Exam 4

When is digital removal of feces contraindicated?

-Client with cardiac issues -After reproductive surgery, abdominoperineal repair, rectal surgery, colostomy, or genitourinary surgery. -Clients who are receiving radioactive isotope therapy or perineal perfusion of anticancer drugs. -Clients who have a bleeding tendency, especially in the rectal or vaginal area. -pregnant women.

Prior to having a guaiac test performed, what instructions should the nurse provide to the client? select all that apply 1. Do not take more than 250 mg/day of vitamin C 2. Avoid taking aspirin or nonsteroidal anti inflammatory drugs one day before the test 3. Do not take antihypertensive medication prior to testing 4. Avoid eating rare red meat prior to testing 5. Avoid dairy products prior to testing

1,2,4

Treatment for GERD

1. Diet 2. Antacids 3. H2 blockers(famotidine) 4.PPIs(omeprazole, pantoprazole)

When administering tap water enema the nurse should observe the client for?

1. elevated blood pressure 2. bounding pulse

Assessment findings with hiatal hernia

1. heartburn 2.belching/pain after eating 3.throat irritation

During endoscopic procedure

1. monitor VS 2. observe for signs of pain/discomfort in client

Post endoscopic procedure

1. pt must remain NPO till gag reflex is back 2. dyspnea or dysphagia 3. changes in VS

Common candidate for Gastric/bariatric surgeries

1.BMI>40 2.Apnea 3.80-100 lbs overweight

Treatment for peptic ulcers?

1.antacids 2.H2 blockers 3.PPIs

Post op complications with gastric/bariatric surgeries?

1.dumping syndrome 2.must receive Vit B12 for life

Assessment findings for Zenker's diverticulum

1.halitosis(foul breath) 2.dysphagia(difficulty swallowing) 3.odynophagia(painful swallowing) 4.belching 5.regurgitation 6.coughing

Assessment finding with peptic ulcer disease?

1.pain(in abdomen/back) 2. hematemesis(bloody emesis) 3.melena(dark stools)

Things that irritate GERD

ASA, chocolate, peppermint, spicy foods, coffee, tomato products, citrus fruits, fried foods, cigarettes, alcohol

What equipment is kept at the bedside following oral surgery

After oral surgery, there should be equipment for suctioning, administration of oxygen, and tracheostomy at the client's bedside. If the client does not have a tracheostomy, a tracheostomy tray must be nearby for emergency use because respiratory distress or airway obstruction requires immediate attention.

What is the type of enema used to introduce contrast solution into the bowel for a radiographic procedure?

Barium Enema

.Why is it necessary for a client with gastroesophageal reflux disease (GERD) to follow a strict diet?

GERD is aggravated if a client has chocolate, peppermint, spicy foods, coffee, tomato products, citrus fruits, or fried foods. Intake of alcohol and overeating exacerbate the condition. Hot or cold liquids intensify the sensation. Hence, clients with GERD should follow a strict diet.

Gastritis is caused by

Helicobacter pylori

Abdominal examination order

Inspection, auscultation, percussion, and palpation

What do long, thin, pencil-like stools indicate?

Long, thin, pencil-like stools suggest a narrowing of the rectum or anal opening, which could be caused by a mass, impaction, or tumor.

What is the correct order of auscultation when listening to bowel sounds?

RLQ, RUQ, LUQ, LLQ

What is a complication the nurse should monitor for in the client after a barium enema?

Some clients develop a fecal impaction after a barium enema; the client is unable to pass stools because of impaction caused by retained barium. Digital removal of impacted stool,(manual disimpaction) may be required to relieve this condition and requires a healthcare provider's order.

What are the nursing considerations to be followed when preparing a client for a cholecystogram?

The nursing considerations when preparing a client for a cholecystogram include instructing the client to avoid fat-free foods the night before the procedure, teaching the client how to take radiopaque dye by mouth, instructing the client to avoid eating for 12 hours after taking the dye, and to avoid smoking, and administering an enema if necessary

Vomiting is dangerous and needs to be prevented in what situations?

Vomiting is dangerous and needs to be prevented in clients who have had recent abdominal surgery or delicate eye surgery (they may incur an injury as a result of the violent action of vomiting) and also in those who have ingested a caustic substance (they can experience additional injury by vomiting).

What are the nursing considerations to be followed when caring for a client after a liver biopsy?

When caring for a client after a liver biopsy, the nurse should ensure that the client is positioned on the right side, pressure is applied on the biopsied site for 4 to 6 hours, vital signs are recorded periodically, and the client is observed for signs of bleeding

Why would constipation be misinterpreted as diarrhea?

With an obstruction/blockage/constipation liquid stool can seep around the hardened stool and give the appearance of diarrhea

The nurse is monitoring a client for signs and symptoms of dumping syndrome. Which indicates this occurrence? a. sweating and pallor b. dry skin and stomach pain c. bradycardia and indigestion d. double vison and chest pain

a

Which prescription should the nurse expect to be prescribed to a patient diagnoses with pancreatitis? a. administer antacids as prescribed b. encourage cough and deep breathing c. administer anticholinergics as prescribed d. maintain the client in supine and flat position e. encourage small frequent high calorie feedings

a,b,c

signs of impaction?

abdominal pain, loose stools, diminished bowel sounds, firmness upon palpation

bright red stool means

active bleeding in rectal or anal

anal fistula

anal canal tract formation

What should be stopped before a liver biopsy test?

anticoagulants and NSAIDS 3-7 days prior(due to bleeding risks)

which organ is located in the RLQ?

appendix

Diet therapy for hiatal hernia

bland, soft, semisoft, liquid

What is a primary concern for liver biopsy pts?

bleeding because of the high vascularity of the liver

A client is scheduled for an esophagogastroduodenoscopy (EGD) to detect lesions in the gastrointestinal tract. The nurse would observe for which of the following while assessing the client during the procedure? a) Signs of perforation b) Gag reflex c) Client's tolerance for pain and discomfort d) Client's ability to retain the barium

c

The nurse is reinforcing discharge instructions to a client after a gastrectomy. Which measure would the nurse include during client teaching to help prevent dumping syndrome? a. ambulate after a meal b. eat high carbohydrate foods c. limit fluid intake with meals d. sit in a high fowlers position during meals

c

The nurse reinforces postoperative liver biopsy instructions to a client. Which would the nurse tell the client? a. avoid alcohol for 8 hrs b. remain NPO for 24 hrs c. lie on the right side for 2 hrs d. save all stools to be checked for blood

c

Nursing Interventions applied to prevent complications of a barium enema?

constipation; hydration: IVF, encourage fluid intake & also ambulation

The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse would suspect the client to is at risk for which vitamin deficiency? a. vit A b. vit C c. vit E d. vit B12

d

melena stool means

dark, black, tarry stools; partially digested blood

hiatal hernia

diaphragm defect when muscle wall weakens

hemorrhoids

dilated veins outside or inside anal sphincter

What is a common complication from gastritis?

dyspepsia

Zenker's diverticulum

esophageal wall weakness; allowing food to be trapped and decomposes in the esophagus

Tenesmus

flatus with severe painful abdominal cramps or spasms=hyperactive bowel sounds

endoscopic retrograde cholangiopancreatography(ERCP)

generally performed as an outpatient procedure with an anesthesiologist and gastroenterologist

Bowel prep prior to barium enema?

goLYTELY, light meal, clears, then NPO after prep

What is our stool like when we are constipated?

hard & dry; hypoactive bowel sounds

cholecytography

identifies stones in the gallbladder, common bile duct, and tumors

pilonidal cyst/sinus

infection in hair follicles; sacrococcygeal area

Peptic Ulcer Disease(PUD)

infection with helicobacter pylori(H.pylori); gastirc inflammation

anorectal abscess

infection with pus collection between internal, external sphincters

yellow/green stool means

infection; presence of microorganisms

gastritis

inflammation of the stomach lining

How do you know if a stoma has prolapsed?

it is protruding and swollen

grey/clay colored stool means

lacking bile(gallbladder disease)

What position is the patient in for a colonoscopy procedure?

left sims position

anal fissure

linear tear in the anal canal tissue

which organ is in the RUQ?

liver

What is our stool like when we have diarrhea?

loose & watery, unformed; hyperactive bowel sounds

gastroesophageal reflux disease (GERD)

lower esophageal splinter(LES) is weak and relaxes allowing stomach acid to flow into the esophagus

yellow/brown stool means

normal amount of bile

barium swallow(esophagography)

observation of esophagus, stomach, and duodenum(entire upper GI). identifies structural abnormalities of the esophagus, swallowing dysfunction, and oral aspiration

barium enema

observation of the lower bowel

Dumping syndrome

overeating or eating food not recommended ex: carbohydrates, electrolytes, Salt, monosodium gluconate

which organ is in the LUQ?

pancreas

What is a serious/life threating complication from gastritis?

perforation

Barret's esophagus

precursor of esophageal cancer.

flexible sigmoidoscopy

process of examining the colon and descending colon with flexible endoscope

Pre procedure steps of getting a Cholangiography are?

remain NPO 6-8hrs prior

which organ is in the LLQ?

sigmoid colon

We want our stool to be?

soft and formed

Never position a client with pancreatitis in?

supine or lying. it become more agitated when a person is lying

hemoccult/guaiac test?

test that determines the presence of occult blood in the stool. False positive could be caused by: Large amounts of rare red meat, radishes, tomatoes, beets, horseradish, or some melons-cantaloupe. A false NEGATIVE could be caused by high doses of vitamin C (>250 mg per day).

Urea Breath test(UBT)

tests for chemical composition resulting from Helicobacter pylori (H. Pylori) bacteria

When administering tap water enema the nurse should be aware of what?

that tap water is hypotonic and may cause circulatory overload. nurse must monitor for s/s of this during and after procedure

colonoscopy

the direct visual examination of the inner surface of the entire colon from the rectum to the cecum

steatorrhea

undigested fat; float; oily(cystic fibrosis; gallbladder disease)

esophagogastroduodenoscopy(EGD)

visual examination of the esophagus, stomach, and duodenum

esophagography(EGD)

visual of esophagus, stomach, and duodenum

What nursing considerations should be kept in mind when antacids are given to a client with ulcers?

• Antacids used for ulcer treatment can disrupt a person's electrolyte balance .• Antacids that contain aluminum hydroxide can cause constipation • Antacids that contain magnesium hydroxide can cause diarrhea • Antacids are often used on rotating basis to maintain a person's acid-base balance