in patients with increased intracranial pressure.

Which area of the body is a location for gastric ulcers?

In the antrum of the stomach Gastric ulcers appear in the antrum of the stomach. Stress ulcers may be found on the proximal duodenum. Duodenal ulcers occur in the upper portion of the duodenum and penetrate through the mucosa and submucosa into the muscularis propria.

What statement about type A gastritis is most accurate?

It is associated with pernicious anemia. A genetic link to type A gastritis has been found in the relatives of those who have pernicious anemia. The gene has an autosomal dominant pattern of inheritance. Type B gastritis is most often caused by H. pylori infection. Atrophic gastritis may occur due to exposure to toxins such as benzene or lead.

A patient with a history of heart failure is to be prescribed an antacid to help with symptoms of peptic ulcer disease. Which antacid does the nurse expect the provider to order for this patient?

Magaldrate Magaldrate contains the lowest sodium concentration and should be ordered for this patient. Patients with a history of heart failure should avoid antacids with a high sodium content such as aluminum hydroxide and magnesium hydroxide. Calcium carbonate is not recommended as an antacid because of the risk of rebound acid secretion.

A patient who has peptic ulcer disease has developed pyloric obstruction. The nurse monitors the patient's laboratory values closely to assess for which complication?

Metabolic alkalosis Metabolic alkalosis is a complication of pyloric obstruction due to persistent vomiting. Patients who develop pyloric obstruction will have vomiting and hypokalemia (not hyperkalemia). Hypernatremia and metabolic acidosis are not associated with pyloric obstruction.

The nurse is reviewing the medications prescribed for a patient with peptic ulcer disease (PUD). Which drug is the patient taking to treat Helicobacter pylori infection?

Metronidazole Metronidazole is an antimicrobial that treats H. pylori infection. Aluminum hydroxide is an antacid that deactivates pepsin and buffers the acid produced in the stomach. Pantoprazole is a proton pump inhibitor that suppresses the H, K-ATPase enzyme system and regulates gastric acid secretion. Nizatidine is an H 2 antagonist that blocks histamine receptors in parietal cells and decreases gastric acid secretion.

The nurse is performing a health history on a patient who is newly diagnosed with peptic ulcer disease (PUD). Which condition in the patient's history prompts the nurse to question the patient further?

Osteoarthritis Nonsteroidal anti-inflammatory drugs are a major cause of PUD and are often used by patients who have arthritis; a report of osteoarthritis should prompt the nurse to explore types of treatments the patient is using. Cardiovascular disease, hyperlipidemia, and urinary tract infections do not predispose patients to PUD.

The nurse is caring for an older adult male patient who reports stomach pain and heartburn. Which characteristic is most significant in determining whether the patient's ulceration is gastric or duodenal in origin?

Pain occurs 1½ to 3 hours after a meal, usually at night. A key symptom of duodenal ulcers is that pain usually awakens the patient between 1 AM and 2 AM, occurring 1½ to 3 hours after a meal. Pain that is worsened with ingestion of food and a malnourished appearance are key features of gastric ulcers. A male over 50 years is a finding that could apply to either type of ulcer.

What are the key features of chronic gastritis? Select all that apply.

Pernicious anemia Nausea and vomiting Intolerance to fatty food

A patient has been diagnosed with rheumatoid arthritis and has a history of peptic ulcer disease (PUD). The physician has decided to prescribe misoprostol to help prevent further gastric damage. What concurrent condition should be ruled out prior to starting this medication?

Pregnancy Misoprostol has two indications: protection of stomach lining and induction of labor. Therefore, the drug should not be given to a pregnant patient unless she is under the care of an obstetrician. Rheumatoid arthritis is an autoimmune disorder. Anemia can accompany peptic ulcer disease and is not a contraindication for misoprostol use. Fecal incontinence is not a contraindication for misoprostol use.

Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN?

Reinforce the teaching about avoiding alcohol and caffeine for a patient with chronic gastritis Reinforcement of teaching done by the RN is within the scope of practice for an LPN/LVN. Retaping the nasogastric tube for a patient who has had a subtotal gastrectomy and vagotomy is a complex task that should be done by the RN. Assessment and documenting instructions about how to use triple therapy are nursing functions that should be done by the RN.

The nurse is assessing a patient who reports episodes of pain in the abdomen. What feature suggests the possibility of a duodenal ulcer?

The patient has type O blood. Patients with duodenal ulcers most often have type O blood. They are usually 50 years or older and are often well-nourished. Another key feature of a duodenal ulcer is a high secretion of gastric acid; abdominal pain due to a duodenal ulcer is therefore relieved by the ingestion of food. Pain usually occurs again about 90 minutes to 3 hours after eating food.

The nurse is caring for a patient who has granular dark vomitus that resembles coffee grounds. Which type of ulcer does the nurse suspect in this patient?

gastric The vomitus of patients with a gastric ulcer is more likely to resemble coffee grounds. Patients with duodenal ulcers generally pass blood in the stool. Esophageal ulcer bleeding is usually bright red. Pyloric obstruction does present with vomiting, but not typically with blood in the vomitus.