Chapter 50, Concepts of Care for Patients With Stomach Disorders
removing part of the stomach when the tumor is located in the mid portion or distal portion of the stomach (lower), a subtotal gastrectomy is typically performed. malignant gastric tumors located in the middle or distal portion of the stomach requires subtotal or partial gastrectomy, which involves partial stomach removal.
A pt is diagnosed with a malignant gastric tumor in the distal portion of the stomach. Which surgical intervention would the nurse expect this patient will be offered?
Total gastrectomy malignant gastric tumors located in the proximal third of the stomach require total gastrectomy. Pts with tumors at the gastric outlet who are not candidates for subtotal or total gastrectomy may need gastroenterostomy as a pallative tx.
A pt is diagnosed with malignant gastric tumor in the proximal portion of the stomach. Which surgical intervention would the nurse anticipate will be planned for this pt?
Progressive weight loss advanced gastric cancer is characterized by nausea and vomiting, obstructive symptoms, iron deficiency anemia, weakness and fatigue, and progressive weight loss. Early manifestations of gastric cancer involve indigestion, epigastric pain and a feeling of fullness
Which finding would occur in a patient who has advanced gastric cancer?
Reducing caffeine intake
Which nutritional recommendation would the nurse provide to the patient with peptic ulcer disease (PUD)?
Intestinal metaplasia development of abnormal tissue is a characteristic assessment finding in chronic atrophic gastritis. Other features include thinning of the gastric mucosa and minimal inflammation. Prominent rugae or mucosal folds are seen in acute gastritis
which pathophysiologic finding is typically seen in chronic atrophic gastritis?
I will restrict vegetables a low intake of fruits and vegetables is a risk factor for atrophic gastritis, which may lead to cancer. Excess salt added to food, eating pickles and nitrates from processed foods may lead to atrophic gastritis.
A nurse gives dietary instructions to a patient with atrophic gastritis. Which statement by the pt indicates the need for further teaching?
Infuse lactated Ringer's solution 500 mL the pts most immediate concern is the hypotension associated with the volume loss. the most rapidly available volume expanders are crystalloids to treat hypovolemia.
The admission assessment for a patient with acute gastric bleeding indicates a blood pressure of 82/40 mm Hg, pulse of 124/min beats/min, and respiratory rate of 26 breaths/min. Which admission prescription would the nurse implement first?
To prevent aspiration to prevent aspiration from gastric reflux.
A nurse who is caring for a patient after conventional open approach surgery elevates the head of the bed. Which rationale supports this intervention?
Starting a large-bore IV it shoudl be placed as soon as ordered do that blood products can be administered.
A patient is experiencing bleeding related to peptic ulcer disease (PUD). Which action would the nurse take?
irrigate the nasogastric tube pigastric pain, fullness of the abdomen, and hiccups, tachycardia and hypotension are manifestions of acute gastric dilation caused by decreased patency of the NG tube after gastric surgery. Irrigation or replacement of the NG tube will fix the problem
A pt reports epigastric pain, fullness of the abdomen, and hiccups after the surgical resection of a malignant gastric tumor. an examination of vitals reveals tachycardia and hypotension. which action would the nurse take?
Curling Ulcer these occur because of excessive stress hormones in the body. a pt with extensive burns would be under extreme stress and would be susceptible to curling ulcers.
The nurse is caring for a pt who has extensive burns. For which type of ulcer would this patient be at high risk?
Nizatidine needs to be taken three times a day to be effective. Nizatidine is most effective if administered once daily at bedtime. A dose of famotidine at bedtime shoudl decrease acid production throughout the night. Sucralfate should be taken 1 hour and 2 hours hours after meals. Because omeprazole is a delayed release capsule, it should be swallowed whole and not crushed.
The nurse is teaching a patient with peptic ulcer disease about the prescribed drug regimen. Which statement made by the patient indicates a need for further teaching?
I should avoid alcohol and tobacco. the pt should eliminate caffeine from the diet. the pt will need to take vitamin b12 shots only if they have pernicious anemia.
The nurse is teaching a pt how to prevent recurrent chronic gastritis symptoms. Which statement by the pt demonstrates a correct understanding of the nurse's instruction?
Endoscopic ultrasound (EUS) EUS allows for the evaluation of the depth of the tumor and the presence of lymph node involvement.
Which diagnostic test is used to evaluate the depth of a gastric tumor?
Nasogastric suction delayed gastric emptying is often present after gastric surgery and usually resolves within 1 week. the edema is resolved with NG suction, maintenance of fluid and electrolyte balance, and proper nutrition.
a postop patient is experiencing delayed gastric emptying. which treatment would the nurse anticipate?
Nausea and vomiting these are symptoms of chronic PUD due to stasis and gastric dilation associated with pyloric obstructions. Abdominal bloating is another symptom of obstruction.
a pt is admitted with chronic peptic ulcer disease PUD, which finding suggests a possible pyloric obstruction?
62 year old patient with achlorhydria achlorhydria is the absence of secretion of hydrochloric acid, which is a risk factor for gastric cancer. the pts age is also a risk factor as gastric caner is common in people ages 60-80
which pt would the nurse consider to be at high risk for developing gastric cancer?
"It produces an enzyme that alters the acidity of the stomach." H pylori secretes urease, which produces ammonia, causing the gastric environment to become alkaline. This causes the release of hydrogen ions and increased acid, which causes mucosal damage. The organism doesn't damage the mucosa directly or secrete acid. It does not affect pyloric sphincter function
A patient asks the nurse how an infection such as Helicobacter pylori causes gastric ulcers. Which information would the nurse provide about this organism?
Contact the health care provider to report these symptoms. pts with these symptoms usually have chronic gastritis and should be evaluated.
A patient experiences regular epigastric discomfort that usually goes away after eating. Which action would the nurse take?
Gastritis is the inflammation of the stomach mucosa. Gastritis is the inflammation of gastric mucosa. H.Pylori infection is not associated with this condition. Gastritis is not a tumor of the duodenum or pancreas and is not caused by prostaglandin.
A patient has been diagnosed with gastritis. Which information describes this condition?
Ability to swallow secretions Pts should be monitored closely after an EGD to determine whether the gag reflex is intact as a safety measure to help prevent aspiration of saliva. Assessing the level of orientation, pain and ability to tolerate clear fluids will also be done.
A patient has undergone an esophagogastroduodenoscopy (EGD) procedure. Which assessment would the nurse make the priority for this patient?
H. pylori infection is spread by the oral-to-oral or fecal-to-oral routes. most common route of h pylori infection transmission is either oral to oral (stomach contents trasmitted from mouth to mouth) or fecal to oral (stool to mouth) contact. h pylori is not contracted during gestation. Human immune deficiency virus is contacted through contact with infected blood or bodily fluids. Mycobacterium tuberculosis, the organism that causes TB, is typically contracted via inhaled droplets.
A patient is diagnosed with a duodenal ulcer caused by Helicobacter pylori infection. The patient asks the nurse how this infection was contracted. Which response would the nurse provide?
Do not take an antacid at the same time as sucralfate the pt should not take antacids at the same time as sucralfate as they may impair the effects of the sucralfate. Meals at bedtime are not recommended with peptic ulcer disease, and pts should avoid alcohol. Sucralfate should be taken on an empty stomach.
A patient is prescribed sucralfate to treat symptoms of peptic ulcer disease. Which information would the nurse include when teaching the patient about this medication?
Helicobacter pylori H. pylori is the most common causative organism of chronic gastrisis. E.Coli can cause gastroenteritis. S. aureus is an organism that can cause a number of bacterial infections; however, gastritis is not one of them. Streptococcus bacteria can also cause a number of infections such as pneumonia, tonsillitis and meningitis.
A patient presents to the clinic and is diagnosed with chronic gastritis. Which organism would the nurse suspect as the likely cause?
Calcium carbonate causes rebound acid secretion, which will make symptoms worse." calcium carbonate is a potent antacid, but it triggers gastrin release, which causes rebound acid secretion. the symptom relief is temporary but not a placebo. symptoms will worsen with the rebound acid secretion; therefore, it is not recommended for a pt with peptic ulcer dz. calcium carbonate does not affect ulcer healing.
A patient tells the nurse that calcium carbonate has been effective in treating the discomfort associated with peptic ulcer disease. Which response would the nurse provide?
"Take the phenytoin 1 to 2 hours before or after the antacid." Antacids may interfere with the effectiveness of phenytoin, so pts should be taught to take the drugs 1 to 2 hours apart. antacids and phenytoin should not be taken at the same time because of absorption of the phenytoin may be impaired.. it's not necessary to discontinue the phenytoin; phenytoin does not increase the effects of the antacid.
A patient who currently takes phenytoin has been started on a multidrug regimen for treatment of peptic ulcer disease. Which information would the nurse provide about these medications?
metabolic alkalosis This is a complication of pyloric obstruction as a result of persistent vomiting. Pts who develop pyloric obstruction will have vomiting and hypokalemia. Hypernatremia and metabolic acidosis are not associated iwth pyloric obstruction
A patient who has peptic ulcer disease has developed pyloric obstruction. The nurse would monitor the patient's laboratory values closely to assess for which complication?
Whole grain breads gastric surgery pts should have a relatively low carb diet. Whole grains are allowed with caution.
A patient who has undergone gastric surgery is advised a specific diet to prevent dumping syndrome. Which food is acceptable with caution?
Contact the health care provider to discuss giving omeprazole or lansoprazole instead. pantoprazole should not be crushed before administration because it is designed to dissolve after passing through the stomach. holding the med until the pt is eating would prevent the pt from receiving an important tx for the ulcer. omeprazole and lansoprazole may be dissolved and given through any size NG tube.
A patient with a duodenal ulcer receives a prescription for pantoprazole tablets. The patient has a small-bore nasogastric (NG) tube and is NPO. Which action would the nurse take?
Maintain NG suction. the pt is exhibiting signs of perforation. the nurse should maintain NG tube suction only to drain gastric secretions and prevent further peritoneal spillage. unless there is reason to suspect incorrect placement, checking the placement of the tube is not the next action.
A patient with a gastric ulcer has a nasogastric (NG) tube in place. The patient develops severe epigastric pain, and the nurse notes a rigid, board-like abdomen. After the nurse notifies the health care provider of this condition, which action would the nurse take?
It will prevent a type of anemia pts who have chronic gastritis usually develop pernicious anemia, which may be prevented or treated with vitamin b 12. vitamin b 12 does not affect the symptoms of gastritis, protect stomach lining or minimize reflux.
A patient with chronic gastritis who is prescribed vitamin B12 asks the nurse why this vitamin is necessary. Which information would the nurse provide?
"Those herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." although licorice and slippery elm may be helpful, the pt should consult with their HCP before making a change in tx. Alternative therapies might or might not be helpful in managing PUD.
A patient with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. Which response would the nurse provide?
Decompression of the stomach patients who develop pyloric obstruction are at risk for gastric distention. the NG tube is used to decompress the stomach
A patient with peptic ulcer disease has developed a pyloric obstruction, and the health care provider orders placement of a nasogastric (NG) tube. For which purpose would the nurse place a NG tube in this patient?
provide oral and written instructions on dressing changes and on symptoms to report. providing the pt and spouse with both oral and written instructions on symptoms to report to the HCP, as well as on how to perform the dressing change, will reinforce important points and boost the. spouse's confidence.
A pt is scheduled to be discharged after a gastrectomy. the pt's spouse expresses concern that the pt will be unable to change the surgical dressing correctly. which action would the nurse take?
poor prognosis this prognosis is expected from symptomatic gastric cancer. Gastric cancers are asymptomatic in the early stages. An asymptomatic patient would be in the advanced stages, making treatment difficult and mostly palliative.
A pt is symptomatic at the time of diagnosis with gastric cancer. Which prognosis would the nurse anticipate?
Melena The term used to describe traces of blood or occult blood in the stool. Hematemesis is a term used to describe the vomiting of blood. Dysepsia describes a sharp burning or gnawing pain.
The laboratory report of a patient with acute gastritis states there are traces of blood in the stool. Which term would the nurse use to document this finding?
Chicken and white rice this is the only selection suitable for the pt who is experiencing dumping syndrome because it contains high protein without he addition of milk or wheat products. the pt with dumping syndrome should not be allowed to have mayonnaise, onions, or buttermilk ranch.
The nurse and the registered dietitian nutritionist are plannign sample diet menus for a pt who is experiencing dumping syndrome. which sample meal would they recommend for this pt?
Administering IV fluids administering IV fluids is necessary to treat the hypovolemia caused by acute GI bleeding. Administration of H2 antagonist will not treat the basic problem, which is upper GI bleeding. Administration of antianxiety medication will not treat the basic problem causing the patient's change in mental status, which is hypovolemia.
The nurse finds a patient vomiting coffee ground-type emesis. The patient is acutely confused, has blood pressure of 100/74 mm Hg, and has a weak and thready pulse. Which intervention would the nurse expect to be prescribed?
"Water goes down the tube to clean out your stomach" Gastric lavage involves the instillation of water or saline through an NG tube to clear out stomach contents and blood clots. It does not involve the instillation of medication
The nurse has placed a nasogastric (NG) tube in a patient with upper GI bleeding to administer gastric lavage. The patient asks the nurse about the purpose of the NG tube for the procedure. Which response would the nurse provide?
Type O blood Most patients with duodenal ulcers have type O blood. are 50 years old or older and well nourished.
The nurse is assessing a patient who reports episodes of abdominal pain. Which patient data suggest increased risk for duodenal ulcer?
Worsens with the ingestion of food Pain from a gastric ulcer usually worsens after the intake of food. pain on the right side of the epigastrium is often due to duodenal ulcer. pain due to a gastric ulcer is often in the upper epigastrium with localization to the left of the midline. It usually occurs 30 to 60 minutes after a meal and is rare at night.
The nurse is assessing the nature of abdominal pain in a patient with a suspected gastric ulcer. Which feature of the patient's pain is consistent with a gastric ulcer?
Rapid urease testing rapid urease testing may be done on tissue samples collected during EGD to detect H pylori infection. Cytologic examination is used to detect cancer cells. IgG or IgM antibody tests are blood tests to diagnose infection, but not the preferred diagnostic for h pylori.
The nurse is assisting with an esophagogastroduodenoscopy (EGD) procedure on a patient who has symptoms of gastritis. Which diagnostic test will the health care provider request on the tissue samples to determine the presence of Helicobacter pylori infection?
Gastric The vomitus of pts with gastric ulcer is more likely to resemble coffee grounds. Pts with duodenal ulcers generally pass blood in the stool. Esophageal ulcer bleeding is usually bright red. Pyloric obstruction does present with vomiting, but not typically with blood.
The nurse is caring for a patient who has granular, dark vomitus that resembles coffee grounds. Which type of ulcer would the nurse suspect in this patient?
Assess for a gag reflex. after an endoscopic procedure, the pt should not be allowed any foods or fluids until the gag reflex has been assessed for prevention of aspiration. The pt's spouse should be instructed to refrain from providing foods or fluids. it is not necessary to obtain a registered dietician nutritionist consult or an order for NG tube insertion.
The nurse is caring for a patient who has just returned from an endoscopic procedure. The patient's spouse verbalizes that the patient must be hungry. Which action would the nurse take?
Assuming the knee-chest position Tender, rigid, board like abdomen Sudden, sharp pain in the mid epigastrium perforation of a peptic ulcer is a life threatening surgical emergency. Perforation causes a sudden sharp pain in the mid-epigastric region. The pt becomes apprehensive and the abdomen becomes tender, rigid and board-like. To decrease the tension of the abdominal muscles, the pt usually assumes a knee-chest position.
The nurse is caring for a patient with peptic ulcer disease (PUD). Which assessment finding suggests a surgical emergency? SATA
NSAIDS Chronic use of NSAIDS can result in gastritis and in serious cases, bleeding or hemorrhage.
The nurse is caring for a pt who has acute gastritis. Which class of medication is likely to increase the pt's risk for bleeding?
Hiccups decreased patency caused by a clogged NG tube can result in acute gastric dilation after surgery. This problem is usually manifested by hiccups, epigastric pain, tachycardia, and hypotension. Irrigation or replacement of the NG tube can relieve these symptoms.
The nurse is caring for a pt with a nasogastric (NG) tube who has undergone open-approach surgery for gastric cancer. Which finding is associated with acute gastric dilation?
The pain occurs 3 hours after meals and at night. the key symptom of duodenal ulcers is that pain usually awakens the pt between 1 and 2am, occurring 1 1/2 to 3 hours after a meal. pain that is worsened by the ingestion of food and a malnourished appearance are key features of gastric ulcers.
The nurse is caring for an older-adult man who reports stomach pain and heartburn. Which characteristic would lead the nurse to suspect the ulcer was duodenal rather than gastric in location?
blood pressure decrease from 140/90mm Hg to 110/70 mm Hg a decrease in BP is the most indicative sign of bleeding. slight decreases in respiratory rate, apical pulse, and temperature are not primary indications of bleeding.
The nurse is monitoring a pt with gastric cancer for signs and symptoms of upper GI bleeding. Which change in vital signs is indicative of blood loss?
Metronidazole it's an antimicrobial that treats H pylori infection.
The nurse is reviewing the medications prescribed for a patient with peptic ulcer disease (PUD). Which drug treats Helicobacter pylori infection?
use of complementary and alternative therapies using both therapies such as relaxation and meditation can help manage stress and discomfort, both of which can cause gastritis to worsen.
The nurse is teaching a patient about self-management of gastritis. Which information would the nurse include?
"Take the famotidine at bedtime." famotidine is given once daily at bedtime to suppress nocturnal acid production. sucralfate is given 1 hour before meals, 2 hours after meals and at bedtime, not given PRN
The nurse is teaching a patient about the use of famotidine and sucralfate to treat gastritis. Which information would the nurse include?
MIS may cure the malignancy You will have less pain after surgery' Quick recovery can be possible after surgery. Gastric cancers diagnosed in the early stages may be cured with MIS along with chemotherapy or radiation therapy. MIS is a laparoscopic procedure so the pain is less in the pt. Quick recovery is seen in pts after MIS because there are fewer post op complications, so pts can be discharged immediately after the surgery and hospital stays are shorter.
The nurse is teaching a pt diagnosed with an early stage of gastric cancer about minimally invasive surgery (MIS). Which information would the nurse include in the teaching? SATA
A large-bore NG tube is required for gastric lavage. required to accommodate the large volumes of fluid flowing in and out of the tube. Water at room temp is appropriate for lavage, not cold water. A sample of the gastric contents is aspirated using a 50-mL catheter tipped syringe.
The nurse will insert a nasogastric (ng) tube for gastric lavage in a pt who is vomiting blood. Which information would the nurse incorporate in planning the intervention?
Helicobacter pylori Many people diagnosed with gastric cancer have a previous history of H.Pylori infection, which is precipitated by atrophic gastritis.
Which bacteria can cause gastric cancer?
Tarry or dark sticky stools, Decreased blood pressure, Dizziness or light-headedness, Bright red or coffee-ground-colored vomitus patients with upper GI bleeding report these symptoms, and they might feel dizzy because of the decreased blood pressure. lab findings of pts with duodenal ulcers would indicate high gastric acid secretion and low pH levels in the duodenum.
Which clinical finding is associated with upper GI bleeding? Select all that apply. One, some, or all responses may be correct.
Hemorrhage It's the most serious of the complications for peptic ulcers. Can be worsened with H Pylori infection; resulting in tarry or dark, sticky stools and bright red vomitus. Perforations can occur when the ulcer is deep enough to wear away the entrire membrane of the stomach and duodenum.
Which complication of peptic ulcer disease is more common in older adults?
Pernicious anemia Patient's with chronic gastritis lose function of the parietal cells and thus the source of intrinsic factor leading to vitamin B12 deficiency and pernicious anemia. Chronic gastritis does not cause an increased risk for appendicitis, chronic constipation, or IBS.
Which condition is a complication of chronic gastritis?
gastric ulcer most gastric ulcers are caused by h pylori infection. the infection causes the activation of inflammatory cells such as cytokines and neutrophils that cause epithelial cell necrosis of the mucous membrane.
Which condition may result from Helicobacter pylori infection?
Nausea and vomiting Enlarged lymph nodes Weakness and fatigue Iron deficiency anemia Low hematocrit and hemoglobin values indicate anemia. Pts with advanced gastric cancer experience progressive weight loss.
Which cue would the nurse assess for a pt with advanced gastric cancer? SATA
Endoscopic ultrasound (EUS) EUS allows for the evaluation of the depth of the tumor and the presence of lymph node involvement.
Which diagnostic test is useful for an accurate staging of gastric cancer?
Atrophic gastritis A form of chronic gastritis often found in older adults that can lead to gastric cancer and MALT lymphoma. Uremia, Crohn disease, and graft versus host disease are systemic disorders that can precipitate chronic gastritis.
Which disorder in older adults has a direct association with mucosa-associated lymphoid tissue (MALT) lymphoma?
Pernicious anemia, Nausea and vomiting, Intolerance to fatty food Pernicious anemia and intolerance to fatty food are key features of chronic gastritis. N/V are key features to both chronic and acute gastritis.
Which finding is a key feature of chronic gastritis? Select all that apply. One, some, or all responses may be correct. heart burn hematemesis pernicious anemia gastric hemorrhage N/V Intolerance to fatty food
Coffee cake coffee cake as well as all sweets and desserts, should be excluded from the diet of pts with dumping syndrome. It will minimize dumping syndrome and decreases gastric stimulation.
Which food would the nurse exclude from the diet of a patient who has dumping syndrome?
Margarine Dietetic drinks Sugar substitutes Teach the patient with dumping syndrome to eat a high protein, high fat, low to moderate carbohydrate diet. Margarine is high in fat, dietetic drinks provide nutrition in small volume and the nurse should encourage several small meals a day for patients with dumping syndrome. sugar substitutes should be encouraged as sugar could worsen dumping syndrome. cabbageproduces gas and carbonated drinks worsen dumping syndrome.
Which food would the nurse promote for a postoperative patient with gastric cancer diagnosed with dumping syndrome? SATA Cabbage margarine dietetic drinks sugar substitiutes diet carbonated drinks
Radiation therapy treatment with radiation therapy is known to be associated with the development of chronic gastritis.
Which information found in a patient's history frequently correlates with a diagnosis of chronic gastritis?
"It is important to eat a well-balanced diet.", Avoid alcoholic beverages in excessive amounts., Avoid excessive intake of coffee or decaffeinated coffee.", "Protect against exposure to toxic substances in the workplace." a healthy lifestyle comprising of a well-balanced diet helps prevent complications. excessive alcohol and caffeinated and decaffeinated drinks can lead to gastritis in adults and these drinks should be avoided. A pt who is exposed to toxic substances such as lead or nickel in the workplace is also susceptible to gastric problems. foods with strong spices such as pepper and mustard should be avoided because they can cause gastric distress.
Which information would the nurse include when teaching patients to prevent gastritis? Select all that apply. One, some, or all responses may be correct.
The liquid form of this is preferable to chewable tablets. the liquid form should be used rather than tablets if palatable, suspensions are more effective than chewable tablets. should be taken 1 hour after meals and at bedtime.
Which information would the nurse provide the patient regarding aluminum hydroxide?
Ensure that food and water are safe and not contaminated, Try complementary and alternative therapies to manage stress., Avoid exposure to toxic substances, such as nickel, at the workplace. Protection against exposure to nickel helps prevent gastritis. ensuring that food and water are safe and uncontaminated helps prevent type B gastritis, which s mostly caused by h pylori infection. Stress and anxiety may contribute to gastritis.
Which instruction would the nurse give to help a patient prevent gastritis? Select all that apply. One, some, or all responses may be correct.
examining the surgical site regularly auscultating the lungs and bowel sounds reminding the pt to perform pulmonary exercises verifying placement and function of the NG tube
Which intervention would the nurse include in the plan of care for a pt after an open partial gastrectomy?
mucosa gastric cancer develops in the mucosal cells that form the innermost lining of the stomach. As the tumor grows, it invades the serosa, submucosa and muscularis layers.
Which layer of the gastric wall is first affected by adenocarcinoma?
Antrum of the stomach Gastric ulcers appear in the antrum of the stomach. Stress ulcers may be found on the proximal duodenum. Duodenal ulcers occur in the upper portion of the duodenum and penetrate through the mucosa and submucosa into the muscularis propria.
Which location is common for gastric ulcers?
evaluating heart rate and BP the manifestation of acute stress ulcers is bleeding caused by gastric erosion. The nurse should monitor for signs of bleeding, including heart rate and BP.
Which nursing action is the priority for the patient with stress ulcer?
Document instructions for a patient with chronic gastritis about how to use triple therapy reinforcement of teaching done by the RN is within the scope of practice for the LPN/LVN.
Which nursing action would the nurse delegate to an experienced licensed practical nurse/licensed vocation nurse (LPN/LVN)?
Reducing caffeine intake Caffeine, especially coffee, stimulates gastrin release, which worsens PUD. Marshmallow root is recommended for PUD tx, but marshmallows do not contain it. Ipecac induces vomiting, which is not beneficial to the patient with PUD. Spicy food worsens most stomach disorders.
Which nutritional recommendation would the nurse provide to the patient with peptic ulcer disease (PUD)?
Vascular congestion Acute inflammatory cell infiltration Degenerative changes in the superficial stomach lining In gastritis, because of the breakdown of the GI barrier, hydrochloric acid diffuses into the mucosa and causes injury to the small vessels. This can cause vascular congestion and acute inflammatory cell infiltration. This diffusion also causes erosion of the superficial epithelium of the stomach lining. Prostaglandins provide a protective mucosal barrier that prevents the stomach from digesting itself. Histamine release and vagus nerve stimulation are aggravating factors of gastritis, but these are not changes caused by gastritis.
Which pathologic change is caused by gastritis? SATA vascular congestion acute inflammatory cell infiltration Prostaglandins providing a mucosal barrier Histamine release and vagus nerve stimulation Degenerative changes in the superficial stomach lining
relatively low carbohydrate content to prevent symptoms of dumping syndrome, the pt should implement a diet with relatively low to moderate carbohydrate content. Fat and protein shoudl be high.
Which principles would the nurse include in teaching a pt how to prevent symptoms of dumping syndrome?
patient b Atrophic gastritis is a precancerous condition associated with gastric cancer.
Which pt is at an increased risk for gastric cancer? Pt / Medical history a/stress ulcers b/atrophic gastritis c/barrett syndrome d/curing ulcers
It strengthens the mucosal lining of the stomach
Which response would the nurse use when a patient with gastritis asks, "Why am I taking this drug called sucralfate?"
You have abnormal tissue development that is precancerious. atrophic gastritis and intestinal metaplasia (abnormal tissue development) are precancerous conditions. Inadequate acid secretion in pts with atrophic gastritis creates an alkaline environment that allows bacteria (especially h pylori) to multiply
Which response would the nurse use when a pt diagnosed with intestinal metaplasia asks, "is this cancer?"
Avoid exposure to lead Atrophic gastritis is a kind of chronic gastritis that is commonly seen in pts exposed to toxic substances such as lead. therefore, exposure to metals such as lead should be limited. The pt should avoid excessive intake of both caffeinated and decaffeinated coffee. The pt with gastritis should quit smoking or tobacco use entirely because it aggravates the condition. The pt may not need to completely avoid NSAID but should use caution when using them.
Which self-management measure would the nurse teach the patient who has gastritis?
peritoneal seeding peritoneal seeding of cancer cells from the tumor site causes cancer of the peritoneum and the ovary. Metastases to lungs, bones, or the liver can occur through hematogenous spread. Lymphatic infiltration of cancer cells can cause distant metastases. Direct invasion of cancer cells results in cancer of the liver, pancreas, and transverse colon.
Which spread mechanism would cause a patient with gastric cancer to develop ovarian metastases?
Most gastric cancers are adenocarcinomas that begin in the glands of the stomach mucosa. In the early stages there are often no symptoms, so they go undetected. Metastasis may occur through direct invasion or lymphatic spread; however, the most common mode of metastasis is through hematogenous spread. Gastric cancers spread to the ovaries by way of peritoneal seeding of cancer cells rather than by direct invasion of the ovaries.
Which statement about the pathophysiology of gastric cancers is accurate?
iron deficiency anemia decreases my risk for developing gastric cancer pts with pernicious anemia are at increased risk for gastric cancer.
Which statement by a patient about the risk for developing gastric cancer needs correction?
to provide a definitive diagnosis HCP uses EGD with biopsy for definitive diagnosis of gastric cancer.
a health care provider advises EGD for a pt suspected of having gastric cancer. What rationale supports this recommendation?
Lie down. these symptoms indicate dumping syndrome.the priority intervention is to lie down.
a nurse is caring for a pt who has undergone surgical resection of a malignant gastric tumor. the pt reports vertigo, tachycardia, syncope, pallor, and increased perspiration within 30 minutes after eating. Which action would the nurse recommend to this patient?
Gastric ulcer symptoms of typical gastric ulcer : pain that is aggravated by food and localized to the left side of the upper epigastric area.
a patient being evaluated reports sharp, burning left-sided upper epigastric pain, which worsens after eating. the nurse notes epigastric tenderness, a soft abdomen and normally active bowel sounds. which condition would the nurse suspect?
Acute gastritis In acute gastritis, the gastric mucosa becomes red and thickened with prominent rugae because of inflammation from being exposed to local irritants. Chronic gastritis appears as a patchy, spread out inflammation of mucosal lining of the stomach. Atophic gastritis is a type of chronic gastritis most often found in older adults.
a patient's endoscopy report reveals a reddened and thick mucosal membrane around the stomach with prominent rugae. Which condition is associated with these findings?
Sweetened juice dumping syndrome occurs because of rapid emptying of food contents into the intestine, resulting in abdominal distention from fluid shift. This condition is a complication of surgical procedures of the abdomen and is prevented by eating many small meals in a day. Sweetened juice is contraindicated in these pts because juices are rich in carbohydrates.
a pt is diagnosed with dumping syndrome. which foods would the nurse recommend that the pt avoid?
i will not need a NG tube with this type of surgery NG tubes are used in conventional open approach surgical procedures; pts having laparoscopic surgery do not require NG tubes.
a pt who has a gastric malignancy is scheduled for partial gastrectomy with an open approach. which statement by the pt indicates the need for further teaching?
pregnancy Misoprostol has two indications: protection of stomach lining and induction of labor, therefore it shouldn't be given to a pregnant pt unless she is under the care of an obstetrician.
a pt who has been diagnosed with rheumatoid arthritis also has a history of peptic ulcer disease (PUD). The HCP has prescribed misoprostol to help prevent further gastric damage. which concurrent condition should be ruled out before starting this medication?
Cardia pts with barrett esophagus because of gastroesophageal reflux disease are at increased risk for cancer in the cardia (where the stomach connects to the esophagus).
pts with Barrett esophagus have an increased risk for cancer in which stomach location?
remove secretions, and emptying the stomach this allows for the surgery to take place without contamination of the peritoneal cavity by gastric secretions. The NG tube stays in place for a few days post op to prevent accumulation of secretions, which may lead to GI distention or vomiting and pressure on the incision.
the nurse is preparing to insert a NG tube for a patient who is scheduled to have surgery for gastric cancer. which purpose of placing the tube would the nurse explain to the pt?
I can eat ice cream in moderation milk products such as ice cream must be eliminated from the diet of a pt with dumping syndrome. the pt with dumping syndrome can no longer consume sweetened drinks. alcohol must be eliminated from the diet. the pt can eat sugar free pudding, custard and gelatin with caution.
the nurse is teaching a pt about dietary choices to prevent dumping syndrome after gastric bypass surgery. which statement by the patient indicates a need for further teaching?
Esopagogastroduodenoscopy (EGD)
which diagnostic test, in combination with biopsy, yields a definitive diagnosis for gastric cancer?
feeling of fullness early manifestations of gastric cancer involve indigestion, epigastric pain, and a feeling of fullness.
which finding is a manifestation of early gastric cancer?
hematogenous spread via systemic circulation to the lungs is the most common mode of metastasis.
which mechanism is responsible for lung metastasis in pts with gastric cancer?
Confusion confusion is a symptom of late dumping syndrome, which is caused by the secretion of excessive amounts of insulin. This is followed by a rapid rise in blood glucose levels because of the rapid entry of high carbohydrate food into the jejunum. Vertigo, tachycardia and pallor are symptoms of early dumping syndrome.
which patient finding 3 hours after eating indicates late dumping syndrome?
implement aggressive respiratory exercises they help prevent respiratory complications and DVT. NG tube should be irrigated only with specific orders from HCP. We encourage ambulation, not bed rest. and HOB should be elevated, not legs. We inspect the incision site every 8-12hr.
which post op intervention would the nurse anticipate implementing for a patient with gastric cancer? SATA implement aggressive respiratory exercises irrigate the NG tube at least every shift encourage bed rest to allow the body to heal place the HOB flat with the legs elevated Inspect the exposed operative site every 24 hours
Many pts with early gastric cancer experience no symptoms at alll. indigestion and abdominal discomfort are the most common symptoms. a continual feeling of fullness is a common symptom in early gastric cancer symptoms are often not taken seriously bcause they are relieved by antacids symptoms become severe and do not respond to medication as the cancer progresses
which statement would the nurse include when teaching a group of pts about recognition of early gastric cancer? SATA