47 & 48 GI

The nurse observes that a client's medical report indicates that the client has Cushing syndrome. During inspection, the nurse notes that the client's BMI is 31, waist circumference is 40 inches, and localized fat pads exist around the neck and upper part of the back. Which of the following must the nurse keep in mind while planning the client's care?

The nurse recognizes that the client's obesity may be specifically related to the endocrine disorder. The nurse performs a thorough nutritional assessment. Certain signs and symptoms that suggest possible nutritional deficiency, such as muscle wasting, poor skin integrity, loss of subcutaneous tissue, and obesity, are easy to note because they are specific; these symptoms should be studied further. Food records, 24-hour diet recall, and dietary education directed at weight loss do not account for the client's medical condition as a factor in the client's weight or nutritional status, although each method helps estimate whether food intake is adequate and appropriate.

A nurse cares for a client who is obese. The health care provider prescribes orlistat in an effort to help client lose weight, along with diet and exercise. When teaching the client about this medication, what will the nurse include?

"It binds with enzymes to help prevent digestion of fat." Orlistat (Xenical) works to bind to gastric and pancreatic lipase to prevent the digestion of 30% of ingested fat, thereby decreasing caloric intake.

A client is scheduled for a Roux-en-Y bariatric surgery. When teaching the client about the surgical procedure, which statement will the nurse use?

"The stomach is stapled to create a very small pouch and part of the small intestine is rerouted." In Roux-en-Y bariatric surgery, a horizontal row of staples across the fundus of the stomach creates a pouch with a capacity of 20 to 30 mL. The jejunum is divided distal to the ligament of Treitz, and the distal end is anastomosed to the new pouch. The proximal segment is anastomosed to the jejunum.

A nurse is preparing a presentation for a local community group of older adults about colon cancer. What would the nurse include as the primary characteristic associated with this disorder?

A change in bowel habits Although abdominal distention and blood in the stool (frank or occult) may be present, the chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Abdominal pain is a late sign.

A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client?

Age Age and family history for cardiovascular disease are risk factors that cannot be changed. Obesity, inactivity, and disylipidemia are risk factors that can be improved by the client through dietary changes, exercise, and other healthy lifestyle choices.

An older client underwent a lumpectomy for a breast lesion that was determined to be malignant. Which factors in the client's history may have increased the risk of breast cancer?

All options are correct (obesity, increased age, not giving birth) Being female, being older than 50 years of age, and having a family history of breast cancer are the most common risk factors. Additional factors include obesity, and having no children or having children after 30 years of age.

A patient arrives in the emergency department with complaints of right lower abdominal pain that began 4 hours ago and is getting worse. The nurse assesses rebound tenderness at McBurney's point. What does this assessment data indicate to the nurse?

Appendicitis In up to 50% of presenting cases of appendicitis, local tenderness is elicited at McBurney's point when pressure is applied (Black & Martin, 2012) (Fig. 48-3). Rebound tenderness (i.e., production or intensification of pain when pressure is released) may be present.

A client with anorexia reports constipation. Which nursing measure would be most effective in helping the client reduce constipation?

Assisting the client in adding more fiber to their diet The nurse should assist the client to increase the dietary fiber in food because it helps reduce constipation. Providing an adequate quantity of food is necessary in maintaining sufficient nutrition and in sustaining normal body weight. Obtaining medical, allergy, and food history would provide valuable information, however, it would not help reduce constipation.

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition?

Borborygmus Borborygmus is the intestinal rumbling caused by the movement of gas through the intestines that accompanies diarrhea. Tenesmus refers to ineffectual straining at stool. Azotorrhea refers to excess of nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a:

Fissure An anal fissure (fissure in ano) is a linear tear in the anal canal tissue. An anal fistula (fistula in ano) is a tract that forms in the anal canal. Hemorrhoids are dilated veins outside or inside the anal sphincter. A pilonidal sinus is an infection in the hair follicles in the sacrococcygeal area above the anus.

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes:

High fiber A high-fiber diet is prescribed to help control diarrhea and constipation. Foods that are possible irritants, such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, and alcohol, should be avoided. Fluids should not be taken with meals because they cause abdominal distention.

A client is scheduled to undergo rhinoplasty in the morning, and reports medications used on a daily basis, which the nurse records on the client's chart. Which daily medications have the potential to result in constipation?

Laxative Constipation may also result from chronic use of laxatives ("cathartic colon")because such use can cause a loss of normal colonic motility and intestinal tone. Laxatives also dull the gastrocolic reflex.

Which group of clients is at high risk of developing breast cancer?

Obese The groups of clients who are at higher risk of developing breast cancer are aging women and women who are obese, had early menarche or late menopause, or have a family history. Additional risk factors include exposure to ionizing radiation as children or adolescents, women already diagnosed with cancer of the breast or elsewhere, and those who consume a high-fat, high-calorie diet and drink 2 to 5 alcoholic drinks per day.

Which of the following is a leading health indicator to be used to measure the health of the nation?

Obesity Leading health indicators to be used to measure the health of the nation include overweight and obesity, physical activity, and mental health. Intelligence, cultural awareness, and religion are not leading health indicators.

A nurse is preparing a presentation for a local community group addressing the influences on health care delivery. Which of the following would the nurse include in presentation when describing disease patterns?

Obesity along with conditions associated with it has become a major health concern. In recent years, obesity has become a major health concern and the multiple comorbidities that accompany it add significantly to its associated mortality. Although many infectious diseases have been controlled or eradicated, some such as tuberculosis, acquired immunodeficiency syndrome and sexually transmitted infections are on the rise. The prevalence of chronic illnesses and disability is increasing because of the lengthened lifespan in the United States and the advances in care and treatment. People with chronic illnesses constitute the largest group of health care consumers in the United States.

A nurse is caring for a client who had an ileo conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation?

Red, sensitive skin around the stoma site Red, sensitive skin around the stoma site may indicate an ill-fitting appliance beefy redness at a stoma site that isn't sensitive to touch is a normal assessment finding. Urine mixed with mucus is also a normal finding.

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction?

Sudden, severe, persisting abdominal pain Sudden, sustained pain, abdominal distention, and fever are symptoms of perforation in a client with intestinal obstruction. A decrease in blood pressure and decrease in urine output are symptoms of shock. Purulent drainage from the gluteal fold is not a symptom of perforation; it only indicates that the client has developed a condition of anorectal abscess.

A client realizes that regular use of laxatives has greatly improved bowel patterns. However, the nurse cautions this client against the prolonged use of laxatives for which reason?

The client's natural bowel function may become sluggish. It is essential for the nurse to caution the client against the prolonged use of laxatives because it decreases muscle tone in the large intestine. Prolonged use of laxatives may cause the client's natural bowel function to become sluggish. Laxatives do not increase the risk of developing inflammatory bowel disease, arthritis, or arthralgia, nor do they cause a loss in appetite.