E4 GI
A client just has returned from the postanesthesia care unit after having a laparotomy. Which initial sign or symptom indicates to the nurse that peristalsis has begun to return?
Borborygmi are auscultated
Calorie content of macros
Carb: 4 Protein: 4 Fat: 9
An emergency department nurse assesses an older client who reports cramping pain in the left lower quadrant, weakness, bloating, and malaise. The client also has a low-grade fever. Which condition does the nurse suspect as the most likely cause of the client's clinical findings?
Diverticulitis
Mr. Lewin is predisposed to dumping syndrome as a result of his surgery. Which of the following characterizes dumping syndrome?
Dizziness after eating, often accompanied by pallor
H2 antagonist indications
GERD PUD Erosive esophagitis Adjunct therapy in control of upper GI bleeding Pathologic gastric hypersecretory conditions (Zollinger-Ellison syndrome)
Proton Pump Inhibitors: Indications
GERD maintenance therapy Erosive esophagitis Short-term treatment of active duodenal and benign gastric ulcers Zollinger-Ellison syndrome Treatment of H. pylori-induced ulcers End goal is the prophylaxis of ulcers
What are major causes of peptic ulcer disease that are recognized in the current literature?
H. pylori NSAIDS Smoking
Antacids: Calcium Salts
May cause constipation Their use may result in kidney stones Long duration of acid action may cause increased gastric acid secretion (hyperacidity rebound) ex: tums
A client arrives in the emergency department with epigastric pain and prolonged vomiting. Assessment findings include rapid and shallow respirations, dry and flushed skin, weakness, and lethargy. Which is the primary nursing concern?
Metabolic alkalosis (which is causing the ineffective breathing pattern)
The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. What nursing intervention is the priority?
Observe for increased confusion An increased serum ammonia level impairs the central nervous system, causing an altered level of consciousness
Saline laxatives (magnesium) are contraindicated in:
Renal Failure patients
If Mr. Lewin has GI bleeding prior to endoscopy, gastric lavage may be needed. Which of the following should be available for gastric lavage?
Room-temperature saline is recommended for gastric lavage when GI bleeding is present. When upper GI bleeding is present, gastric lavage is done to clear the stomach of excess blood and clots.
A client who has a history of alcohol abuse now has recurrent exacerbations of chronic pancreatitis. The nurse asks the client to obtain a stool specimen. When assessing the client's stool, what would the nurse expect to observe?
Steatorhhea (more fat content)
"You will be given a dye by vein, after which x-rays will be taken."
This description explains a computed tomography (CT) scan of the abdomen
"You will drink a white liquid, after which x-rays will be taken."
This description explains an upper GI series (barium swallow). It is usually the initial procedure done when peptic ulcer disease is suspected and GI bleeding is not present.
A client with a history of gastrointestinal varices develops severe hematemesis, and insertion of a Sengstaken-Blakemore tube has been scheduled. What information about the design and purpose of the tube does the nurse provide the client?
Triple-lumen to compress the esophagus One lumen inflates the esophageal balloon, The second inflates the gastric balloon, The third decompresses the stomach
A nurse is teaching a newly admitted client who has acute pancreatitis about dietary restrictions. What should the education include?
Use of IV fluids Acute pancreatitis requires an NPO status to allow the pancreas to rest. IV fluids are administered.
Hiatal Hernia + predisposing actors
a. Part of stomach protrudes through the esophageal hiatus of the diaphragm into thoracic cavity b. Predisposing factors include: Increased intra-abdominal pressure Increased age Trauma Congenital weakness Forced recumbent position
H. pylori treatment
antibotic & proton pump inhibitor
Antacid types w/corresponding side effects
oAluminum and calcium Constipation o Magnesium Diarrhea o Calcium carbonate Produces gas and belching; often combined with simethicone
An IV infusion of pantoprazole IV is prescribed for Mr. Lewin. He asks you why he has to take this medication. What is the correct response to give the client for the use of pantoprozole IV?
suppress gastric acid secretion Pantoprazole IV is a proton pump inhibitor. Proton pump inhibitors block gastric acid secretion. When an ulcer is present and a bleeding episode has occurred, IV administration of proton pump inhibitors can help to prevent additional bleeding
A client had a cholecystectomy and asks whether there will be any dietary restrictions after the client's discharge. The nurse evaluates that the dietary teaching is understood when the client makes what comment to a family member?
"I need to eat smaller amounts of food at a time, and they should contain low to moderate fats."
Indicators of a severe attack of pancreatitis that are associated with an increased risk for complications and death include:
70+ years, Obesity, Hemoconcentration (hematocrit greater than 44%), Shock, Organ failure (respiratory, renal), GI bleeding
Albumin normal range and high/low indications
A normal albumin range is 3.4 to 5.4 g/dL. If you have a lower albumin level, you may have malnutrition. It can also mean that you have liver disease or an inflammatory disease. Higher albumin levels may be caused by acute infections, burns, and stress from surgery or a heart attack
Mrs. Barker symptoms include severe abdominal pain, and nausea and vomiting. You assess Mrs. Barker for other signs and symptoms that are common with acute pancreatitis. Which of the following do you expect?
Abdominal distention is common with acute pancreatitis, because of intestinal hypo-motility
Pancreatitis S/S
Abdominal pain nausea./vomiting Fatty stools Anxiety, chills, fever Weakness Weight loss Jaundice Plural effusion Multi system failure Coagulation defects Shock Decreased serum calcium Elevated: serum amylase, lipase, glucose & urine amylase, bilirubin, WBC
The nurse instructs a client with a new colostomy to avoid foods and drinks that produce a large amount of gas, specifically to avoid the intake of what?
Cabbage
Which client response during the insertion of a nasogastric tube indicates to the nurse that the client is experiencing serious difficulty with the insertion?
If the nasogastric tube is passed accidentally into the trachea rather than the esophagus, it will occlude the airway, causing cyanosis
A healthcare provider informs a client that a T-tube will be in place after an abdominal cholecystectomy and a choledochostomy. What should the nurse include in the preoperative teaching for this client regarding the primary reason why a T-tube is necessary?
Keep the common bile duct patent
acute epigastric or left upper quadrant pain may indicate
Pancreatitis
When does the nurse's teaching say that the client's new sigmoid colostomy should be irrigated?
Stools start to become formed Once stool is formed, peristalsis needs to be stimulated to promote the passage of the stool
IBS nursing interventions
Stress Management Diet Therapy: -Avoid lactose products, caffeine, ETOH, sorbitol or fructose -Increase fiber (30-40 gm) -Fluid intake of 8-10 cups per day -meal planning
Used for prevention of NSAID-induced gastric ulcers
misoprostol (Cytotec)
Which of the following assessments are relevant to hypovolemic shock?
-Blood pressure -Pulse -Skin -Urine output -Urine specific gravity
Shifting of periumbilical pain to the lower right quadrant and localizing at McBurney's point may indicate
Appendicitis
Right upper quadrant pain that may be referred to the right shoulder and scapula. may indicate
Cholecystitis
An obese client with a hiatal hernia asks the nurse how to prevent esophageal reflux. Which is the nurse's best response?
Eat less food each meal Eating less food not only relieves intraabdominal pressure, but it promotes weight loss, which helps to decrease the tendency of gastric contents to reflux into the esophagus.
A client was diagnosed with ulcerative colitis. Two months after the diagnosis, the client is readmitted for an exacerbation of the illness. The client is weak, thin, and irritable. The client states, "I am now ready for surgery to create an ileostomy." Which nursing intervention will best meet the client's priority need?
Fluid and electrolyte replacement is a life-saving strategy; it must be done before surgery is performed
A client is receiving hypertonic tube feedings. What should the nurse consider to be the main reason this client may experience diarrhea?
High osmolality of the feedings
Crohn's disease + s/s
Inflammatory disease of small intestines, colon, or both (terminal ileum) s/s: 5-10 **fatty** stools per day (steatorrhea) Flatus Malabsorption Weight loss **Diffuse bilateral lower quadrant pain** Fever with perforation or fistula Fluid, electrolyte and vitamin deficits
A client suspected of carcinoma of the liver is scheduled for a liver biopsy. For which procedural contraindication should the nurse assess the client?
International normalized ratio (INR) greater than 4.5 A normal INR range is 0.7 to 1.8. INR values over 4.5 increase the risk of major hemorrhage. This should be corrected before the biopsy to prevent hemorrhage
A nurse is teaching a client with an acute exacerbation of ulcerative colitis about the most appropriate diet. Which food selected by the client indicates that the dietary teaching is effective?
Low-fiber foods and lactose-free foods are recommended during acute exacerbations
A client is a candidate for intubation as a result of bleeding esophageal varices. Which type of tube should the nurse anticipate will most likely be used to meet the needs of this client?
Sengstaken-Blakemore includes an esophageal balloon that exerts pressure on inflation, which retards hemorrhage.
A client has laparoscopic surgery to remove a calculus from the common bile duct. What postoperative client response indicates to the nurse that bile flow into the duodenum is reestablished?
Stools become brown
Crohn's treatment & considerations
Surgery is not a cure Ileostomy often resulted education + pain management is focus small frequent meals complications: Intestinal obstruction Fistulas Malabsorption syndrome Liver and biliary diseases Kidney stones Arthritis
"pyrosis." The layman's term for this symptom is:
heartburn
Achlorhydria
lack of hydrochloric acid
H2 Antagonists mechanism of action
- More for longterm use Block histamine (H2) at the receptors of acid-producing parietal cells Production of hydrogen ions is reduced, resulting in decreased production of HCl
Dumping syndrome patient teaching points
- Restrict fluids during meals - Lie down 30 minutes after meals
A nurse reviews the laboratory results of a client with acute pancreatitis. Which test is most significant in determining the client's response to treatment?
Amylase level In 90% of clients with acute pancreatitis, the amylase level is elevated up to three times over baseline; serum amylase usually returns to expected adult levels within three days after treatment begins
The nurse is assessing a client with severe cirrhosis and discovers fetor hepaticus. What did the nurse assess?
Breath The client's breath has a sweet odor (fetor hepaticus) because the liver is not metabolizing the food, especially proteins
IBS + s/s
Chronic disorder of diarrhea and constipation -abdominal pain relieved by defecation -abdominal distention -sensation of incomplete BM (bowel movement) -Presence of mucus
Peripherally Acting Mu-Opioid Receptor Agonists (PAMORAs): Indications
Opiate Induced Constipation Methylnaltrexone has injectable formulation, good for use with NPO post op patients, injection typically has fast response. Monitor pain control, some drugs can antagonize opiate pain regimen
A client is admitted to the hospital with a history of cancer of the liver and jaundice. In relation to the jaundice, the nurse expects the client to report the presence of what symptom?
Pruritus
When discussing a scheduled liver biopsy with a client, the nurse explains that for several hours after the biopsy the client will have to remain in what position?
The right side-lying position with pillows placed under the costal margin
H2-receptor purpose, examples, side effects?
To promote ulcer healing, an H2-receptor antagonist may be prescribed after the initial therapy is completed. Ex: nizaditine, cimetidine, ranitidine, and famotidine H2 receptor antagonists are most effective when taken at bedtime. Headache is a common side effect of these medications
Delirium tremens (DTs)
do not occur in the early hours of alcohol withdrawal. Delirium tremens characterizes the later stages of alcohol withdrawal, beginning approximately 40-48 hours after the cessation of drinking characterized by high blood pressure, tachycardia, fever, tremors, diaphoresis, disorientation, confusion, agitation, hallucinations, delusions, and seizures. DTs may last 1-3 days, and reoccurrence may continue for weeks
Laxatives: side effects (per catagory)
oBulk forming Impaction Fluid overload oEmollient Skin rashes Decreased absorption of vitamins oHyperosmotic Abdominal bloating Rectal irritation o Saline Magnesium toxicity (with renal insufficiency) Cramping Diarrhea Increased thirst o Stimulant Nutrient malabsorption Skin rashes Gastric irritation Rectal irritation All laxatives can cause electrolyte imbalances!
Laxatives: Mechanism of Action: Emollient
oStool softeners and lubricants oPromote more water and fat in the stools oLubricate the fecal material and intestinal walls oExamples: nStool softeners: docusate salts (Colace, Surfak) nLubricants: mineral oil
A patient with acute pancreatitis may be most comfortable in what position?
on their side in the fetal position, or in a sitting position with the knees drawn up. In bed
What is melena and what might it indicate?
Melena refers to black, tarry stool containing digested blood; melena is caused by upper gastrointestinal bleeding
A nurse is caring for a postoperative client who has a nasogastric tube attached to low continuous suction. Which assessment findings indicate that the client may be experiencing hypokalemia?
Muscle weakness and cardiac dysrhythmias
A client is admitted to the hospital after taking an overdose of aspirin. A nasogastric tube is inserted for lavage. Which solution should the nurse obtain for the gastric lavage?
Normal saline
Six hours after major abdominal surgery, a client reports severe abdominal pain and feeling faint. The nurse identifies a thready, rapid pulse. The nurse checks the medication administration record (MAR) (Physiological Aspects of Care record) and determines that the client can receive another injection of pain medication in an hour. Which is the most appropriate action by the nurse?
Notify healthcare provider (s/s indicate shock)
A nurse is caring for a client with chronic inflammation of the bowel. Which most serious complication should the nurse monitor for in this client?
Perforation
A nurse is caring for a client with acute pancreatitis. Which elevated laboratory test result is most indicative of acute pancreatitis?
Serum lipase Lipase concentration is increased in the pancreas and is elevated in the serum when the pancreas becomes acutely inflamed; this distinguishes pancreatitis from other acute abdominal problems.
Treatment options for gastritis
a. NPO status to rest GI tract for 6 - 12 hours, reintroduce clear liquids gradually and progress; intravenous fluid and electrolytes if indicated b. Medications: proton-pump inhibitor or H2-receptor blocker; sucralfate (carafate) acts locally; coats and protects gastric mucosa c. If gastritis from corrosive substance: immediate dilution and removal of substance by gastric lavage (washing out stomach contents via nasogastric tube), **no vomiting**
NSAIDS and ulcers connection
interrupts prostaglandin synthesis which maintains mucous barrier of gastric mucosa (prostiglandins are responsible for contraction and relaxation of smooth muscle)
Antidiarrheal Agents: Nursing Implications
oObtain thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes, and assess for allergies oDO NOT give bismuth subsalicylate to children younger than age 16 or teenagers with chickenpox because of the risk of Reye's syndrome (a life-threatening metabolic disorder in young children, of uncertain cause but sometimes precipitated by aspirin and involving encephalitis and liver failure) oUse absorbents carefully in geriatric patients or those with decreased bleeding time, clotting disorders, recent bowel surgery, confusion oAnticholinergics should not be administered to patients with a history of glaucoma, BPH, urinary retention, recent bladder surgery, cardiac problems, myasthenia gravis
Hepatitis nursing management
Medications include: Vit K if prolonged PT, antihistamines for relief of pruritis, antiemetics. Bile acid sequestrants (Clestid, Questran) bind with bile acids in the GI tract and is excreted in feces, relieving pruritis. Skin care: emollients and lipid cream (Eucerin) Reduce fatique Diet of low fat, high carb is better tolerated. Na restriction may be necessary.
Part of discharge teaching for a client with a sigmoid colostomy includes how to protect clothing from colostomy leakage. What is the nurse's most appropriate response when the client asks about the use of appliances and dressings?
"Many people do not need appliances once they regulate the bowels with routine irrigations." Regular irrigation and effective evacuation prevent unexpected bowel movements; generally a drainage pouch is needed only immediately after an irrigation
Cullen's sign
Bruising around umbilicus (possible s/s of pancreatic cancer)
Upper GI bleed S/S
Coffee ground vomitus Black, tarry stools Melena Decreased B/P Vertigo Drop in Hct, Hgb Confusion Syncope
For which clinical indicator associated with a complication of portal hypertension should the nurse assess the client?
Hemorrhage from esophageal varices
Stomach pH and effect on secretion/absorption of drugs
Increased stomach pH- increase adsorption of the basic drug and decreased absorption of the acidic drugs. Decreased stomach pH-increases excretion of the acidic drug and decreases excretion of the basic drug.
A client reports pain as a result of a gastric ulcer. What clinical findings is the nurse most likely to identify during an assessment of the client's pain? Select all that apply
Vomiting removes gastric hydrochloric acid (HCl), which irritates the ulcer and causes pain. Typically, gastric ulcer pain is described as burning or gnawing. Eating causes the secretion of HCl, which increases pain
Barrett's esophagus
changes in cells lining esophagus with increased risk for esophageal cancer
Omeprazole is prescribed to:
inhibit gastric acid secretion Omeprazole is a proton pump inhibitor. Proton pump inhibitors block the final step in gastric acid production. Other proton pump inhibitors include lansoprazole and pantoprazole. These drugs should be taken on an empty stomach. Headache, abdominal pain, and diarrhea may occur as side effects
Anticholinergics
oDecrease intestinal muscle tone and peristalsis of GI tract oResult: slowing the movement of fecal matter through the GI tract oExamples: belladonna alkaloids (Donnatal), atropine
Hyperosmotic laxatives
oIncrease fecal water content oResult: bowel distention, increased peristalsis, and evacuation oExamples: npolyethylene glycol (GoLYTELY) nsorbitol (increases fluid movement into intestine) nglycerin lactulose (Chronulac)
The nurse identifies a decrease in serum sodium when reviewing the laboratory reports of an older client with diarrhea. A decrease in which additional electrolyte is a cause for the greatest concern for this client?
Potassium Sodium, potassium, and bicarbonate are the electrolytes most often lost with diarrhea because they are excreted before they can be absorbed. Hypokalemia can cause cardiac dysrhythmias, a life-threatening complication
Cirrhosis: S/S
Weakness, fatigue Weight loss, anorexia, nausea, diarrhea Abdominal pain, sterility, loss of libido, impotence Hematemesis Urine may be dark ( urobilinogen) Stools may be pale or grey (lack of bilirubin)
sucralfate (Carafate)
@@@Do not administer with other medications@@@ oCytoprotective agent oUsed for stress ulcers, erosions, PUD oAttracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas oProtects these areas from pepsin, which normally breaks down proteins (making ulcers worse) oLittle absorption from the gut oMay cause constipation, nausea, and dry mouth oMay impair absorption of other drugs, especially tetracycline oBinds with phosphate; may be used in chronic renal failure to reduce phosphate levels
Diverticulitis s/s
Abdominal pain, tenderness to palpation Elevated temperature >101, may have chills Abdominal guarding, rebound tenderness
Leading question for suspected acute pancreatitis?
How often do you drink & when was your last drink of alcohol? Long term use of alcohol is associated with increased incidence of the development of chronic pancreatitis.
A client with a long history of alcohol abuse develops cirrhosis of the liver. The client exhibits the presence of ascites. What does the nurse conclude is the most likely cause of this client's ascites?
Impaired portal venous return
A nurse is assessing two clients. One client has ulcerative colitis, and the other client has Crohn disease. Which is more likely to be identified in the client with ulcerative colitis than in the client with Crohn disease?
Involvement starting distally with rectal bleeding that spreads continuously up the colon Ulcerative colitis involvement starts distally with rectal bleeding that spreads continuously up the colon to the cecum. In ulcerative colitis, pathology usually is in the descending colon; in Crohn disease, it is primarily in the terminal ileum, cecum, and ascending colon
Proton Pump Inhibitors: Mechanism of Action
Irreversibly bind to H+/K+ ATPase enzyme Result: achlorhydria—ALL gastric acid secretion is blocked
A nurse is caring for a client with a nasointestinal tube. Which solution should the nurse use when instilling the tube to ensure its patency?
Isotonic saline
A client is admitted with the diagnosis of acute pancreatitis. Which clinical manifestations should a nurse assess in the client?
Jaundice Acute pain Increased lipase & amylase
A nurse is providing dietary teaching for a client with celiac disease. Which foods should the nurse teach the client to avoid when following a gluten-free diet?
Rye Oats Wheat
A client is diagnosed with hepatitis A. The nurse provides the client with information about untoward signs and symptoms related to hepatitis. The nurse instructs the client to contact the primary healthcare provider if the client develops what symptom? Why?
Clay colored stools Clay-colored stools are indicative of hepatic obstruction because bile is prevented from entering the intestines
A nurse is discussing the regaining of bowel control with a client who recently had surgery for a colostomy in the descending colon. What is most important to emphasize in this teaching?
Colostomy irrigations done daily at the same time help to establish a regular pattern of bowel evacuation
The nurse understands that research demonstrates that malnutrition occurs in as many as 50% of hospitalized clients. The nurse should assess a postoperative client with anorexia for what sign of malnutrition?
Delayed wound healing
Immediately after a subtotal gastrectomy, a client is admitted to the postanesthesia care unit (PACU). The nurse irrigates the nasogastric tube and observes small blood clots in the return. Which is the best nursing intervention?
Document this as an expected response (post op)
A client is admitted to the hospital with the diagnosis of acute salmonellosis. Which priority medication will the nurse prepare to administer?
Electrolytes Fluids of dextrose and normal saline and electrolytes are administered to prevent profound dehydration caused by an excessive loss of water and electrolytes through diarrhea output.
Antacids: Aluminum Salts
Have constipating effects Often used with magnesium to counteract constipation Examples Aluminum carbonate: Basaljel Hydroxide salt: AlternaGEL Combination products (aluminum and magnesium): Gaviscon, Maalox, Mylanta, Di-Gel
While receiving a blood transfusion, a client develops flank pain, chills, and fever. What type of transfusion reaction does the nurse conclude that the client probably is experiencing?
Hemolytic A hemolytic transfusion reaction results from a recipient's antibodies that are incompatible with transfused red blood cells; it is called a type II hypersensitivity. The clinical findings are a result of red blood cell hemolysis, agglutination, and capillary plugging
Antidiarrheal Agents: Side Effects
oUrinary retention, hesitancy, impotence oHeadache, dizziness, confusion, anxiety, drowsiness oDry skin, rash, flushing oBlurred vision, photophobia, increased intraocular pressure oHypotension, hypertension, bradycardia, tachycardia Because these drugs are anticholinergics they have all the same side effects and can effect other systems such as increase HR, dysrhythmias, CNS excitation, restlessness, disorientation, dilated pupils, these are all effects of the atropine.
Protonix significance for medication route
opantoprazole (Protonix) is the only proton pump inhibitor available for parenteral administration, and can be used for patients who are unable to take oral medications
When a patient presents with acute pancreatitis, she is also assessed for Cullen's sign and Turner's sign. These are:
uncommon ominous signs that occur with severe necrotizing pancreatitis. Faint bluish discoloration around the umbilicus (a result of hemoperitoneum) characterizes Cullen's sign. Blue-red or green-brown discoloration of the flanks characterizes Turner's sign (a result of tissue catabolism of hemoglobin)
A nurse teaches a client about limiting the discomfort associated with a hiatal hernia. Which statement from the client indicates teaching by the nurse is effective?
"after meals I will rest sitting up 1 hr" Gravity (sitting up after meals) facilitates digestion and prevents reflux of stomach contents into the esophagus
You discuss the upper GI endoscopy procedure with Mr. Lewin. Which description is the most accurate?
A tube will be passed through your mouth and advanced into your stomach and upper intestines
A client returns from surgery with a permanent colostomy. During the first 24 hours the colostomy does not drain. What does the nurse determine is the probable cause of this response, and what is the treatment?
Absence of gastrointestinal motility; continue to monitor The colostomy starts functioning when peristalsis returns. Intestinal manipulation and the depressive effects of anesthesia and analgesics cause absence of gastrointestinal motility; this is an expected response, so continue to monitor.
A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, "What does my drinking have to do with my diagnosis?" What effect of alcohol should the nurse include when responding?
Alcohol stimulates pancreatic enzyme secretion and an increase in pressure in the pancreatic duct. The backflow of enzymes into the pancreatic interstitial spaces results in partial digestion and inflammation of the pancreatic tissue
You know that a diagnosis of acute pancreatitis is often made on the basis of symptoms and elevation of which of the following serum lab values?
Amylase Lipase
A client has a diagnosis of hemorrhoids. Which signs and symptoms does the nurse expect the client to report? Select all that apply
Anal itching Blood in stool Rectal bulging Pain when defecating
A nurse is reviewing the history, physical examination, and diagnostic test results of a client with colitis. What clinical findings are associated with this disorder?
Anemia Diarrhea Abdominal cramps Ulceration of the intestinal mucosa commonly occurs, causing blood loss and anemia. The inflammatory process tends to increase peristalsis, causing diarrhea, electrolyte imbalances, and weight loss. The inflammatory process tends to increase peristalsis, causing abdominal cramping and diarrhea
A client with an acute episode of ulcerative colitis is admitted to the hospital. Blood studies reveal that the chloride level is low. What should the nurse be prepared to administer?
IV therapy
An older client comes to the emergency department after three days of diarrhea and is admitted to the hospital for rehydration therapy. In addition to sodium, what electrolyte should the nurse be concerned about most when the client's laboratory results are documented?
Potassium
Which symptom is consistent with peptic ulcer disease?
Burning pain over the stomach region is common with peptic ulcer disease. Pain may also be described as gnawing, aching, or fullness.
Mr. Lewin is advised to watch for GI bleeding. Which sign could indicate a bleeding ulcer, and should be reported?
Black bowel movement Melena, black tarry stools, is a result of digested blood from upper GI bleeding. Melena should be reported. Bright red blood is present in stools when there is lower GI tract bleeding Vomiting dark brown or bloody fluid Hematemesis, bloody vomit, may occur with bleeding ulcers. It is more common with gastric ulcers than with duodenal ulcers. Bloody vomit should be reported
A nurse assesses a client with the diagnosis of an intestinal obstruction in the descending colon. When auscultating the midabdomen, what should the nurse expect to hear?
Borborygmi Borborygmi are rapid, high-pitched bowel sounds that are indicative of the hyperperistalsis that occurs behind an intestinal obstruction
Antacids: Magnesium Salts
Commonly cause diarrhea; usually used with other agents to counteract this effect Dangerous when used with renal failure —the failing kidney cannot excrete extra magnesium, resulting in hypermagnesemia
A client is admitted to the hospital with slight jaundice and reports of pain on the left side and back. A diagnosis of acute pancreatitis is made. Which common response to acute pancreatitis should the nurse monitor in the client?
Hypovolemia
Mr. Lewin's nasogastric (NG) tube is a vented (double lumen) type, attached to suction. The tube does not have an anti-reflux valve. You notice that gastric contents are leaking from the air vent (pigtail) port. What should you do initially?
With vented NG tubes, the air vent allows entry of air to decrease the effect of suction pressure on the stomach lining. The air vent needs to remain free of fluid. It is appropriate to instill air or saline (generally a volume of about 10 mL) into the air vent lumen, to clear it of fluid. Positioning the air vent above the level of the client's stomach may be helpful in preventing future occurrences of leaking
PUD clinical manifestations
a. Pain is classic symptom: gnawing, burning, aching hungerlike in epigastric region possibly radiating to back; often occurring 30 to 60 minutes after eating (gastric) or up to 3 hours or at night (duodenal) OR can be relieved by eating food (duodenal) b. Symptoms less clear in older adult; may have poorly localized discomfort, dysphagia, weight loss; presenting symptom may be complication: GI hemorrhage or perforation of stomach or duodenum
Hiatal hernia - treatment
a. Similar to GERD: diet and lifestyle changes, medications b. If medical treatment is not effective or hernia becomes incarcerated, then surgery; usually Nissen fundoplication by thoracic or abdominal approach (Anchoring the lower esophageal sphincter by wrapping a portion of the stomach around it to anchor it in place)
Cancer of stomach - diagnostic tests
a.CBC indicates anemia b.Upper GI series, ultrasound identifies a mass c.Upper endoscopy: visualization and tissue biopsy of lesion
Treatment of chronic gastritis
eradicate H. pylori infection with combination therapy of two antibiotics (metronidazole (Flagyl) and clarithomycin or tetracycline) and proton-pump inhibitor (Prevacid or Prilosec)
Pepto bismol considerations
is a salicytate and there fore if over used will cause the side effects such as tinnitus and hearing loss also dark stools and black gums if overused. Be careful with it use in children
Peritonitis s/s
Main two: Rigid board like abdomen Abdominal pain/tenderness Distended abdomen Nausea and vomiting Diminished to no bowel sounds No stools or flatus Fever Tachycardia
Ulcerative colitis s/s
Main: Tenesmus (Straining) Anemia LLQ pain/cramping Fatigue 10-20 liquid stools per day Wt loss
CM of cirrhosis?
- Fruity breath (liver cant metabolize methionine) - Asterixis (hand flapping) - Clay colored stools (decreased bile) - Darker urine (bilirubin in the urine) - Ascites (portal hypertension, low albumin)
A client is admitted to the hospital with a diagnosis of cirrhosis of the liver. For which assessment signs of hepatic encephalopathy should the nurse assess this client?
Mental confusion Flapping hand tremors Musty, sweet breath odor
hallmark sign of peritonitis
Abdomen becomes rigid, boardlike with absent bowel sounds; symptoms of shock
PUD - pharmacological management
Antacids (Mylanta) -Neutralizes acids Proton pump inhibitors (Prilosec, Prevacid) -Block gastric acid secretion Histamine blockers (Tagamet, Zantac, Axid) -Blocks gastric acid secretion Carafate -Forms protective layer over the site Mucosal barrier enhancers (colloidal bismuth, prostoglandins) -Protect mucosa from injury Antibiotics (PCN, Amoxicillin, Ampicillin) -Treat H. Pylori infection
A client with carcinoma of the colon is scheduled for an abdominoperineal resection. What does preparation for the surgery include?
Antibiotics to reduce intestinal bacteria
Proton pump inhibitors: nursing implications
Assess for allergies and history of liver disease May increase serum levels of diazepam, phenytoin, and cause increased chance for bleeding with warfarin It should be taken before meals The capsule should be swallowed whole, not crushed, opened, or chewed It may be given with antacids Emphasize that the treatment will be short term
Common Symptoms of Gallbladder Disease
Severe and intermittent pain in the right upper abdomen. This pain can also spread to the chest, shoulders or back. Sometimes this pain may be mistaken for a heart attack. Chronic indigestion and nausea.
A nurse is providing dietary teaching for a client who is receiving a high-protein diet while recovering from an acute episode of colitis. What should the nurse include in the rationale for this diet?
Tissue repair
Appendicitis treatment
Monitor pain (severe rebound tenderness) Monitor bowel sounds (absent) NPO, IVF, NO laxatives or enemas Surgical management: -Open or laparoscopic appendectomy
Appendicitis nursing interventions
Monitor vital signs Assess bowel sounds Monitor pain Monitor lab values Post operative management: -Vitals signs, bowel sounds, diet resumption, antibiotic therapy as ordered
Antacids: Mechanism of Action
Promote gastric mucosal defense mechanisms Secretion of: Mucus: protective barrier against HCl Bicarbonate: helps buffer acidic properties of HCl Prostaglandins: prevent activation of proton pump which results in ß HCl production Antacids DO NOT prevent the over-production of acid Antacids DO neutralize the acid once it's in the stomach
Antacids: Nursing Implications
Monitor for side effects Nausea, vomiting, abdominal pain, diarrhea With calcium-containing products: constipation, acid rebound Monitor for therapeutic response Notify heath care provider if symptoms are not relieved
You recall what you know about the pathophysiology of acute pancreatitis. Which of the following best describes acute pancreatitis?
In acute pancreatitis, pancreatic enzymes attack pancreatic cells. Inflammation with edema follows. With severe forms of pancreatitis, pancreatic tissue becomes necrotic and may become infected. Pancreatic tissue may also become hemorrhagic
Functions of the liver
It has many functions, among them the synthesis of proteins, immune and clotting factors, and oxygen and fat-carrying substances. Its chief digestive function is the secretion of bile, a solution critical to fat emulsion and absorption. The liver also removes excess glucose from circulation and stores it until it is needed. It converts excess amino acids into useful forms and filters drugs and poisons from the bloodstream, neutralizing them and excreting them in bile (Glucose metabolism, Ammonia conversation, protein metabolism, fat metabolism, vitamin/iron storage, drug&toxin metabolism)
Appendicitis S/S
Lower right quadrant pain Low grade fever Nausea and vomiting Rebound tenderness @Mc Burney's point Increased WBC
After a client has a total gastrectomy, the nurse plans to include in the discharge teaching the need for what treatment?
Monthly injections of cyanocobalamin Intrinsic factor is lost with removal of the stomach, and cyanocobalamin is needed to maintain the hemoglobin level once the client is stabilized; injections are given monthly for life
After surgery to create an ileal conduit, a client awakens and asks for a sip of water. The nurse informs the client that water by mouth cannot be given until what occurs?
Nasogastric suction is maintained to prevent pressure on the intestinal anastomosis; oral fluids are permitted when peristalsis resumes and the nasogastric suction is stopped.
A client is admitted to the hospital with a diagnosis of Crohn disease. What is most important for the nurse to include in the teaching plan for this client?
Nutritional needs To avoid gastrointestinal pain and diarrhea, these clients often refuse to eat and become malnourished. The consumption of a high-calorie, high-protein diet is advised
Antacids: Sodium Bicarbonate
Quick onset, but short duration May cause metabolic alkalosis Sodium content may cause problems in patients with HF, hypertension, or renal insufficiency (fluid retention)
dumping syndrome
Rapid passage of concentrated fluid into the small intestine When high-osmotic fluid passes rapidly into the small intestine, it causes hypovolemia; this results in a sympathetic response of tachycardia, diaphoresis, and dizziness. The symptoms also are attributed to a sudden increase and subsequent decrease in blood glucose level
A client with a diagnosis of gastric cancer has a gastric resection with a vagotomy. Which clinical response should alert the nurse that the client is experiencing dumping syndrome?
Reactive hypoglycemia
Hemorrhoids: cause, s/s, treatment
Swollen or distended veins in rectal region, Internal & external Cause: pregnancy, obesity, constipation Symptoms: bleeding, edema, and prolapsed Treatment: cold packs, sitz bath, diet, Tucks ®, topical anesthetics, and surgery
NG tube rationale
The NG tube is used to remove gas and fluids from the stomach. Until peristalsis returns these can accumulate and cause vomiting. The NG tube can often be discontinued a day or two after colon resection, when peristalsis returns The NG tube is not used to administer feedings
Upper GI Bleed: Treatment
Volume replacement - NS - Blood transfusion NG lavage EGD -Endoscopic treatment of bleeding ulcer -Sclerotheraphy-injecting bleeding ulcer with necrotizing agent to stop bleeding Sengstaken-Blakemore tube -Used with bleeding esophageal varacies Surgical intervention -Removal of part of the stomach
Twelve hours after a subtotal gastrectomy, a nurse identifies large amounts of bloody drainage from the client's nasogastric (NG) tube. Which action should the nurse take?
Obtain vital signs Large amounts of blood or excessive bloody drainage 12 hours postoperatively indicate that the client is hemorrhaging. Vital signs should be taken.
A nurse obtains daily stool specimens for a client with chronic bowel inflammation. What does the nurse determine is the reason these stool examinations were prescribed?
Occult blood
A client has a colon resection with an anastomosis. What assessments by the nurse support a suspicion of impending shock? Select all that apply.
Oliguria Hypotension Irritability Decreased blood flow to the kidneys leads to oliguria or anuria. Irritability, along with restlessness and anxiety, occurs because of a decrease in oxygen to the brain. Hypotension and a narrowing of the pulse pressure occur because of declining blood volume. Restlessness, not lethargy, usually occurs because of decreased cerebral blood flow
The nurse assesses a client for the development of pernicious anemia after reviewing the client's history. Which condition did the nurse most likely find in the history?
Partial gastrectomy Removal of the fundus of the stomach (gastrectomy) destroys the parietal cells that secrete intrinsic factor (needed to combine with vitamin B 12 preliminary to its absorption in the ileum). Hemorrhaging may cause anemia; however, pernicious anemia occurs when the intrinsic factor is not produced
A client is admitted to the hospital with signs and symptoms of obstruction of the common bile duct. Laboratory test results indicate prolonged bleeding and clotting times. What can the nurse conclude these test results indicate?
Phytonadione is not being absorbed
After a transurethral resection of the prostate, the retention catheter is pulled taut and secured to the client's leg. The client reports a feeling of pressure and asks why this is necessary. What rationale should the nurse include in a response to this question?
Prevents bleeding
A client is experiencing stomatitis as a result of chemotherapy. Which action should the nurse take when caring for this client?
Provide frequent saline mouthwashes