Chapter 46: Management of Patients With Gastric and Duodenal Disorders
The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client states:
"I have learned some relaxation strategies that decrease my stress."
A nurse is teaching a client who has experienced an episode of acute gastritis and knows further education is necessary when the client makes the following statement:
"My appetite should come back tomorrow." The gastric mucosa is capable of repairing itself after an episode of gastritis. As a rule, the client recovers in about 1 day, although the appetite may be diminished for an additional 2 or 3 days. Acute gastritis is also managed by instructing the client to refrain from alcohol and food until symptoms subside. When the client can take nourishment by mouth, a nonirritating diet is recommended.
is an accronym for Dietary Approaches to Stop Hypertension.
DASH diet
Which of the following appears to be a significant factor in the development of gastric cancer?
Diet (Che's tortas)
A client with acute gastritis asks the nurse what might have caused the problem. Which of the following are possible causes?
-Dietary indiscretion -Excessive alcohol intake -Radiation therapy Possible causes of gastritis include dietary indiscretion, overuse of aspirin and other nonsteroidal anti-inflammatory drugs, excessive alcohol intake, bile reflux, and radiation therapy. Allergy medicine and fruit juices are not causes of acute gastritis.
A client with active schizophrenia has developed acute gastritis after ingesting a strongly alkaline solution during a psychotic episode. Corrosion is extensive. Which of the following emergency treatments might the team working with this client use? Select all that apply.
-Diluted lemon juice -Diluted vinegar Emergency treatment consists of diluting and neutralizing the offending agent. To neutralize acids, common antacids (eg, aluminum hydroxide) are used; to neutralize an alkali, diluted lemon juice or diluted vinegar is used. If corrosion is extensive or severe, emetics such as syrup of ipecac and lavage are avoided because of the danger of perforation and damage to the esophagus.
The nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows that what minimal daily intake of fluids is required?
1.5 L
A patient has had a gastrostomy tube inserted. What does the nurse anticipate the initial fluid nourishment will be after the insertion of the gastrostomy tube?
10% glucose and tap water
Morbid obesity is defined as being how many pounds over the person's ideal body weight?
100
Morbid obesity is defined as being how many pounds over the person's ideal body weight?
100 Morbid obesity is a term applied to people who are more than two times their ideal body weight or whose body weight index (BMI) exceeds 30 kg/m2. Another definition of morbid obesity is body weight that is more than 100 pounds greater than the ideal body weight.
Early manifestations of dumping syndrome occur
15 to 30 minutes after eating.
A patient being treated for pyloric obstruction has a nasogastric (NG) tube in place to decompress the stomach. The nurse routinely checks for a residual amount that would indicate obstruction. Choose that amount.
450 mL
A client returns from the operating room after receiving extensive abdominal surgery. He has 1,000 mL of lactated Ringer's solution infusing via a central line. The physician orders the IV fluid to be infused at 125 mL/hr plus the total output of the previous hour. The drip factor of the tubing is 15 gtt/min, and the output for the previous hour was 75 mL via Foley catheter, 50 mL via nasogastric tube, and 10 mL via Jackson Pratt tube. For how many drops per mintue should the nurse set the IV flow rate to deliver the correct amount of fluid? Enter the correct number ONLY.
65 First, calculate the volume to be infused (in milliliters): 75 mL + 50 mL + 10 mL = 135 mL total output for the previous hour; 135 mL + 125 mL ordered as a constant flow = 260 mL to be infused over the next hour Next use the formula Volume to be infused/Total minutes to be infused x Drip factor = Drops per min In this case, 260 mL divided by 60 min x 15 gtt/min = 65 gtt/min
dietary indiscretion—a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy.
Acute gastritis is often caused by
A client with gastric cancer is scheduled to undergo a Billroth II procedure. The client's spouse asks how much of the client's stomach will be removed. Which of the following would be the most accurate response from the nurse?
Approximately 75% The Billroth II is a wide resection that involves removing approximately 75% of the stomach and decreases the possibility of lymph node spread or metastatic recurrence.
While caring for a patient who has had radical neck surgery, the nurse notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. What does the nurse know is an expected amount of drainage in the wound unit?
Approximately 80 to 120 mL
A physician has written an order for ranitidine (Zantac), 300 mg once daily. The nurse schedules the medication for which time?
At bedtime Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton-pump inhibitors, and bismuth salts that suppress or eradicate H. pylori. Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (eg, metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (eg, lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton-pump inhibitor and bismuth salts (Pepto-Bismol). Research is being conducted to develop a vaccine against H. pylori.
A client is scheduled for removal of the lower portion of the antrum of the stomach and a small portion of the duodenum and pylorus. What surgical procedure will the nurse prepare the client for?
Billroth I
removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum.
Billroth I procedure involves
The health care provider prescribes a combination of three drugs to treat peptic ulcer disease. The nurse, preparing to review the drug actions and side effects with the patient, understands that the triple combination should be in which order?
Bismuth salts, antibiotics, and proton pump inhibitors Refer to Table 23-1 in the text to review the recommended triple combination.
The nurse is assessing a client with advanced gastric cancer. The nurse anticipates that the assessment will reveal which finding?
Bloating after meals
Which of the following is an inaccurate clinical manifestation associated with hemorrhage?
Bradycardia
A patient comes to the clinic with the complaint, "I think I have an ulcer." What is a characteristic associated with peptic ulcer pain that the nurse should inquire about? (Select all that apply.)
Burning sensation localized in the back or mid-epigastrium Feeling of emptiness that precedes meals from 1 to 3 hours Severe gnawing pain that increases in severity as the day progresses
the term for wasting syndrome.A general state of ill health involving marked weight loss and muscle loss
Chachexia
As a nurse completes the admission assessment of a client admitted for gastric bypass surgery, the client states, "Finally! I'll be thin and able to eat without much concern." How should the nurse intervene?
Evaluate the client's understanding of the procedure.
A client has a new order for metoclorpramide (Reglan). The nurse identifies that this medication should not be used long term and only in cases where all other options have been exhausted. This is because this medication has what type of potential side effect?
Extrapyramidal
The nurse is caring for a comatose patient and administering gastrostomy feedings. What does the nurse understand is the reason that gastrostomy feedings are preferred to nasogastric (NG) feedings in the comatose patient?
Gastroesophageal sphincter is intact, lessening the possibility of regurgitation.
A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett's esophagus and has been admitted to a medical unit. The nurse is writing a care plan for this patient. What information is essential to include?
He will need to undergo an upper endoscopy every 6 months to detect malignant changes.
The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage?
Hematemesis
The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage? Hematemesis Bradycardia Hypertension Polyuria
Hematemesis The nurse interprets hematemesis as a sign/symptom of possible hemorrhage from the ulcer. Other signs that can indicate hemorrhage include tachycardia, hypotension, and oliguria/anuria.
The client has been taking famotidine (Pepcid) at home. The nurse prepares a teaching plan for the client indicating that the medication acts primarily to achieve which of the following? Inhibit gastric acid secretions. Neutralize acid in the stomach. Shorten the time required for digestion in the stomach. Improve the mixing of foods and gastric secretions.
Inhibit gastric acid secretions.
refers to one that is hard to treat, relieve, or cure
Intractable ulcer
Which is a true statement regarding the nursing considerations in administration of metronidazole?
It leaves a metallic taste in the mouth.
The nurse assists the client to identify stressful or exhausting situations. A hectic lifestyle and an irregular schedule may aggravate symptoms and interfere with regular meals taken in relaxed settings along with the regular administration of medications. The client may benefit from regular rest periods during the day, at least during the acute phase of the disease. Biofeedback, hypnosis, behavior modification, massage, or acupuncture may be helpful.
Peptic Ulcer Disease
Omeprazole (Prilosec) is a proton pump inhibitor that, if used according to the health care provider's directions, will result in healing in 90% of patients. The other drugs are Ranitidine (Zantac) Cimetidine (Tagamet) Famotidine (Pepcid): H2 receptor antagonists that need to be used for 6 weeks.
Peptic Ulcer Disease Treatment
Josephine Hites, an 80-year-old retired dress shop clerk, is reporting for her semiannual physical at the primary care group where you practice nursing. She demonstrates an unintentional loss of ten pounds in the last six months. When asked, she reports "Food just doesn't taste good anymore!" If her anorexia becomes chronic, what effect could this have on her blood cell counts?
RBCs increase in size
The nurse advises the patient who has just been diagnosed with acute gastritis to:
Refrain from food until the GI symptoms subside.
complete rest for the GI tract, placing the client in a recumbent position with the legs elevated, blood transfusions, and gastric lavage with saline solution.
Treatment of hemorrhage includes
Which statement correctly identifies a difference between duodenal and gastric ulcers?
Vomiting is uncommon in clients with duodenal ulcers.
What is the pH of gastric aspirate
acidic
including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccuping, which can last from a few hours to a few days. Often caused by dietary indiscretion—a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms.
acute gastritis may have a rapid onset of symptoms,
A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, the nurse must remain alert for:
diaphoresis, vomiting, and diarrhea.
hemorrhoids
dilated or varicose veins in the rectal or anal area
Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down.
dumping syndrome
The nurse is creating a discharge plan of care for a client with a peptic ulcer. The nurse tells the client to avoid:
decaffeinated coffee. The nurse should include avoidance of decaffeinated coffee in the client's discharge teaching plan. Decaffeinated coffee is avoided to keep from overstimulating acid secretion.
A hypersecretion of stomach acid
duodenal ulcer is characterized by
Rebound hypoglycemia is a complication of parenteral nutrition caused by
feedings stopped too abruptly.
constipation
fewer than 3 bowel movements per week that are hard, dry, small, or difficult to pass
Using the the client's weight in pounds (215) is divided by the height in inches squared (68 inches squared) and then multiplied by 703.
formula for BMI,
diarrhea
frequent passage of loose, watery stools
hyposecretion of stomach acid.
gastric ulcer evidences
Diverticulitis
inflammation of a diverticulum
The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience
pain 2 to 3 hours after a meal.
reduced if the client avoids smoking, coffee (including decaffeinated coffee) and other caffeinated beverages, and alcohol. It is important to counsel the client to eat meals at regular times and in a relaxed setting and to avoid overeating.
peptic ulcer disease nonpharmacologic ways to prevent recurrence
A nurse is caring for a client who is undergoing a diagnostic workup for a suspected GI problem. The client reports gnawing epigastric pain following meals and heartburn. The nurse suspects the client has:
peptic ulcer disease. Peptic ulcer disease is characterized by dull, gnawing pain in the midepigastrium or the back that worsens with eating. Ulcerative colitis is characterized by exacerbations and remissions of severe bloody diarrhea. Appendicitis is characterized by epigastric or umbilical pain along with nausea, vomiting, and low-grade fever. Pain caused by diverticulitis is in the left lower quadrant and has a moderate onset. It's accompanied by nausea, vomiting, fever, and chills.
gastrocolic reflex
peristaltic movements of the large bowel occurring five to six times daily that are triggered by distention of the stomach
To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction
"Avoid coffee and alcoholic beverages."
To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction?
"Avoid coffee and alcoholic beverages."
Which of the following are signs/symptoms of perforation?
Sudden, severe upper abdominal pain
A client who is being treated for pyloric obstruction has a nasogastric (NG) tube in place to decompress the stomach. The nurse routinely checks for obstruction which would be indicated by what amount?
450 mL
is sometimes associated with autoimmune disease, such as pernicious anemia, but not as a cause of the anemia.
Chronic gastritis
Helicobacter pylori is implicated in the development of peptic ulcers.
Chronic gastritis caused by
Which is an accurate statement regarding cancer of the esophagus?
Chronic irritation of the esophagus is a known risk factor
is associated with duodenal ulcers.
Chronic renal failure
nutritional deficits and may have cachexia. Therefore, correcting nutritional deficits is a top priority. Discharge planning before surgery is important, but correcting the nutritional deficits is a higher priority. Radiation therapy hasn't been proven effective for gastric cancer, and teaching about it preoperatively wouldn't be appropriate. Preventing DVT isn't a high priority before surgery, but it assumes greater importance after surgery.
Clients with gastric cancer commonly have
A client has given a confirmed diagnosis of gastric cancer. Two more procedures may be performed to assess tumor depth and lymph node involvement and surgical resectability. Which two are the procedures? Choose the two that apply.
Computed tomography (CT) Endoscopic ultrasound Esophagogastroduodenoscopy for biopsy and cytologic washings is the diagnostic study of choice, and a barium x-ray examination of the upper GI tract may also be performed. Endoscopic ultrasound is an important tool to assess tumor depth and any lymph node involvement. Pelvic ultrasound is not used to confirm the diagnosis of gastric cancer.
The nurse is developing a plan of care for a patient with peptic ulcer disease. What nursing interventions should be included in the care plan? Select all that apply.
Frequently monitoring hemoglobin and hematocrit levels Observing stools and vomitus for color, consistency, and volume Checking the blood pressure and pulse rate every 15 to 20 minutes
The nurse is caring for a client who has just returned from the PACU after surgery for peptic ulcer disease. For what potential complications does the nurse know to monitor? Select all that apply.
Hemorrhage Perforation Penetration Pyloric obstruction
Lansoprazole and esomeprazole
Proton Pump Inhibitors (PPIs)
is a cytoprotective drug.
Sucralfate (Carafate)
A patient taking metronidazole (Flagyl) for the treatment of H. pylori states that the medication is causing nausea. What suggestion can the nurse provide to the patient to alleviate this problem?
Take the medication with meals to decrease the nausea. Metronidazole (Flagyl) should be administered with meals to decrease GI upset.
inflammatory bowel disease (IBD)
group of chronic disorders (ulcerative colitis and Crohn's disease) that result in inflammation or ulceration (or both) of the bowel lining
An obese male patient has sought advice from the nurse about the possible efficacy of medications in his efforts to lose weight. What should the nurse teach the patient about pharmacologic interventions for the treatment of obesity? 1. "Medications are usually reserved for people who have had unsuccessful bariatric surgery." 2. "Medications may be of some use, but they don't tend to resolve obesity on their own." 3. "Medications are an excellent option for individuals who prefer not to exercise or reduce their food intake." 4. "Medications have the potential to reduce hunger but they rarely result in weight loss."
"Medications may be of some use, but they don't tend to resolve obesity on their own." Medications for obesity rarely result in a loss of more than 10% of total body weight. They are not intended as a substitute for exercise or a healthy diet. They are not solely intended for those individuals who have undergone bariatric surgery.
A client has a family history of stomach cancer. Which of the following factors would further increase the client's risk for developing gastric cancer? Select all that apply. Caucasian ancestry Female gender Age 55 years High intake of fruits and vegetables Previous infection with H. pylori
-Age 55 years -Previous infection with H. pylori The typical client with gastric cancer is between 40 and 70 years, but gastric cancer can occur in younger people. Men have a higher incidence of gastric cancer than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as Caucasian Americans to develop gastric cancer. A diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk of gastric cancer. Other factors related to the incidence of gastric cancer include chronic inflammation of the stomach, H. pylori infection, pernicious anemia, smoking, achlorhydria, gastric ulcers, subtotal gastrectomy more than 20 years ago, and genetics.
Which medication is classified as a histamine-2 receptor antagonist
Famotidine
Familial tendency also may be a significant predisposing factor. People with blood type O are more susceptible to peptic ulcers than are those with blood type A, B, or AB. Blood type is not a predisposing factor for gastric cancer, esophageal varices, and diverticulitis.
GI disorders
The nurse is developing a plan of care for a patient with peptic ulcer disease. What nursing interventions should be included in the care plan? Select all that apply.
Observing stools and vomitus for color, consistency, and volume Checking the blood pressure and pulse rate every 15 to 20 minutes Frequently monitoring hemoglobin and hematocrit levels
During assessment of a patient with gastritis, the nurse practitioner attempts to distinguish acute from chronic pathology. One criteria, characteristic of gastritis would be the:
Immediacy of the occurrence.
Which of the following dietary guidelines should be followed following bariatric surgery? Select all that apply.
Include two protein snacks per day. Eat slowly. Eat three meals per day.
are nausea, vomiting, distended abdomen, and abdominal pain.
Indicators of pyloric obstruction
is erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning.
Perforation
Which is a true statement regarding the nursing considerations in administration of metronidazole?
It leaves a metallic taste in the mouth. Metronidazole leaves a metallic taste in the mouth. It may cause anorexia and should be given with meals to decrease gastrointestinal upset. Metronidazole increases the blood-thinning effects of warfarin.
The nurse is managing a gastric (Salem) sump tube for a patient who has an intestinal obstruction and will be going to surgery. What interventions should the nurse perform to make sure the tube is functioning properly?
Keep the vent lumen above the patient's waist to prevent gastric content reflux.
include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test.
Less invasive diagnostic measures for detecting H. pylori
The nurse is aware that hemorrhage is a common complication of peptic ulcer disease. Therefore, assessment for indicators of bleeding is an important nursing responsibility. Which of the following are indicators of bleeding? Select all that apply.
Melena Tachypnea Thirst Mental confusion
Which of the following medications, used in the treatment of GERD, accelerate gastric emptying
Metoclopramide (Reglan)
DRUG CLASS THAT CAUSE GASTRITIS
NSAIDS
decompress the stomach.
Nasogastric tube (NG tube)
The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order
Nasogastric tube insertion
Which medication classification represents a proton (gastric acid) pump inhibitor
Omeprazole
Which medication classification represents a proton (gastric acid) pump inhibitor?
Omeprazole
decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells.
Omeprazole
The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition?
Peptic ulcers
The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition? Pernicious anemia Systemic infection Peptic ulcers Colostomy
Peptic ulcers Chronic gastritis caused by Helicobacter pylori is implicated in the development of peptic ulcers. Chronic gastritis is sometimes associated with autoimmune disease, such as pernicious anemia, but not as a cause of the anemia. Chronic gastritis is not implicated in system infections and/or colostomies.
presents with a rigid, boardlike abdomen, tenderness, and fever.
Peritonitis
The nurse is teaching a client with peptic ulcer disease who has been prescribed misoprostol (Cytotec). What information from the nurse would be most accurate about misoprostol?
Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Misoprostol is a synthetic prostaglandin that protects the gastric mucosa against ulceration and is used in clients who take NSAIDs. Misoprostol should be taken with food. It does not improve emptying of the stomach, and it increases (not decreases) mucus production.
A nurse practitioner, who is treating a patient with GERD, knows that responsiveness to this drug classification is validation of the disease. The drug classification is:
Proton pump inhibitors
A nurse is preparing to discharge a client newly diagnosed with peptic ulcer disease. The client's diagnostic test results were positive for H. pylori bacteria. The doctor has ordered the "triple therapy" regimen. Which of the following is the correct representation of "triple therapy" refers?
Proton-pump inhibitor and two antibiotics Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton-pump inhibitors, and bismuth salts that suppress or eradicate H. pylori bacteria. Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (eg, metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (eg, lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton-pump inhibitor and bismuth salts (Pepto-Bismol). Research is being conducted to develop a vaccine against H. pylori.
also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down.
Pyloric obstruction
when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down.
Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs
A health care provider counsels a patient about bariatric surgery. He recommends the Roux-en-Y gastric bypass. The nurse explains to the patient that this procedure involves which of the following?
Separation of the jejunum with an anastomosis The Roux-en-Y gastric bypass is recommended for long-term weight loss because it uses a combined restrictive and malabsorptive procedure. Refer to Figure 23-3 (A to D) in the text.
Sudden, severe upper abdominal pain (persisting and increasing in intensity), which may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (boardlike) abdomen; and hypotension and tachycardia, indicating shock.
Signs and symptoms of perforation
include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.
Signs of bleeding
cool skin, confusion, increased heart rate, labored breathing, and blood in the stool.
Signs of hemorrhage following surgery include
A client is preparing for discharge to home following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal?
Slows gastric emptying
The nurse is inserting a Levin tube for a patient for gastric decompression. The tube should be inserted to 6 to 10 cm beyond what length?
The distance measured from the tip of the nose to the earlobe and from the earlobe to the xiphoid process
The nurse is inserting a nasoenteric tube for a patient with a paralytic ileus. How long does the nurse anticipate the tube will be required? (Select all that apply.)
Until bowel sound is present Until flatus is passed Until peristalsis is resumed
The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is: stress and anxiety. gram-negative bacteria. alcohol and tobacco. ibuprofen and aspirin.
gram-negative bacteria. The nurse should include that the most common cause of peptic ulcers is gram-negative bacteria (Helicobacter pylori).
After a client received a diagnosis of gastric cancer, the surgical team decides that a Billroth II would be the best approach to treatment. The nurse explains to the family that this procedure involves:
Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach The Billroth I involves a limited resection and offers a lower cure rate than the Billroth II. The Billroth II procedure is a wider resection that involves removing approximately 75% of the stomach and decreases the possibility of lymph node spread or metastatic recurrence. A proximal subtotal gastrectomy may be performed for a resectable tumor located in the proximal portion of the stomach or cardia. A total gastrectomy or an esophagogastrectomy is usually performed in place of this procedure to achieve a more extensive resection.
colostomy
a surgical operation that creates an opening from the colon to the surface of the body to function as an anus
Most clients are asymptomatic during the early stage of the disease. Men have a higher incidence of gastric cancer. The prognosis is poor because the diagnosis is usually made late because most clients are asymptomatic during the early stage. Most cases of gastric cancer are discovered only after local invasion has advanced or metastases are present.
gastric cancer
The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is:
gram-negative bacteria.
peritonitis
inflammation of the lining of the abdominal cavity
People with blood type O are
more susceptible to peptic ulcers than those with blood type A, B, or AB.
The healthcare provider of a client with oral cancer has ordered the placement of a GI tube to provide nutrition and to deliver medications. What would be the preferred route
nasogastric intubation
The healthcare provider of a client with oral cancer has ordered the placement of a GI tube to provide nutrition and to deliver medications. What would be the preferred route?
nasogastric intubation
is a histamine-2 receptor antagonist.
Famotidine (Pepcid)
Which medication is classified as a histamine-2 receptor antagonist?
Famotidine
is an antibiotic, specifically an amebicide.
Metronidazole
A patient has been taking a 10-day course of antibiotics for pneumonia. The patient has been having white patches that look like milk curds in the mouth. What treatment will the nurse educate the patient about?
Nystatin (Mycostatin)
Which of the following is the most common type of diverticulum?
Zenker's diverticulum
is useful for treating and preventing ulcers and managing gastroesophageal reflux disease. It functions by inhibiting the action of histamine at the H-2 receptor site located in the gastric parietal cells, thus inhibiting gastric acid secretion.
Famotidine (Pepcid)
A client has been taking famotidine at home. What teaching should the nurse include with the client?
Famotidine will inhibit gastric acid secretions.
sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.
Signs and symptoms of perforation includes
severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature, and increased heart rate.
Signs of penetration and perforation are
Which are accurate clinical manifestations associated with hemorrhage? Select all that apply.
Tachycardia
hypersecretion of acid may be controlled with high doses of H2 receptor antagonists. These clients may require twice the normal dose, and dosages usually need to be increased with prolonged use. Octreotide (Sandostatin), a medication that suppresses gastrin levels, also may be prescribed.
Zollinger-Ellison syndrome (ZES)
Which is an accurate statement regarding gastric cancer? Females have a higher incidence of gastric cancers than males. Most gastric cancer deaths occur in people younger than 40 years of age. The incidence of stomach cancer continues to decrease in the United States. A diet low in smoked foods and high in fruits and vegetables may increase the risk of gastric cancer.
The incidence of stomach cancer continues to decrease in the United States. While the incidence in the United States continues to decrease, gastric cancer still accounts for 10,700 deaths annually. While gastric cancer deaths occasionally occur in younger people, most occur in people older than 40 years of age. Males have a higher incidence of gastric cancers than females. More accurately, a diet high in smoked foods and low in fruits and vegetables may increase the risk of gastric cancer.
The nurse interprets hematemesis. Other signs include tachycardia, hypotension, and oliguria/anuria.
sign/symptom of possible hemorrhage from an ulcer
fissure
normal or abnormal tract that arise between two internal organs or between an internal organ and the body surface
is an unpleasant set of vasomotor and GI symptoms that occur in up to 76% of patients who have had bariatric surgery. Early symptoms include a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. These symptoms resolve once the intestine has been evacuated (i.e., with defecation).
Dumping syndrome
daily fluid goal
Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals. 120 X 6 = 720 mL.
Diet seems to be a significant factor: a diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk .The typical patient is between 50 and 70 years of age. Men have a higher incidence than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as Caucasian Americans to develop
Gastric cancer
The client may have nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.
Pyloric obstruction, also called gastric outlet obstruction (GOO), signs
inflammatory bowel syndrome
chronic functional disorder characterized by recurrent abdominal pain that affects frequency of defecation and consistency of stools
After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals.
recovering from gastric surgery
include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers.
risk factors for peptic (gastric and duodenal) ulcers
diverticulum
saclike out-pouching of the lining of the bowel protruding through the muscle of the intestinal wall
ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate.
severe form of acute gastritis is caused by
ileosotomy
surgical opening into the ileum by means of a stoma to allow drainage of bowel contents
The most significant complication related to continuous tube feedings is
the potential for aspiration.
