Hesi GI

The nurse provides information to the client about measures to treat gastrointestional esophageal reflux disease (GERD). Which statement by the client indicates the need for further teaching?

"I should lie down for at least an hour after I eat

Assessment findings in chronic pancreatitis

Abdominal pain and tenderness Left upper quadrant mass Steatorrhea and foul-smelling stools Weight loss, muscle wasting Jaundice Signs and symptoms of diabetes mellitus

Assessment findings for ulcerative colitis

Anorexia and weight loss Abdominal tenderness and cramping Severe diarrhea that may contain blood and mucus Dehydration and electrolyte imbalances Anemia Vitamin K deficiency

The nurse should include which information in the preoperative plan of care for a client with appendicitis? Select all that apply.

Apply an ice bag to the abdomen Insert an intravenous (IV) line and infuse IV fluids as prescribed

Hemorrhoids nursing considerations

Apply cold packs or witch hazel soaks and topical anesthetics to the anorectal area. Sitz baths may relieve discomfort. Encourage a high-fiber diet, fluids, and stool softeners.

A nurse provides home care instructions to a client who has been hospitalized for acute diverticular disease. Which instruction should the nurse give the client to prevent the occurrence of an acute episode?

Avoid lifting, straining, or coughing.

A nurse caring for a client with acute pancreatitis looks for the Cullen sign. Which finding should the nurse look for?

Bluish discoloration of the abdomen and periumbilical area

Virtual Colonoscopy

Combines computed tomography (CT) scanning or magnetic resonsnce imaging (MRI) with computer virtual reality software to detect intestine and colon diseases. Air is introduced via a tube placed in the rectum to enlarge the colon to enhance visualization.

The nurse is providing preprocedure instructions to a client who is scheduled for a endoscopic colonoscopy. Which teaching should be provided to the client?

Complete bowel preparation is necessary before the procedure

Crohn Disease assessment findings

Crampy, colicky pain after meals Diarrhea (semisolid), possibly containing mucus and pus Abdominal distention Anorexia, nausea and vomiting Weight loss Anemia Dehydration Electrolyte imbalances Signs of malnutrition

Vitamin B12 Deficiency

Deficiency results from inadequate intake of vitamin B12 or inadequate absorption of vitamin B12 ingested from the intestinal tract . Pernicious anemia results from deficiency of intrinsic factor, which is necessary for intestinal absorption of vitamin B12. Gastric disease or surgery can result in a lack of intrinsic factor.

Hemorrhoids

Dilated varicose veins of the anal canal may result from portal hypertension, straining at stool, irritation, or increased venous or abdominal pressure. The affected individual experiences bright-red bleeding with defecation and rectal pain and itching.

Diverticulosis and Diverticulitis Nursing Considerations

During the acute phase, the client is restricted to bed rest; enforce NPO status or provide clear liquids as prescribed. A fiber-containing diet is introduced gradually, once inflammation has resolved. Antibiotics, analgesics, and anticholinergics may be prescribed to reduce bowel spasms . Instruct the client to refrain from lifting, straining, coughing, or bending to help prevent increased intraabdominal pressure. Monitor the client for signs of perforation, hemorrhage, fistulas, and abscesses. Instruct the client to increase fluid intake to 2500 to 3000 mL daily, unless contraindicated. Instruct the client to eat soft high-fiber foods, such as whole grains, but to avoid high-fiber foods when inflammation occurs, because these foods will irritate the mucosa further. Instruct the client to avoid gas-forming foods and foods containing indigestible roughage, seeds, or nuts, which can become trapped in diverticula, resulting in inflammation . Instruct the client to consume a small amount of bran daily and to take bulk-forming laxatives as prescribed to increase stool mass.

Liver Biopsy nursing considerations

Ensure that the client is placed in the supine or left lateral position during the procedure to expose the right side of the upper abdomen. Restrict the client to bed for several hours after the procedure as prescribed; ensure that the client is placed on the right side for 2 hours with a pillow under the costal margin to splint the puncture site. Instruct the client to avoid coughing or straining after the procedure and to avoid heavy lifting and strenuous exercise for 1 week.

Dumping Syndrome

Gastric contents are rapidly emptied into the small intestine. Dumping may occur after gastric resection.

nursing considerations for Paracentesis

Have the client void before the procedure to move the bladder out of the way of the paracentesis needle. Measure abdominal girth, weight, and baseline vital signs before paracentesis. Ensure that the client is positioned upright on the edge of the bed with the back supported and the feet resting on a stool. (The semi-Fowler position is used for the client confined to bed.) . Apply a dry sterile dressing to the insertion site and monitor the site for bleeding. Measure abdominal girth and weight after the procedure. Monitor the client for hematuria resulting from bladder trauma.

A nurse preparing to administer a tube feeding checks the nasogastric tube for placement and residual volume. The nurse determines that the tube is correctly placed but aspirates 275 mL of contents from the client's stomach. Which action by the nurse is appropriate?

Hold the feeding and notifying the health care provider of the volume of aspirate If a large volume of aspirate (250 mL or more) is obtained, the aspirate is returned to the client's stomach (unless it is abnormal), the feeding is withheld

A nurse provides home care instructions to a client with acute hepatitis. Which statement by the client indicates a need for further teaching?

I need to maintain my normal physical activity and daily routine. A client with hepatitis needs considerable rest during the acute phase of illness to promote healing of the liver.

Hepatobiliary Procedures

In endoscopic retrograde cholangiopancreatography, perhaps better known as ERCP, the hepatobiliary system is examined by way of a flexible endoscope inserted into the esophagus to the descending duodenum. Multiple positions are required during ERCP to facilitate passage of the endoscope.

Hiatal Hernia

In this condition, also known as esophageal or diaphragmatic hernia, a portion of the stomach herniates through the diaphragm and into the thorax. results from weakening of the muscles of the diaphragm but is aggravated by factors that increase abdominal pressure (e.g., pregnancy, ascites obesity, tumors, heavy lifting). Assessment findings include complaints of heartburn, regurgitation or vomiting, and a feeling of fullness.

Liver Biopsy

In this invasive procedure, a needle is inserted through the abdominal wall and into the liver to obtain a tissue sample for biopsy and microscopic examination.

Upper Gastrointestinal Tract Study

In this test, perhaps better known as a barium swallow, fluoroscopic examination of the upper GI tract is performed after the client has drunk barium sulfate.

Duodenal Ulcers

In this type of ulcer, the break occurs in the duodenal mucosa. The affected individual experiences burning pain in the midepigastric area 1½ to 3 hours after eating and during the night (often relieved by eating) and melena.

Nursing Considerations for dumping syndrome

Instruct the client to consume a high-protein, high-fat, low-carbohydrate diet. The client should eat small, frequent meals and avoid consuming fluids with meals. Milk, sweets, and other foods containing sugars should be avoided. The client should lie down after meals. Antispasmodic medications may be prescribed to delay gastric emptying.

Diverticulosis and Diverticulitis assessment findings

Left lower quadrant abdominal pain that increases with coughing, straining, or lifting Increased temperature Nausea and vomiting Flatulence, cramplike pain Abdominal distention and tenderness Palpable, tender rectal mass may be present Blood in stool

Peptic Ulcer Disease nursing considerations

Monitor the client for bleeding and take the appropriate measures if it occurs. Small, frequent bland feedings are appropriate during the active phase. Histamine H2-receptor antagonists and proton pump inhibitors may be prescribed to decrease secretion of gastric acid. Antacids may be prescribed to neutralize gastric secretions. Anticholinergics are used to reduce gastric motility. A mucosal barrier protectant may be administered 1 hour before meals. Prostaglandins are prescribed for their protective and antisecretory actions.

Nursing Considerations: Appendectomy

Monitor the client for changes in the level of pain. Position the client on the right side or low to semi-Fowler position to promote comfort. Apply ice packs to abdomen for 20 to 30 minutes every hour; avoid the application of heat to the abdomen, laxatives, or enemas, because they increase the risk of perforation.

The nurse assists a health care provider in performing a liver biopsy. In what position should the nurse place the client after the procedure?

On the right side

Assessment findings before rupture of appendicitis

Pain in the periumbilical area that descends to the right lower quadrant Abdominal pain that is most intense at the McBurney point Rebound tenderness Abdominal rigidity Low-grade fever Increased white blood cell count Anorexia and nausea and vomiting Self-positioning of client in a side-lying position, with abdominal guarding and the legs flexed

complications of cirrhosis

Portal hypertension Ascites, Bleeding esophageal varices, Coagulation defects Jaundice, Portal systemic encephalopathy, Hepatorenal syndrome

The nurse is assigned to care for a client who has had a Salem Sump tube, which will be attached to low continuous suction, inserted into the stomach. Which actions should the nurse plan to take? Select all that apply.

Positioning the client with the head of the bed elevated 30 degree Positioning the air vent lumen so that it is higher than the client's stomach Instilling 30 mL of air into the air vent and irrigating the main lumen with normal saline solution if leakage occurs through the air vent

Stool Specimens

Quantitative 24- to 72-hour collections must be kept refrigerated until they are taken to the laboratory.

A nurse is conducting the admission interview of a client with cholecystitis who is scheduled for laparoscopic cholecystectomy. Which finding does the nurse expect the client to report?

Right upper quadrant abdominal pain that radiates to the back and right shoulder after the client eats fatty food

Assessment findings of B-12 deficiency

Severe pallor Fatigue Weight loss Smooth, beefy-red tongue Paresthesias of hands and feet Disturbances of gait and balance

Acute pancreatitis assessment findings

Sudden-onset abdominal pain in the midepigastric area or left upper quadrant, radiating to the back and aggravated by fatty food, alcohol, or lying in a recumbent position Sudden-onset of abdominal pain Nausea and vomiting Cullen sign Turner sign Increased levels of lipase and amylase

dumping syndrome

Symptoms occurring 30 minutes after the client eats Nausea and vomiting Feelings of abdominal fullness and abdominal cramping Diarrhea Palpitations and tachycardia Diaphoresis Weakness and dizziness Borborygmus (loud gurgles indicating hyperperistalsis)

Appendicitis

The appendix becomes inflamed. Rupture may occur within hours, leading to peritonitis and sepsis. Treatment is surgical removal of appendix before perforation occurs.

nursing considerations of GERD

The client should avoid foods, drinks, and positions that decrease lower esophageal sphincter pressure or cause esophageal irritation. Advise the client to eat a low-fat, high-fiber diet and small frequent meals; minimize consumption of liquids at mealtimes; and avoid caffeine and carbonated beverages. Advise the client to avoid reclining for 1 hour after eating. The client should avoid eating and drinking for 2 hours before bedtime. Tight clothing can exacerbate GERD. Encourage the client to elevate the head of the bed on 6- to 8-inch blocks. Medications such as antacids, histamine H2-receptor antagonists and proton pump inhibitors which neutralize or decrease gastric acid secretions and prokinetic medications, which accelerate gastric emptying, may be prescribed; anticholinergics are avoided because they delay stomach emptying.

Nursing Considerations for barium swallow/ upper GI tract study

The client should not eat or drink after midnight before the day of the test. After the procedure, instruct the client to increase fluid intake to help pass the barium. Monitor the stools for the passage of barium (evidenced by chalky whiteness), because barium can cause bowel obstruction. A laxative may be prescribed if the client requires assistance in passing the barium.

esophagogastroduodenoscopy/Upper Gastrointestinal Endoscopy: nursing considerations

The client should not eat or drink for 6 to 12 hours before the test. A local anesthetic (spray or gargle) may be administered, along with a sedating medication, just before the scope is inserted. The client is positioned on the left side to facilitate saliva drainage and ease access of the endoscope. After the procedure, keep the client from eating or drinking until the gag reflex has returned. Monitor the client for signs of perforation (i.e., pain, bleeding, unusual difficulty in swallowing, increased temperature). Maintain bedrest until the sedated client has regained alertness. Lozenges, saline gargles, or oral analgesics may be used to relieve minor sore throat after the gag reflex returns.

Esophageal Varices

These dilated, tortuous veins in the submucosa of the esophagus are caused by portal hypertension. Varices are often associated with hepatic cirrhosis. The risk for rupture increases as portal circulation pressure increases; bleeding varices are a life-threatening emergency.

cirrhosis

This chronic progressive disease of the liver is characterized by diffuse repeated damage to hepatic cells resulting in fibrosis (see image, left) and nodular regeneration (right).

Crohn Disease

This inflammatory disease, which most often affects the terminal ileum, results in thickening and scarring, a narrowed lumen, fistulas, ulcerations, and abscesses. Disease may be external or internal. The disorder is characterized by remissions and exacerbations.

Upper Gastrointestinal Endoscopy

This invasive test is also known as esophagogastroduodenoscopy. After the client is sedated, an endoscope is passed down the esophagus to view the gastric wall, sphincters, and duodenum; tissue specimens may be obtained.

Ulcerative Colitis

This ulcerative and inflammatory disease of the bowel results in poor absorption of nutrients . The colon becomes edematous, and bleeding lesions and ulcers may develop; ulceration may lead to perforation. Scar tissue develops, resulting in loss of elasticity and loss of ability to absorb nutrients. The condition is characterized by various periods of remissions and exacerbations. Surgical intervention involves creation of an ostomy within the ileum (ileostomy) or at any of various sites within the large bowel (colostomy).

Gastric Ulcers

Ulceration of the mucosal lining may extend to the submucosal layer of the stomach. The affected individual experiences sharp, gnawing pain in or left of the midepigastric region 30 to 60 minutes after eating (eating worsens the pain) and hematemesis.

Appendicitis after rupture

Untreated, peritonitis develops; the client experiences worsening fever and chills, guards the right side of the abdomen, and exhibits tachycardia and tachypnea, pallor, and restlessness

In percutaneous transhepatic cholangiography,

an invasive procedure, dye is injected directly into the biliary tree to clearly outline the hepatic ducts within the liver, the length of the common bile duct, the cystic duct, and the gallbladder.

Gastritis assessment findings

complaints of abdominal discomfort, heartburn after eating, belching, and a sour taste in the mouth; hiccupping; and vitamin B12 deficiency.

assessment findings of GERD

heartburn and regurgitation.

Esophageal Varices assessment findings

hematemesis, melena or tarry stools, ascities, and dilated abdominal veins.

Ulcerative Colitis Nursing Considerations

in the acute phase, maintain nothing-by-mouth (NPO) status and administer fluids and electrolytes IV or in parenteral nutrition as prescribed. After the acute phase, the diet is advanced from clear liquids to a low-fiber diet as tolerated Restrict the client's activity (encourage rest)

Assessment findings Cholecystitis

include vomiting; pain in the right upper quadrant, radiating to the back and right shoulder, that occurs 2 to 4 hours after the client eats fatty foods (may persist for 4 to 6 hours); and the Murphy sign Biliary obstruction is marked by jaundice, foamy dark-orange urine, steatorrhea and clay-colored feces, and pruritus.

Cholecystitis

inflammation of the gallbladder, may occur as an acute or chronic process.

Gastritis

inflammation of the stomach or gastric mucosa—may be acute or chronic.

Chronic gastritis

is caused by benign or malignant ulcers or by the bacterium Helicobacter pylori; it may also be caused by autoimmune diseases, dietary factors, medications, alcohol, smoking, or reflux.

Acute gastritis

is caused by ingestion of food contaminated with disease-causing microorganisms or food that is irritating or too highly seasoned, the overuse of aspirin or other nonsteroidal antiinflammatory drugs, excessive alcohol intake, bile reflux, or radiation therapy.

Gastroesophageal Reflux Disease

is chronic backflow of gastric and duodenal contents into the esophagus. is caused by an incompetent lower esophageal sphincter, pyloric stenosis, or a motility disorder.

Paracentesis

is the invasive transabdominal removal of fluid from the peritoneal cavity for analysis and for promoting comfort in the client (e.g., with end stage liver disease or an oncological disorder).

Acute pancreatitis

may occur suddenly, as one attack; it may also be recurrent but resolving.

A nurse provides information to a client who has undergone a Billroth II procedure about dietary measures to prevent dumping syndrome. Which menu choices by the client indicates an understanding of the teaching? Select all that apply.

rice eggs beef

Peptic Ulcer Disease

ulceration of the mucosal wall of the stomach, pylorus, duodenum, or esophagus in portions that are accessible to gastric secretions. Erosion may extend through muscle.