GI surgeries/procedures (7)

A nurse assesses a client who is recovering from a Whipple procedure. Which assessment finding alerts the nurse to urgently contact the health care provider? a. Drainage from a fistula b. Absent bowel sounds c. Pain at the incision site d. Nasogastric (NG) tube drainage

ANS: A Complications of a Whipple procedure include secretions that drain from a fistula and peritonitis. Absent bowel sounds, pain at the incision site, and NG tube drainage are normal postoperative findings.

A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be most helpful? a. Arrange a dietary consult. b. Increase fluid intake. c. Limit the clients foods. d. Make the client NPO.

ANS: A The client with dumping syndrome after a gastrectomy has multiple dietary needs. A referral to the registered dietitian will be extremely helpful. Food and fluid intake is complicated and needs planning. The client should not be NPO

A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition? (Select all that apply.) a. Canned unsweetened apricots b. Coffee cake c. Milk shake d. Potato soup e. Steamed broccoli

ANS: A, D Canned apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, low- to moderate-carbohydrate diet. Coffee cake and other sweets must be avoided. Milk products and sweet drinks such as shakes must be avoided. Gas-forming foods such as broccoli must also be avoided

The nurse anticipates that the patient who has had a subtotal gastrectomy will need supplemental: a. protein due to the loss of some of the digestive processes. b. vitamin B12 due to the loss of the intrinsic factor. c. bulk to prevent constipation. d. vitamin A due to the loss of the gastric lining.

ANS: B It is recommended that all patients with a gastrectomy have a blood serum vitamin B12 level measured every 1 to 2 years. Decreased absorption of vitamin B12 may cause pernicious anemia.

After bariatric surgery, a patient who is being discharged tells the nurse, I prefer to be independent. I am not interested in any support groups. Which response by the nurse is best? A) I hope you change your mind so that I can suggest a group for you. B) Tell me what types of resources you think you might use after this surgery. C) Support groups have been found to lead to more successful weight loss after surgery. D) Because there are many lifestyle changes after surgery, we recommend support groups.

ANS: B This statement allows the nurse to assess the individual patients potential needs and preferences. The other statements offer the patient more information about the benefits of support groups, but fail to acknowledge the patients preferences.

nurse cares for a client who is recovering from an open Whipple procedure. Which action should the nurse take? a. Clamp the nasogastric tube. b. Place the client in semi-Fowlers position. c. Assess vital signs once every shift. d. Provide oral rehydration.

ANS: B Postoperative care for a client recovering from an open Whipple procedure should include placing the client in a semi-Fowlers position to reduce tension on the suture line and anastomosis sites, setting the nasogastric tube to low suction to remove free air buildup and pressure, assessing vital signs frequently to assess fluid and electrolyte complications, and providing intravenous fluids.

nurse assesses a client who is recovering from a Whipple procedure. Which clinical manifestations alert the nurse to a complication from this procedure? (Select all that apply.) a. Clay-colored stools b. Substernal chest pain c. Shortness of breath d. Lack of bowel sounds or flatus e. Urine output of 20 mL/6 hr

ANS: B, C, D, E Myocardial infarction (chest pain), pulmonary embolism (shortness of breath), adynamic ileus (lack of bowel sounds or flatus), and renal failure (urine output of 20 mL/6 hr) are just some of the complications for which the nurse must assess the client after the Whipple procedure. Clay-colored stools are associated with cholecystitis and are not a complication of a Whipple procedure.

The nurse will be teaching self-management to patients after gastric bypass surgery. Which information will the nurse plan to include? A) Drink fluids between meals but not with meals. B) Choose high-fat foods for at least 30% of intake. C) Developing flabby skin can be prevented by exercise. D) Choose foods high in fiber to promote bowel function.

Ans: A Intake of fluids with meals tends to cause dumping syndrome and diarrhea. Food choices should be low in fat and fiber. Exercise does not prevent the development of flabby skin.

The nurse is caring for a 54-year-old female patient on the first postoperative day after a Roux-en-Y gastric bypass procedure. Which assessment finding should be reported immediately to the surgeon? A) Bilateral crackles audible at both lung bases B) Redness, irritation, and skin breakdown in skinfolds C) Emesis of bile-colored fluid past the nasogastric (NG) tube D) Use of patient-controlled analgesia (PCA) several times an hour for pain

ANS: C Vomiting with an NG tube in place indicates that the NG tube needs to be repositioned by the surgeon to avoid putting stress on the gastric sutures. The nurse should implement actions to decrease skin irritation and have the patient cough and deep breathe, but these do not indicate a need for rapid notification of the surgeon. Frequent PCA use after bariatric surgery is expected.

A client is in the bariatric clinic 1 month after having gastric bypass surgery. The client is crying and says I didnt know it would be this hard to live like this. What response by the nurse is best? A) Assess the clients coping and support systems. B) Inform the client that things will get easier. C) Re-educate the client on needed dietary changes. D) Tell the client lifestyle changes are always hard.

Ans: A Feedback: The nurse should assess this clients coping styles and support systems in order to provide holistic care. The other options do not address the clients distress.

Dumping syndrome after a Billroth II procedure occurs when high-carbohydrate foods are ingested over a period of less than 20 minutes. What would the nurse suggest to reduce the risk of dumping syndrome? a. Eating a high-carbohydrate diet b. Drinking 10 oz of fluids with meals c. Remaining upright for 2 hours after meals d. Eating six small daily meals high in protein and fat

ANS: D Treatment for dumping syndrome includes eating six small meals daily that are high in protein and fat, and low in carbohydrates. Fluids should be avoided during meals. If possible, the patient should lie down for 1 hour after meals.

A nurse, writing a nursing diagnosis in the care plan for a female client after bariatric surgery, should write, "Risk for nausea related to: 1. overfilling of the stomach pouch." 2. being female." 3. the lower half of the stomach becoming spastic." 4. handling of the duodenum with resulting inflammatory response."

ANSWER: 1 Bariatric surgery results in the construction of a small pouch (10-30 mL) in the upper part of the stomach. Overfilling of this pouch stimulates afferent nerve fibers, which relay information to the chemoreceptor trigger zone in the brain. Bariatric surgery is performed on both men and women. The function of the lower half of the stomach is not affected by this surgery, and the duodenum is not handled during this surgery. ➧ Test-taking Tip: Since the second half of a nursing diagnosis (the related to part) should focus on signs and symptoms for nursing interventions, select option 1, since the nurse can intervene with this situation. Understanding the causes of nausea and knowledge of the generic bariatric surgical procedure is required to answer correctly.

Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en-Y gastric bypass? A) Educating the patient about the nasogastric (NG) tube B) Instructing the patient on coughing and breathing techniques C) Discussing necessary postoperative modifications in lifestyle D) Demonstrating passive range-of-motion exercises for the legs

Ans: B Feedback: Coughing and deep breathing can prevent major postoperative complications such as carbon monoxide retention and hypoxemia. Information about passive range of motion, the NG tube, and postoperative modifications in lifestyle will also be discussed, but avoidance of respiratory complications is the priority goal after surgery.

A client is awaiting bariatric surgery in the morning. What action by the nurse is most important? A) Answering questions the client has about surgery B) Beginning venous thromboembolism prophylaxis C) Informing the client that he or she will be out of bed tomorrow D) Teaching the client about needed dietary changes

Ans: B Feedback: Morbidly obese clients are at high risk of venous thromboembolism and should be started on a regimen to prevent this from occurring as a priority. Answering questions about the surgery is done by the surgeon. Teaching is important, but safety comes first.

A patient who underwent gastric banding 3 days ago is having her diet progressed on a daily basis. Following her latest meal, the patient complains of dizziness and palpitations. Inspection reveals that the patient is diaphoretic. What is the nurses best action? A) Insert a nasogastric tube promptly. B) Reposition the patient supine. C) Monitor the patient closely for further signs of dumping syndrome. D) Assess the patient for signs and symptoms of aspiration.

Ans: C Feedback: The patients symptoms are characteristic of dumping syndrome, which results in a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. Aspiration is a less likely cause for the patients symptoms. Supine positioning will likely exacerbate the symptoms and insertion of an NG tube is contraindicated due to the nature of the patients surgery

A 61-year-old man is being admitted for bariatric surgery. Which nursing action can the nurse delegate to unlicensed assistive personnel (UAP)? A) Demonstrate use of the incentive spirometer. B) Plan methods for bathing and turning the patient. C) Assist with IV insertion by holding adipose tissue out of the way. D) Develop strategies to provide privacy and decrease embarrassment.

Ans: C UAP can assist with IV placement by assisting with patient positioning or holding skinfolds aside. Planning for care and patient teaching require registered nurse (RN)level education and scope of practice.

A client just returned to the surgical unit after a gastric bypass. What action by the nurse is the priority? A) Assess the clients pain. B) Check the surgical incision. C) Ensure an adequate airway. D) Program the morphine pump.

Ans: C Feedback: All actions are appropriate care measures for this client; however, airway is always the priority. Bariatric clients tend to have short, thick necks that complicate airway management.

After vertical banded gastroplasty, a 42-year-old male patient returns to the surgical nursing unit with a nasogastric tube to low, intermittent suction and a patient-controlled analgesia (PCA) machine for pain control. Which nursing action should be included in the postoperative plan of care? A) Offer sips of fruit juices at frequent intervals. B) Irrigate the nasogastric (NG) tube frequently. C) Remind the patient that PCA use may slow the return of bowel function. D) Support the surgical incision during patient coughing and turning in bed.

Ans: D Feedback: The incision should be protected from strain to decrease the risk for wound dehiscence. The patient should be encouraged to use the PCA because pain control will improve the cough effort and patient mobility. NG irrigation may damage the suture line or overfill the stomach pouch. Sugar-free clear liquids are offered during the immediate postoperative time to decrease the risk for dumping syndrome.