GI stuff

What is Hirschprung disease? What could it lead to?

-Absence of parasympathetic ganglion cells in the rectum and other areas of intestine -Could lead to ischemia and enterocolitis (s/s: fever, GI bleeding, explosive watery diarrhea

Pre op nursing management for patients w/ HD (just some extra info)

-Assess bowel function -Monitor hydration & F&E, provide IV fluids as prescribed -Admin abx as prescribed to clear bowel of bacteria -Measure abd girth -Daily weight -No rectal temps -Monitor for resp distress due to abd distention

Medications for constipation

-Bowel evacuation: enemas -Fiber supps: psyllium -Stool softeners: ducosate sodium -Stimulant laxatives: bisacodyl -Saline agents: magnesium hydroxide -Lubricants: mineral oil -Osmotic agents: polyethylene glycol & electrolytes

Bobby is diagnosed with celiac disease, what does he have intolerance to?

-Gluten -Wheat, barley, rye, oats

A patient with HD should be on what kind of diet?

-High protein, high calorie, low fiber -TPN in some cases

How is dehydration assessed in infants?

-Mild to moderate: slow; skin fold visible for less than 2 seconds -Severe dehydration: very slow, skin fold visible for longer than 2 seconds -Other: dry mucous membranes, reduced tears, decreased urine output -*Assess those fontanelles*

Complications of ileostomies

-Peristomal skin irritation due to leakage due to poor fitting --> use skin barrier -Fluid volume deficit --> fluids -Urinary calculi due to FVD -Cholelithiasis --> assess for abd pain that radiates to back and right shoulder -Stenosis of the site from scar tissue

Post op nursing management for patients w/ HD (just some extra info)

-Resp & airway -Vitals, no rectal temp -Assess site for bleeding, redness, swelling -Assess stoma for bleeding or skin breakdown (should be red and moise) -Assess anal area for presence of stool, redness or discharge -NPO til bowel sounds return or flatus -Admin pain management -I&Os

A patient is being educated about risk factors for constipation upon discharge and ways to decrease the chance of it occurring. What would be included in this teaching?

-Risk factors: opioids, laxative overuse (never give lacatives with acute constipation associated w/ fever, nausea, abd pain); obstructions; metanolic or neuromuscular disorders; colon disease (IBS); endocrine disorders (DM, hypothyroid) -Ways to avoid: increase fiber, water, ambulation; bowel habit training; education about laxative use

What is the treatment for moderate to severe HD?

-Surgery: colostomy may be needed to rest the affected area of colon, once the area is less inflamed, surgical repair is performed via a pull-through procedure to excise portions of bowel -Mild to moderate treatment: relieve chronic constipation w/ stool softeners and rectal irrigations

A nurse is educating a patient with celiac disease about the importance of reading what? A. Food labels B. The newspaper C. What kind of toilet paper they use D. Any added minerals to their water

A -Fine to eat: meat such as beef, port, poultry, and fish; eggs;, milk & some dairy products; veggies, fruits, rice, corn, gluten-free flour, puffed rice, cornflakes, cornmeal, & pre-cooked gluten free cereals -Avoid: commercially prepared ice cream; malted milk; prepared puddings; and grains, including anything made from wheat, rye, oats, or barley, such as breads, rolls, cookies, cakes, crackers, cereal, spaghetti, macaroni noodles, beer, and ale

What should a patient with an ostomy do if it is dry and a purplish color? A. Call the physician B. Apply a lubricant C. Nothing, this is normal D. Measure it

A --> this indicated poor perfusion -Should look pink or red and moist and should protrude about 3/4 inches from abd wall

A patient has just gotten back to the floor post ileostomy creation. What interventions should the nurse perform? (SA) A. Monitor electrolytes B. Administer IV fluids C. Administer a diuretic D. Monitor for drainage E. Empty bag every 8-12 hours

A B D -Appliance should be emptied every 4-6 hours or when pt empties bladder, bag should be changed every 5-7 days -A lot of fluid can be lost--> assess for signs of dehydration & F&E imbalances (thirst, dry mucous membranes, decreased urine output, weakness, dizziness, etc.) -IV fluids for 4-5 days

A patient that is being discharged after severe diarrhea is being educated about risk factors for diarrhea, which would be included? (SA) A. Tube feeding B. Stool softeners C. Opioids D. Infections E. Dehydration

A B D Other: meds (laxatives, HRT, abx, chemo, magnesium-based antacids); metabolic, endocrine disorders, enteral feedings

A nurse of a patient with suspected celiac disease identifies which of the following as ways of diagnosing it (SA)? A. Serum immunoglobulin A B. Radiographic contrast studies C. Biopsy D. Fecal fat measurement E. Improvement w/removal of gluten food

A C D E -Biopsy is most definitive

A nurse is taking care of a patient with celiac disease, what would she expect in her assessment? (SA) A. Steatorrhea B. Obesity C. Diarrhea D. Abdominal pain E. Failure to thrive in infants

A C D E -These patients are usually skinny not obese -Key management for these patients: pain, fluid intake (can become dehydrated easily)

A nurse is taking care of a patient with HD, what clinical manifestations may the patient present with? (SA) A. Abdominal distention B. Episodes of vomiting bile C. Constipation D. Failure to thrive E. Failure to pass meconium w/in 24-48 hrs F. Ribbon-like stool

All

Annabelle is being discharged with a colostomy, and you're teaching her about colostomy care. Which statement correctly describes a healthy stoma? 1. "At first, the stoma may bleed slightly when touched." 2. "The stoma should appear dark and have a bluish hue." 3. "A burning sensation under the stoma faceplate is normal." 4. "The stoma should remain swollen away from the abdomen."

Answer: 1. "At first, the stoma may bleed slightly when touched." For the first few days to a week, slight bleeding normally occurs when the stoma is touched because the surgical site is still new. She should report profuse bleeding immediately.

You have to teach ostomy self care to a patient with a colostomy. You tell the patient to measure and cut the wafer: 1. To the exact size of the stoma. 2. About 1/16" larger than the stoma. 3. About 1/8" larger than the stoma. 4. About 1/4″ larger than the stoma.

Answer: 2. About 1/16" larger than the stoma. A proper fit protects the skin but doesn't impair circulation. A 1/16" should be cut.

You're preparing a teaching plan for a 27 y.o. named Jeff who underwent surgery to close a temporary ileostomy. Which nutritional guideline do you include in this plan? 1. There is no need to change eating habits. 2. Eat six small meals a day. 3. Eat the largest meal in the evening. 4. Restrict fluid intake.

Answer: 2. Eat six small meals a day To avoid overloading the small intestine, encourage the patient to eat six small, regularly spaced meals.

You're assessing the stoma of a patient with a healthy, well-healed colostomy. You expect the stoma to appear: 1. Pale, pink and moist 2. Red and moist 3. Dark or purple colored 4. Dry and black

Answer: 2. Red and moist Good circulation causes tissues to be moist and red, so a healthy, well-healed stoma appears red and moist.

You're caring for Carin who has just had ileostomy surgery. During the first 24 hours post-op, how much drainage can you expect from the ileostomy? 1. 100 ml 2. 500 ml 3. 1500 ml 4. 5000 ml

Answer: 3. 1500 ml The large intestine absorbs large amounts of water so the initial output from the ileostomy may be as much as 1500 to 2000 ml/24 hours. Gradually, the small intestine absorbs more fluid and the output decreases.

A nurse is caring for a client who has diarrhea for the past four days. When assessing a client, the nurse should expect which of the following findings? Select all that apply. A. Bradycardia B. Hypotension C. Fever D. Poor skin turgor E. Peripheral edema

Answer: B, C and D Prolonged diarrhea lead to dehydration, which causes a decrease in blood pressure. Prolonged diarrhea leads to dehydration, which causes fever. Prolonged diarrhea is more likely to cause take a tachycardia than bradycardia. Peripheral edema results from a fluid overload. Prolonged diarrhea is more likely to cause a fluid deficit.

A nurse is talking with a client who reports constipation. When the nurse discusses dietary changes that can help prevent constipation, which of the following foods should the nurse recommend? A. Macaroni and cheese B. Fresh food and whole wheat toast C. Rice pudding and ripe bananas D. Roast chicken and white rice

Answer: B. Fresh food and whole wheat toast. A high fiber diet promotes normal bowel elimination. The choice of fruit and toast is the highest fiber option. Macaroni and cheese is a low residue option that could actually worse and constipation. Rice pudding and ripe bananas are low residue options that could actually worsen constipation. Roast chicken and white rice or low residue options that could actually worsen constipation.

Dustin who was diagnosed with Hirschsprung's disease has a fever and watery explosive diarrhea. Which of the following would Nurse Joyce do first? A. Administer an antidiarrheal. B. Notify the physician immediately. C. Monitor the child every 30 minutes. D. Nothing. (These findings are common in Hirschsprung's disease.)

Answer: B. Notify the physician immediately. B: For the child with Hirschsprung's disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physician should be notified directly. A: Generally, because of the intestinal obstruction and inadequate propulsive intestinal movement, antidiarrheals are not used to treat Hirschsprung's disease. C: The child is acutely ill and requires intervention, with monitoring more frequently than every 30 minutes. D: Hirschsprung's disease typically presents with chronic constipation.

An 11-year-old girl with celiac disease was discharged from the hospital. An appropriate teaching was carried out by the nurse if the parents are aware of avoiding which of the following? A. Chicken B. Wheat C. Milk D. Rice

Answer: B. Wheat -B: Children with celiac disease cannot tolerate or digest gluten. Therefore, because of its gluten content, wheat and wheat-containing products must be avoided. -A,C,D: Rice, milk, and chicken do not contain gluten and need not be avoided.

Mr. and Ms. Byers' child failed to pass meconium within the first 24 hours after birth; this may indicate which of the following? A. Celiac disease B. Intussusception C. Hirschsprung's disease D. Abdominal-wall defect

Answer: C. Hirschsprung's disease C: Failure to pass meconium within the first 24 hours after birth may be a sign of Hirschsprung's disease, a congenital anomaly resulting in mechanical obstruction due to weak motility in an intestinal segment. A,B,D: Failure to pass meconium is not connected with celiac disease, intussusception, or abdominal-wall defect.

10. Steve is diagnosed with celiac disease and experiences celiac crisis secondary to upper respiratory tract infection; which of the following would Nurse Nancy expect to assess? A. Lethargy B. Weight gain C. Respiratory distress D. Watery diarrhea

Answer: D. Watery diarrhea -D: Episodes of celiac crises are precipitated by infections, ingestion of gluten, prolonged fasting, or exposure to anticholinergics. Celiac crisis is typically characterized by severe watery diarrhea. -A: Irritability, rather than lethargy, is more likely. -B: Because of the fluid loss associated with the severe watery diarrhea, the child's weight is more likely to be decreased. -C: Respiratory distress is unlikely in a routine upper respiratory tract infection.

A patient is experiencing abdominal pain and is irritable. Their bloop pressure is 140/92 and they have have no appetite. What condition would you expect this patient to have? A. Diarrhea B. Constipation C. Celiac disease D. Hyperkalemia

B -Manifestations: abd pain and/or distention; possible presence of hard fecal mass upon digital exam; irritability, loss of appetite; malaise & headache; N/V -Complications: HTN; straining/Valsalva maneuver; fecal impaction, fissures, hemorrhoids, megacolon, syncopal episode --> death

A patient is receiving loperamide for their symptoms, what condition would you expect this patient to have? A. Celiac disease B. Diarrhea C. Hirschprung's D. Constipation

B Give opioids for diarrhea: loperamide and diphenoxylate/atropine

A nurse is educating a patient with a new ileostomy about important diet teaching, what would be included? (SA) A. High fiber diet B. Avoid seeds C. Eat strained fruits & veggies D. Drink milk when lightheaded E. Drink electrolye rich beverages

B C E -Should have low residue diet: low fiber (less than 7-10 g/day), restrict milk, prune juice -Reintroduce foods one at a time

A patient with suspected HD is undergoing a diagnostic study, which one would he be receiving? A. BUN/Creatinine B. Immunoglobulin A C. Rectal Biopsy D. Fecal Fat Measurement

C -Rectal biopsy is most definitive -Also get history and physical assessed and can receive radiographic contrast studies

What would a patient with an ostomy clean it with? (SA) A. With an alcohol based soap B. Pat dry with a gauze pad C. Mild, pH balanced soap D. No soap at all & just water

C D

A nurse reviews a 3wk old infant's record and notes the physician documented a Dx of suspected Hirschsprung's disease. The nurse knows which symptom led mom to seek health care? A.Diarrhea B.Vomiting C.Regurgitation D.Foul smelling, ribbon like stool

D-Hirschsprugs's manifestations=Chronic constipation beginning in the 1st month and results in foul smelling, ribbon like stool, Bowel obstruction, Abdominal pain, Distention, Failure to thrive-Delayed passage or absence of meconium is the cardinal sign

Main complication of diarrhea?

Dehydration Monitor hydration and electrolytes, monitor character of stools (small intestine=watery; large=soft), monitor skin integrity, I&Os

Kock pouch?

Diverting a portion of the distal ileum to the abd wall & creating a stoma; eliminates the need for an external fecal collection bag. It collects for a few hours then removed via a catheter through a nipple valve

T or F: acute diarrhea lasts longer than 4 weeks

False -Acute: lasts less than 2 weeks -Chronic: lasts longer than 4 weeks

A patient with celiac disease comes in to the hospital for their disease. Respiratory and cardiac are found to be within parameters, what is the priority assessment?

Gastrointestinal

What is important to educate a patient with an ostomy to do every time they change it for the first 8 weeks?

Measure it

What is the first poop called?

Meconium -passed w/in 24-48 hrs of healthy full-term babies

Due to poor nutrition, what may patients with celiac disease need to receive?

Mineral & Vitamin supplements, including iron, folic acid, and fat-soluble vitamins A, D, E and K -These patients should should have a diet high in calories & protein w/ simple carbs, fruits and veggies, low in fat

Which of the following food choices would be allowed for a patient with celiac disease? A. Rice B. Oatmeal C. Rye toast D. Wheat toast

Rice

What should be replaced in the diet of a patient with disease as substitutes?

Rice, millet, corn

What is needed to identify to be done before a patient with diarrhea is taken off of isolation?

Stool culture

T or F: Celiac disease is life long

True