MS exam 1: Chapter 56

what are the different types of IBS?

-IBS-D (diarrhea) -IBS-C (constipation) -IBS-A (alternating diarrhea/constipation) -IBS-M (mix of diarrhea/constipation)

what post-op care needs to be done with a patient who had an intestinal obstruction?

-NG: clear liquids -Liquids may be started while NG is in place (suction off & capped for 1-2 hours) -When peristalsis is present: NG suction stopped, tube clamped - if no nausea then NG removed -Colostomy care education needed if have a colostomy

what are polyps?

-small growths covered with mucosa attached to the stomach lining -most are benign but have the potential to become malignant -usually asymptomatic and found during a routine colonoscopy

what are the roles of the ostomy nurse?

-trained in colostomy management and may be involved in the decision of where the colostomy is placed -can support patient and family after surgery -ostomy pouch may also be called an appliance

what are the indications if a patient has a decreased level of potassium?

-vomiting -gastric suctioning -diarrhea -drainage from intestinal fistulas

A 21-year-old with a stab wound to the abdomen has come to the emergency department (ED). Once stabilized, the patient is admitted to the medical-surgical unit. What does the admitting nurse do first for this patient? a. Administer pain medication. b. Assess skin temperature and color. c. Check on the amount of urine output. d. Take vital signs.

D

what can happen post-op after colorectal cancer surgery if nerves are damaged?

sexual dysfunction or urinary incontinence

what should you do if you suspect your patient has Dumping syndrome?

use as little amount of flush as possible after feeding your patient through their tube feeding

when should you empty the ostomy pouch?

when it is 1/3-1/2 full of stool

what will the stool look like in the ostomy pouch?

•If colostomy is in ascending colon, it will be liquid •Transverse colon, it will be more pasty •Descending colon, it will be solid

Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a patient with advanced colorectal cancer for relief of symptoms? a. Analgesics and antiemetics b. Analgesics and benzodiazepines c. Steroids and analgesics d. Steroids and anti-inflammatory medications

A

A male patient in a long-term care facility is 2 days postoperative after an open repair of an indirect inguinal hernia. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? a. Assessing the patient's incision for signs of infection b. Assisting the patient to stand to void c. Instructing the patient in how to deep-breathe d. Monitoring the patient's pain level

B

A patient suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the patient about this test? a. "During the test, you will drink small amounts of an antacid as directed by the technician." b. "If you have IBS, hydrogen levels may be increased in your breath samples and can be an indication that you have IBS." c. "The test will take between 30 and 45 minutes to complete." d. "You must have nothing to drink (except water) for 24 hours before the test."

B

A patient with a family history of colorectal cancer (CRC) regularly sees a primary health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this patient? a. Decrease in liver function test results b. Elevated carcinoembryonic antigen c. Elevated hemoglobin levels d. Negative test for occult blood

B

A patient with irritable bowel syndrome (IBS) is constipated. The nurse instructs the patient about a management plan. Which patient statement shows an accurate understanding of the nurse's teaching? a. "A cup (236 mL) of caffeinated coffee with cream & sugar at dinner is OK for me." b. "I need to go for a walk every evening." c. "Maintaining a low-fiber diet will manage my constipation." d. "Limiting the amount of fluid that I drink with meals is very important."

B

What symptom does the nurse expect the patient with intussusception to exhibit? A. Decrease in pulse B. Singultus (hiccups) C. Frequent bloody stools D. Extremely elevated body temperature

B

A patient is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possibly contributing to the patient's condition? Select all that apply. a. Antihistamines b. Caffeinated drinks c. Stress d. Sleeping pills e. Combinations of genetic, immunological, and hormonal factors

B, C, E

A patient at risk for colorectal cancer asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting this disease?" Which dietary selection does the nurse suggest? a. Steak with pasta b. Spaghetti with tomato sauce c. Steamed broccoli with turkey d. Tuna salad with wheat crackers

C

A patient with colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this patient? a. "Are you afraid of what your spouse will think of the colostomy?" b. "Don't worry. You will get used to the colostomy eventually." c. "Tell me what worries you the most about this procedure." d. "Why are you so afraid of having this procedure done?"

C

can colorectal cancer spread? how?

Can spread by peritoneal seeding (when the tumor is cut into or excised and cancer cells break off, spreading into the peritoneal cavity- happens during resection of tumor)

The nurse recognizes that which ethnic group has a higher incidence of colorectal cancer? A. Asian B. Caucasian C. Hispanic/Latino D. African-American

D

The patient's stool is positive for occult blood, and he is admitted to the inpatient oncology unit 3 hours later. Two hours after admission, the patient is passing bright red blood from his rectum. Where does the nurse anticipate that the patient's tumor may be located? A. Ascending colon B. Transverse colon C. Descending colon D. Rectosigmoid colon

D

what is the intervention for abdominal hernias?

MIS

what diagnostic screening needs to be done for colorectal cancer?

-Age 40 physician may start to discuss screening, by age 50 there needs to be regular screening -Fecal occult testing every year, colonoscopy every 10 years, or double contrast barium enema every 5 years -Screening can occur earlier and more often if these risks are present`

what assessment questions need to be asked when you suspect an obstruction?

-Ask about: the color of emesis, pain (onset, aggravating factors, alleviating factors, patterns) -Severe pain that stops & changes to tenderness - may be perforation - report this to the provider! -Hiccups: common with intestinal obstruction -NPO: if suspect obstruction -Fever above 100: may be strangulated obstruction or peritonitis -Partial obstruction: diarrhea may be present, may have ribbonlike stools -Decreased bowel sounds in early obstruction, absent bowel sounds in later stages

what are the 2 types of mechanical obstruction?

-Closed loop obstruction: blockage in 2 areas -Strangulated obstruction: compromised blood flow and bleeding can result, at risk for bacterial peritonitis

what happens during a mechanical obstruction?

-Distention -Bowel becomes edematous, increases capillary permeability (becomes leaky), decreased circulatory blood volume, hypovolemia, electrolyte imbalances -Metabolic alkalosis or metabolic acidosis -Hypovolemia leads to kidney injury -Can lead to septic shock -Increased abdominal pressure can lead to compartment syndrome (pressure buildup due to bleeding or swelling, causes decreased blood flow to muscles and nerves) -Intussusception: telescoping of the intestine within itself -Volvulus: twisting

what is IBS?

-Etiology: Unclear -Nervous colon -Most common digestive disorder -Associated with mental health (stress, anxiety, depression)- dealing with IBS can lead to secondary depression -Symptoms begin in young adulthood -Women are 2 x more likely than men to have this

what are the surgical interventions for intestinal obstructions?

-Exploratory laparotomy: surgical opening to investigate the cause of the obstruction -MIS via laparoscopy (no NG tube), or open (large incision) -If adhesions: they are lysed (cut & released) -Tumor or diverticulitis: colon resection (ay have a temporary or permanent colostomy) -Intestinal infarction: embolectomy, thrombectomy, resection -Severe cases - colectomy (removal of entire colon)

what laboratory/imaging assessments need to be done when you suspect your patient has colorectal cancer?

-Fecal occult blood test (FOBT) -Carcinoembryonic antigen (CEA) -Sigmoidoscopy: scope of the lower colon -Colonoscopy: entire large bowel, gives us definitive diagnosis of colorectal cancer -Decreased H&H -If it has spread to the liver, there may be an increase in liver enzymes

what are the non-surgical interventions for intestinal obstructions?

-NPO -NG: to suction (low continuous), when listening for bowel sounds turn off suction -Disimpaction & enema -Barium enema -Postop ileus: Entereg (increases GI motility) -IVF (NS, LR, may need to add potassium) -Blood -Parenteral nutrition -Ice chips -Position changes: promotes peristalsis -Antibiotics -Sandostatin: enhances gastric motility

what is a non-mechanical obstruction?

-No obstruction inside or outside - peristalsis is decreased or absent (slowing or backup of contents) -lasts few hours to days

how should you perform ostomy care?

-Normal appearance of stoma (want it to be reddish pink, moist, needs to protrude about 2 cm, may be slightly edematous initially and may be a small amount of bleeding) -stoma should start functioning 2-3 days after surgery- patient will have excess gas (empty the pouch often because it will fill with gas) -S&S of complications -Measurement of stoma -Choice, use, care, application of appropriate appliance to cover stoma -Measures to protect skin -Dietary measures to control gas and odor -Resumption of normal activities -encourage pt and family to participate as soon as they are able

what is colorectal cancer?

-One of the most common malignancies (adenocarcinomas) but is highly curable -Can arise from polyps

what is the intervention for polyps?

-Physician may want a biopsy -Can do a procedure to remove the polyp or can do a colectomy (if there is a chance for cancer)

what are the interventions for hemorrhoids?

-Primary treatment: prevention of constipation -Surgery: hemorrhoidectomy

what interventions can be done for colorectal cancer?

-Radiation- colon (palliative- for comfort)- rectal (radiation is always part of the plan) -Chemotherapy- after stage 2 or 3 -May also remove regional lymph nodes -Ileostomy or colostomy (both drain fecal matter) -MIS is common

what are hemorrhoids?

-Swollen, distended veins -Involves prolapse of the vessels -Internal or external, they can bleed -Common -Not significant unless they cause pain or bleeding

what is malabsorption syndrome?

-The nutrient involved in malabsorption depends on the type and location of the abnormality in the intestinal tract -Can occur in the hospital due to cultural food preferences, increased need for nutrition, NPO status, and unbalanced nutritional intake

what diagnostic assessments need to be done when you suspect your patient has an obstruction?

-WBC normal: unless strangulated obstruction (would have elevated WBC and fever) -H&H, creatinine, BUN elevated due to dehydration -Na, chloride, K decreased -Abdominal CT scan, MRI, abdominal ultrasound, endoscopy -Goal= discover cause & relieve the obstruction

what is an abdominal hernia?

-Weakness in the abdominal muscle wall -Bowel or another abdominal structure will protrude -Associated with lifting heavy objects -Can become strangulated (blood supply will be cut off, ischemia, obstruction, necrosis, sepsis, and bowel perforation)

what are the risk factors for colorectal cancer?

-age 50+ -genetics -personal or family history of cancer -polyps (familial adenomatous polyposis) -Crohn's disease -ulcerative colitis -smoking -obesity -inactivity -alcohol -high-fat diet (red meat)

what assessments need to be done when you suspect that your patient has colorectal cancer?

-ask about risk factors -ask them if they have been participating in screening -have they been vomiting or had any changes in bowel? -have they been fatigue, felt abdominal fullness, weight loss, abdominal pain?

what is a mechanical obstruction?

-bowel blocked by problems outside the intestine, in the bowel wall, or in the intestinal lumen -adhesions, Crohn's, tumors

what are the S&S of malabsorption syndrome?

-chronic diarrhea -steatorrhea (fat in the feces) -increased stool mass -weight loss -bloating -gas -decreased libido -easy bruising -anemia -bone pain -edema

what is the significance of increased CEA?

-colorectal, stomach, pancreatic cancer -ulcerative colitis -Crohn's disease -hepatitis -cirrhosis

how can you prevent fecal impaction?

-eat high-fiber foods, including plenty of raw fruits and vegetables and whole-grain products -drink adequate amounts of water -do not routinely administer a laxative -exercise regularly -use natural foods to promote peristalsis, such as warm beverages and prune juice -take bulk-forming products, such as Metamucil to provide fiber -check the pt's stool for amount and frequency; oozing of soft or diarrheal stool often indicates a fecal impaction -have the pt sit on a toilet or bedside commode rather than on a bedpan

what is the post-op care for abdominal hernias?

-encourage the patient to avoid coughing**** -use deep breathing and ambulation to promote lung expansion

what causes a non-mechanical obstruction?

-handling of the intestines during abdominal surgery -hypokalemia predisposes the pt. to this -peritonitis -Intestinal ischemia (vascular insufficiency) can cause ileus: thrombosis, embolus

how should you care for a patient with an intestinal obstruction?

-monitor VS, especially BP, for indicators of fluid balance -assess pt's abdomen at least twice a day for BS, distention, and passage of flatus -monitor fluid and electrolyte status, including laboratory values -manage the pt who has an NG tube: monitor drainage, ensure patency, check placement, irrigate tube as prescribed, maintain the pt's NPO status, provide frequent mouth and nares care, and maintain the pt in semi-Fowler's -give analgesics for pain as prescribed -give alvimopan (entereg) as prescribed for pts with post-op ileus -maintain parenteral nutrition if prescribed

what are the interventions for IBS?

-patient may need antidepressant or fluids (prevents constipation and sets up normal bowel regulation) -physician may want a stool culture to assess for occult blood (results will be normal-negative) -health teaching: 30 to 40 g of fiber daily -drug therapy is symptom specific -stress reduction: relaxation, meditation, yoga

what are the most common S&S of colorectal cancer?

-rectal bleeding -anemia -change in stool consistency or shape

what can a polyp cause?

-rectal bleeding -obstruction -intesscuption (telescoping of the bowel)

The next morning the patient is scheduled for surgery to remove the tumor and place a sigmoid colostomy. He returns to the unit with a clear ostomy pouch system in place. The stoma appears healthy. 1. How would the nurse document this finding? 2. How soon postoperatively would the nurse expect the colostomy to begin functioning?

1. "Reddish pink, moist, and protrudes about 2 cm from the abdominal wall." Initially the stoma may be slightly edematous and there may a small amount of bleeding. 2. About 2 to 4 days postoperatively.

what is the normal range of CEA (carcinoembryonic antigen)?

<5 ng/mL

A patient who has colorectal cancer is scheduled for a colostomy. Which referral is initially of greatest value to this patient? a. Certified Wound, Ostomy, and Continence Nurse (CWOCN) b. Home health nursing agency c. Hospice d. Hospital chaplain

A

A patient with colorectal cancer had colostomy surgery performed yesterday. The patient is very anxious about caring for the colostomy and states that the primary health care provider's instructions "seem overwhelming." What does the nurse do first for this patient? a. Encourage the patient to look at and touch the colostomy stoma b. Instruct the patient about complete care of the colostomy c. Schedule a visit from a patient who has a colostomy and is successfully caring for it d. Suggest that the patient involve family members in the care of the colostomy

A

The nurse is caring for a patient who is to be discharged after a bowel resection and the creation of a colostomy. Which patient statement demonstrates that additional instruction from the nurse is needed? a. "I can drive my car in about 2 weeks." b. "I need to avoid drinking carbonated sodas." c. "It may take 6 weeks to see the effects of some foods on my bowel patterns." d. "Stool softeners will help me avoid straining."

A

What does the nurse advice a patient diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? a. Bulk-forming laxatives b. Saline laxatives c. Stimulant laxatives d. Stool-softening agents

A

The patient is discharged and home health services are arranged. What are the home health nurse's assessment priorities? (Select all that apply.) A. GI status B. Condition of the stoma C. Peristomal skin condition D. Patient and family's coping skills E. Results of daily laxative prescription

A, B, C, D

the emergency department nurse is assessing a client with a know inguinal hernia. which assessment findings indicate that the hernia may have strangulated? select all that apply. a. fever b. tachycardia c. abdominal distention d. mild abdominal pain e. N/V

A, B, C, E

The nurse is teaching a group of patients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? Select all that apply. a. Acupuncture b. Decreasing physical activities c. Meditation d. Peppermint oil capsules e. Yoga

A, C, D, E

The nurse is teaching a patient with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? Select all that apply. a. Broccoli b. Buttermilk c. Mushrooms d. Onions e. Peas f. Yogurt

A, C, D, E

A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which patient statement indicates a need for further teaching about this procedure? a. "I may have trouble urinating immediately after the surgery." b. "I will need to stay in the hospital overnight." c. "I will not eat after midnight the day of the surgery." d. "My chances of having complications after this procedure are slim."

B

A 67-year-old male patient, with no surgical history, reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? a. Femoral b. Reducible c. Strangulated d. Incarcerated

B

The RN on the medical-surgical unit receives a shift report about four patients. Which patient does the nurse assess first? a. A 34-year-old who has returned to the unit after a colon resection with a new colostomy stoma, which is pink and moist. b. A 36-year-old admitted after a motor vehicle collision (MVC) with areas of ecchymosis on the abdomen in a "lap-belt" pattern c. A 40-year-old with a reducible inguinal hernia asking questions about surgery. d. A 51-year-old with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy

B

The nurse is teaching a patient who has undergone a hemorrhoidectomy about a follow-up plan of care. Which patient statement demonstrates a correct understanding of the nurse's instructions? a. "I would take Ex-Lax after the surgery to 'keep things moving'." b. "I will need to eat a diet high in fiber." c. "Limiting my fluids will help me with constipation." d. "To help with the pain, I'll apply ice to the surgical area."

B

the community nurse is talking with a group of individuals about colorectal cancer (CRC) risk factors. which community participant is at the highest risk for development of CRC? a. 23-year-old vegetarian b. 30-year-old with Crohn's disease c. 39-year-old with no family history of cancer d. 46-year-old with genetic predisposition to cancer

B

a client had an open partial colectomy and ascending colostomy 3 days ago. which assessment findings does the nurse expect? select all that apply. a. black, moist stoma b. gas inside the pouch c. pain controlled with analgesics d. small amount of formed stool from the colostomy e. serosanguinous fluid draining from two Jackson-Pratt drains

B, C, E

A patient with a bowel obstruction is ordered a Salem sump nasogastric tube (NGT). After the nurse inserts the tube, which nursing intervention is the highest priority for this patient? a. Attaching the tube to low intermittent suction b. Auscultating for bowel sounds and peristalsis while the suction runs c. Connecting the tube to low continuous suction d. Flushing the tube with 30 mL of normal saline every 24 hours

C

A patient with colorectal cancer was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. What does the nurse tell the patient about the cause of diarrhea and mouth ulcers? a. "A combination of chemotherapeutic agents has caused them." b. "GI problems are symptoms of the advanced stage of your disease." c. "5-FU cannot discriminate between your cancer and your healthy cells and is causing your ulcers and diarrhea." d. "You have these as a result of the radiation treatment."

C

The home health nurse is teaching a patient about the care of a new colostomy. Which patient statement demonstrates a correct understanding of the instructions? a. "A dark or purplish-looking stoma is normal and would not concern me." b. "If the skin around the stoma is red or scratched, it will heal soon." c. "I need to check for leakage underneath my colostomy." d. "I need to strive for a very tight fit when applying the barrier around the stoma."

C

A client with rectal bleeding who is preparing to undergo a colonoscopy tells the nurse, "I'm very afraid of having polyps and cancer." what is the appropriate nursing response? a. let's worry about that after the procedure b. polyps are never cancerous, so you don't need to worry c. unfortunately all polyps are malignant, so you may already have cancer d. it's understandable that you are fearful. tell me what frightens you the most.

D

A male patient's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. The patient asks the nurse whether he will inherit the disease too. How does the nurse respond? a. "Have you asked your primary health care provider what he or she thinks your chances are?" b. "It is hard to know what can predispose a person to develop a certain disease." c. "No. Just because they both had CRC doesn't mean that you will have it, too." d. "The only way to know whether you are predisposed to CRC is by genetic testing."

D

A patient is being evaluated in the emergency department (ED) for a possible small bowel obstruction. Which signs/symptoms does the nurse expect to assess? a. Cramping intermittently, metabolic acidosis, and minimal vomiting b. Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis c. Metabolic acidosis, upper abdominal distention, and intermittent cramping d. Upper abdominal distention, metabolic alkalosis, and a great amount of vomiting

D

A patient received one positive fecal occult blood test. Which response is most appropriate? A. The patient has colon cancer B. The patient has bleeding in the GI tract C. The patient may be taking Aspirin D. The patient will need two samples on three consecutive days.

D

A patient with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? a. Administers medication for pain b. Changes the nasogastric suction level from "intermittent" to "constant" c. Positions the patient in high-Fowler's position d. Prepares the patient for emergency surgery

D

A patient with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? a. "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development." b. "It is inherited, so it could run in your family." c. "It might be caused by a virus, so you could have gotten it almost anywhere." d. "There are a variety of things that can cause malabsorption syndrome to occur. You may have a deficiency is certain enzymes, a bacteria or changes in the lining of your intestines."

D

At the oncologist's office, the patient tells the nurse that he has been experiencing vomiting and diarrhea. He states that he is tired all the time and has lost about 15 pounds over the past month. What is the priority diagnostic test that the nurse anticipates? A. Esophagogastroduodenoscopy (EGD) B. Colonoscopy C. Serum electrolytes D. Stool for fecal occult blood

D

The Certified Wound, Ostomy, and Continence Nurse is teaching a patient with colorectal cancer how to care for a newly created colostomy. Which patient statement reflects a correct understanding of the necessary self-management skills? a. "I will have my spouse change the bag for me." b. "If I have any leakage, I'll put a towel over it." c. "I can put aspirin tablets in the pouch in order to reduce odor" d. "I will apply a non-alcoholic skin sealant around the stoma and allow it to dry prior to applying the bag."

D

Three days later the stoma is functioning. What stool assessment does the nurse anticipate? A. Very little stool and mostly gas B. Diarrhea liquid stool C. Pasty stool D. More solid stool

D

What is the mechanism of action for the chemotherapeutic drug cetuximab (Erbitux)? a. It destroys the cancer's cell wall, which will kill the cell. b. It decreases blood flow to rapidly dividing cancer cells. c. It stimulates the body's immune system and stunts cancer growth. d. It blocks factors that promote cancer cell growth.

D

The patient is a 57-year-old male with a family history (sister, father) of colorectal cancer (CRC). His diet includes lots of red meat and fried foods. He was diagnosed with ulcerative colitis 3 years ago and treated for prostate cancer 2 years ago. What risk factors suggest a diagnosis of colorectal cancer for this patient?

Positive family history with first-degree relatives; dietary habits (red meat and fried foods); history of ulcerative colitis and prostate cancer.

what are some other causes of obstruction?

appendicitis complications, hernias, fecal impactions (older adults), endometriosis, vascular disorders

what are the most common causes of obstruction among adults 65 and older?

diverticulitis, tumors, fecal impaction

what should you do if your patient comes back from surgery with a petroleum dressing over their stoma?

get a pouch placed on them as soon as possible (ostomy nurse can help)

what is the most common abdominal hernia?

indirect inguinal hernia (found in men- follows tract of when testes descend into the scrotum and happens at birth)- requires surgical repair

what is a double barrel stoma?

one drains mucus and the other stool