N 403 Ch 46 PrepU
The nurse practitioner suspects that a patient may have a gastric ulcer after completing a history and physical exam. Select an indicator that can be used to help establish the distinction. - Amount of hydrochloric acid (HCL) secretion in the stomach - Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) - Presence of H. pylori - Patient's age
Correct response: Amount of hydrochloric acid (HCL) secretion in the stomach Explanation: A duodenal ulcer is characterized by hypersecretion of stomach acid, whereas a gastric ulcer evidences hyposecretion of stomach acid. The other three choices have similar characteristics in both types of ulcers.
The nurse is cautiously assessing a client admitted with peptic ulcer disease because the most common complication that occurs in 10% to 20% of clients is: - Hemorrhage - Intractable ulcer - Perforation - Pyloric obstruction
Correct response: Hemorrhage Explanation: Hemorrhage, the most common complication, occurs in 10% to 20% of clients with peptic ulcers. Bleeding may be manifested by hematemesis or melena. Perforation is erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Intractable ulcer refers to one that is hard to treat, relieve, or cure. Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down.
A client who is being treated for pyloric obstruction has a nasogastric (NG) tube in place to decompress the stomach. The nurse routinely checks for obstruction which would be indicated by what amount? - 150 mL - 250 mL - 350 mL - 450 mL
Correct response: 450 mL Explanation: A residual of greater than 400 mL strongly suggests obstruction.
Which of the following interventions are appropriate for clients with gastritis? Select all that apply. - Use a calm approach to reduce anxiety. - Give the client food and fluids every 4 hours. - Discourage cigarette smoking. - Notify the physician of indicators of hemorrhagic gastritis. - Provide general education about how to prevent recurrences.
Correct response: Use a calm approach to reduce anxiety. Discourage cigarette smoking. Notify the physician of indicators of hemorrhagic gastritis. Explanation: The nurse should use a calm approach when answering questions and providing teaching. He or she should discuss smoking cessation and monitor for any indicators of hemorrhagic gastritis. The client will take nothing by mouth for up to a few days until symptoms subside. The nurse needs to develop an individualized teaching plan for the client that includes information about stress management, diet, and medications.
A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccupping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems? - Acute gastritis - Duodenal ulcer - Gastric cancer - Gastric ulcer
Correct response: Acute gastritis Explanation: A client with acute gastritis may have a rapid onset of symptoms, including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccupping, which can last from a few hours to a few days. Acute gastritis is often caused by dietary indiscretion-a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. A client with a duodenal ulcer will present with heartburn, nausea, excessive gas and vomiting. A client with gastric cancer will have persistent symptoms of nausea and vomiting, not sudden symptoms. A client with a gastric ulcer will have bloating, nausea, and vomiting, but not necessarily hiccups.
A client is scheduled for removal of the lower portion of the antrum of the stomach and a small portion of the duodenum and pylorus. What surgical procedure will the nurse prepare the client for? - Vagotomy - Pyloroplasty - Billroth I - Billroth II
Correct response: Billroth I Explanation: A Billroth I is the removal of the lower portion (antrum) of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. A vagotomy is a surgical dissection of the vagus nerve to decrease gastric acid. A pyloroplasty is a procedure to widen the pylorus. A Billroth II is the removal of the lower portion (antrum) of stomach with anastomosis to the jejunum.
A patient comes to the clinic with the complaint, "I think I have an ulcer." What is a characteristic associated with peptic ulcer pain that the nurse should inquire about? Select all that apply. - Burning sensation localized in the back or mid-epigastrium - Feeling of emptiness that precedes meals from 1 to 3 hours - Severe gnawing pain that increases in severity as the day progresses - Pain that radiates to the shoulder or jaw - Vomiting without associated nausea
Correct response: Burning sensation localized in the back or mid-epigastrium Feeling of emptiness that precedes meals from 1 to 3 hours Severe gnawing pain that increases in severity as the day progresses Explanation: As a rule, the patient with an ulcer complains of dull, gnawing pain or a burning sensation in the mid-epigastrium or the back. Although vomiting is rare in uncomplicated peptic ulcer, it may be a symptom of a complication of an ulcer.
A client has given a confirmed diagnosis of gastric cancer. Two more procedures may be performed to assess tumor depth and lymph node involvement and surgical respectability. Which two are the procedures? Choose the two that apply. - Barium x-ray of the upper GI tract - Esophagogastroduodenoscopy (EGD) - Computed tomography (CT) - Endoscopic ultrasound
Correct response: Computed tomography (CT) Endoscopic ultrasound Explanation: Esophagogastroduodenoscopy for biopsy and cytologic washings is the diagnostic study of choice, and a barium x-ray examination of the upper GI tract may also be performed. Endoscopic ultrasound is an important tool to assess tumor depth and any lymph node involvement. Pelvic ultrasound is not used to confirm the diagnosis of gastric cancer.
A client with gastric cancer is having a resection. What is the nursing management priority for this client? - Discharge planning - Correcting nutritional deficits - Preventing deep vein thrombosis (DVT) - Teaching about radiation treatment
Correct response: Correcting nutritional deficits Explanation: Clients with gastric cancer commonly have nutritional deficits and may have cachexia. Therefore, correcting nutritional deficits is a top priority. Discharge planning before surgery is important, but correcting the nutritional deficits is a higher priority. Radiation therapy hasn't been proven effective for gastric cancer, and teaching about it preoperatively wouldn't be appropriate. Preventing DVT isn't a high priority before surgery, but it assumes greater importance after surgery.
A client sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this client? - Curling's ulcer - Peptic ulcer - Esophageal ulcer - Meckel's ulcer
Correct response: Curling's ulcer Explanation: Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum. Peptic, esophageal, and Meckel's ulcers are not related to burn injuries.
A client with acute gastritis asks the nurse what might have caused the problem. What is a possible cause of acute gastritis? - Dietary indiscretion - Overuse of allergy medicine - Excessive alcohol intake - Drinking fruit juices - Radiation therapy
Correct response: Dietary indiscretion Excessive alcohol intake Radiation therapy Explanation: Possible causes of gastritis include dietary indiscretion, overuse of aspirin and other nonsteroidal anti-inflammatory drugs, excessive alcohol intake, bile reflux, and radiation therapy. Allergy medicine and fruit juices are not causes of acute gastritis.
The nurse is developing a plan of care for a patient with peptic ulcer disease. What nursing interventions should be included in the care plan? Select all that apply. - Making neurovascular checks every 4 hours - Frequently monitoring hemoglobin and hematocrit levels - Observing stools and vomitus for color, consistency, and volume - Checking the blood pressure and pulse rate every 15 to 20 minutes - Inserting an indwelling catheter for incontinence
Correct response: Frequently monitoring hemoglobin and hematocrit levels Observing stools and vomitus for color, consistency, and volume Checking the blood pressure and pulse rate every 15 to 20 minutes Explanation: The nurse assesses the patient for faintness or dizziness and nausea, which may precede or accompany bleeding. The nurse must monitor vital signs frequently and evaluate the patient for tachycardia, hypotension, and tachypnea. Other nursing interventions include monitoring the hemoglobin and hematocrit, testing the stool for gross or occult blood, and recording hourly urinary output to detect anuria or oliguria (absence of or decreased urine production).
Which diagnostic test would be used first to evaluate a client with upper GI bleeding? Upper GI series Endoscopy Hemoglobin and hematocrit Arteriography
Correct response: Hemoglobin and hematocrit Explanation: The nurse assesses for faintness or dizziness and nausea, which may precede or accompany bleeding. It is important to monitor vital signs frequently and to evaluate for tachycardia, hypotension, and tachypnea. Other nursing interventions include monitoring the hemoglobin and hematocrit, testing the stool for gross or occult blood, and recording hourly urinary output to detect anuria or oliguria (absence of or decreased urine production). If bleeding cannot be managed by the measures described, other treatment modalities such as endoscopy may be used to halt bleeding and avoid surgical intervention. There is debate regarding how soon endoscopy should be performed. Some clinicians believe endoscopy should be performed within the first 24 hours after hemorrhaging has ceased. Others believe endoscopy may be performed during acute bleeding, as long as the esophageal or gastric area can be visualized (blood may decrease visibility). An upper GI is less accurate than endoscopy and would not reveal a bleed. Arteriography is an invasive study associated with life-threatening complications and would not be used for an initial evaluation.
The nurse is caring for a client who has just returned from the PACU after surgery for peptic ulcer disease. For what potential complications does the nurse know to monitor? Select all that apply. - Hemorrhage - Inability to clear secretions - Perforation - Penetration - Pyloric obstruction - Cachexia
Correct response: Hemorrhage Perforation Penetration Pyloric obstruction Explanation: Potential complications may include hemorrhage, perforation, penetration, and pyloric obstruction. A client who has had surgery for peptic ulcer disease may have a decreased appetite in the immediate postoperative stage, but it is not something the nurse would monitor for and would not cause cachexia. Inability to clear secretions is generally not a complication of peptic ulcer surgery.
A client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? - Notify the health care provider. - Reposition the tube. - Irrigate the tube. - Increase the suction level.
Correct response: Notify the health care provider. Explanation: The nurse should notify the health care provider because an NG tube that fails to drain during the postoperative period may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.
A health care provider counsels a client about bariatric surgery and recommends the Roux-en-Y gastric bypass. What is the best response by the nurse to further explain this procedure to the client? Gastroplasty with a vertical band allowing for a pouch with a 15 to 20 mL capacity Biliopancreatic diversion with a duodenal switch Separation of the jejunum with an anastomosis Gastric banding that incorporates a prosthetic device to restrict oral intake
Correct response: Separation of the jejunum with an anastomosis Explanation: The Roux-en-Y gastric bypass is recommended for long-term weight loss because it uses a combined restrictive and malabsorptive procedure.
A healthcare provider prescribes a combination of three drugs to treat reoccurring peptic ulcer disease, and the client asks the nurse the reason for all the medications. What teaching should the nurse review with the client? - The antibiotics, prostaglandin E1 analogs, and bismuth salts will work together to suppress or eradicate H. pylori. - The proton pump inhibitors, prostaglandin E1 analogs, and bismuth salts will suppress or eradicate H. pylori. - The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. - The prostaglandin E1 analogs, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori.
Correct response: The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. Explanation: The recommended triple combination of bismuth salts, antibiotics, and proton pump inhibitors will suppress or eradicate H. pylori. Prostaglandin E1 analogs enhance mucosal resistance to injury; they do not suppress or eradicate H. pylori.
Which is an accurate statement regarding gastric cancer? - The incidence of stomach cancer continues to decrease in the United States. - Most gastric cancer-related deaths occur in people younger than 40 years. - Females have a higher incidence of gastric cancers than males. - A diet high in smoked foods and low in fruits and vegetables may decrease the risk of gastric cancer.
Correct response: The incidence of stomach cancer continues to decrease in the United States. Explanation: While the incidence in the United States continues to decrease, gastric cancer still accounts for 10,700 deaths annually. While gastric cancer deaths occasionally occur in younger people, most occur in people older than 40 years of age. Males have a higher incidence of gastric cancers than females. More accurately, a diet high in smoked foods and low in fruits and vegetables may increase the risk of gastric cancer.
A morbidly obese client asks the nurse if medications are available to assist with weight loss. The nurse knows that the client would not be a candidate for phentermine if the following is part of the client's health history: - Coronary artery disease - Diabetes - Use of lithium - Peptic ulcer disease
Correct response: Coronary artery disease Explanation: Phentermine, which requires a prescription, stimulates central noradrenergic receptors, causing appetite suppression. It may increase blood pressure and should not be taken by people with a history of heart disease, uncontrolled hypertension, hyperthyroidism, or glaucoma.
Which of the following dietary guidelines should be followed following bariatric surgery? Select all that apply. - Include two protein snacks per day. - Eat slowly. - Eat three meals per day. - Eat and drink at the same time. - Total meal size should be 1 cup.
Correct response: Include two protein snacks per day. Eat slowly. Eat three meals per day. Explanation: Dietary guidelines for the patient who has had bariatric surgery include eating slowly, eating three meals per day, and including two protein snacks per day. The patient should avoid eating and drinking at the same time and his or her total meal size should be less than 1 cup.
The nurse is creating a discharge plan of care for a client with a peptic ulcer. The nurse tells the client to avoid acetaminophen. decaffeinated coffee. skim milk. octreotide.
Correct response: decaffeinated coffee. Explanation: The nurse should include avoidance of decaffeinated coffee in the client's discharge teaching plan. Decaffeinated coffee is avoided to keep from overstimulating acid secretion.
A client admitted for treatment of a gastric ulcer is being prepared for discharge. The client will follow a regimen of antacid therapy. Discharge teaching should include which instructions? Choose all that apply. - "Continue to take antacids even if your symptoms subside." - "You may take antacids with other medications." - "You may be prescribed H2-receptor antagonists for up to 1 year." - "Be sure to take antacids with meals." - "The antacids will make you sleepy, so do not operate machinery while taking them."
Correct response: "Continue to take antacids even if your symptoms subside." "You may be prescribed H2-receptor antagonists for up to 1 year." Explanation: The client is advised to adhere to and complete the medication regimen to ensure complete healing of the ulcer. Because most clients become symptom-free within 1 week, the nurse stresses the importance of following the prescribed regimen so that the healing process can continue uninterrupted and the return of chronic ulcer symptoms can be prevented. Maintenance dosages of H2-receptor antagonists are usually recommended for 1 year. Taking antacids concomitantly with other drugs should be avoided. For best results antacids should be taken 1 hour before or 2 hours after meals. Antacids will not make the client sleepy.
The nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows that what minimal daily intake of fluids is required? - 1.0 L - 1.5 L - 2.0 L - 2.5 L
Correct response: 1.5 L Explanation: Daily fluid intake and output are monitored to detect early signs of dehydration (minimal fluid intake of 1.5 L/day, minimal output of 0.5 mL/kg/h).
Which statement correctly identifies a difference between duodenal and gastric ulcers? - Malignancy is associated with duodenal ulcer. - Weight gain may occur with a gastric ulcer. - A gastric ulcer is caused by hypersecretion of stomach acid. - Vomiting is uncommon in clients with duodenal ulcers.
Correct response: Vomiting is uncommon in clients with duodenal ulcers. Explanation: Vomiting is uncommon in clients diagnosed with duodenal ulcer. Malignancy is associated with a gastric ulcer. Weight gain may occur with a duodenal ulcer. Duodenal ulcers cause hypersecretion of stomach acid.
Which of the following manifestations are associated with a deficiency of vitamin B12? Select all that apply. - Pernicious anemia - Macrocytic anemia - Thrombocytopenia - Loss of hair - Lethargy
Correct response: Pernicious anemia Macrocytic anemia Thrombocytopenia Explanation: Decreased vitamin B12 can result in pernicious anemia, macrocytic anemia, and thrombocytopenia. Decreased iron can result in lethargy and loss of hair.
Peptic ulcer disease occurs more frequently in people with which blood type? - A - B - AB - O
Correct response: O Explanation: People with blood type O are more susceptible to peptic ulcers than those with blood type A, B, or AB.
A patient comes to the clinic complaining of pain in the epigastric region. The nurse suspects that the patient's pain is related to a peptic ulcer when the patient states the pain is relieved by what? - Eating - Drinking milk - Suppressing emesis - Having a bowel movement
Correct response: Eating Explanation: Taking antacids, eating, or vomiting often relieves the pain. Pain occurs about 2 hours after eating. Milk is contraindicated in relieving peptic ulcer pain.
Which of the following is considered an early symptom of gastric cancer? - Pain relieved by antacids - Weight loss - Bloating after meals - Dyspepsia
Correct response: Pain relieved by antacids Explanation: Symptoms of early disease, such as pain relieved by antacids, resemble those of benign ulcers and are seldom definitive. Symptoms of progressive disease include weight loss, bloating after meals, and dyspepsia.
The nurse reviews dietary guidelines with a client who had a gastric banding. Which teaching points are included? Select all that apply. - Eat six meals a day. - Limit meal size to 450 to 500 mL. - Do not eat and drink at the same time. - Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. - avoid fruit drinks and soda.
Correct response: Do not eat and drink at the same time. Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. Avoid fruit drinks and soda. Explanation: Total meal size should be restricted to less than 8 oz or 240 mL. Three meals a day are recommended.
The nurse is teaching a client with peptic ulcer disease who has been prescribed misoprostol. What information from the nurse would be most accurate about misoprostol? - Works best when taken on an empty stomach - Increases the speed of gastric emptying - Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) - Decreases mucus production
Correct response: Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: Misoprostol (Cytotec) is a synthetic prostaglandin that protects the gastric mucosa against ulceration and is used in clients who take NSAIDs. Misoprostol should be taken with food. It does not improve emptying of the stomach, and it increases (not decreases) mucus production.
The nurse is assessing an 80-year-old client for signs and symptoms of gastric cancer. The nurse differentiates which as a sign/symptom of gastric cancer in the geriatric client, but not in a client under the age of 75? - Abdominal mass - Agitation - Hepatomegaly - Ascites
Correct response: Agitation Explanation: The nurse understands that agitation, along with confusion and restlessness, may be the only signs/symptoms seen of gastric cancer in the older client. Abdominal mass, hepatomegaly, and ascites may all be signs/symptoms of advanced gastric cancer.
A health care provider counsels a client about bariatric surgery and recommends the Roux-en-Y gastric bypass. What is the best response by the nurse to further explain this procedure to the client? - Gastroplasty with a vertical band allowing for a pouch with a 15 to 20 mL capacity - Biliopancreatic diversion with a duodenal switch - Separation of the jejunum with an anastomosis - Gastric banding that incorporates a prosthetic device to restrict oral intake
Correct response: Separation of the jejunum with an anastomosis Explanation: The Roux-en-Y gastric bypass is recommended for long-term weight loss because it uses a combined restrictive and malabsorptive procedure.
A nurse is teaching a client who has experienced an episode of acute gastritis. The nurse knows further education is necessary when the client makes which statement? - "I should feel better in about 24 to 36 hours." - "My appetite should come back tomorrow." - "I should limit alcohol intake, at least until symptoms subside." - "Once I can eat again, I should stick with bland foods."
Correct response: "My appetite should come back tomorrow." Explanation: The gastric mucosa is capable of repairing itself after an episode of gastritis. As a rule, the client recovers in about 1 day, although the appetite may be diminished for an additional 2 or 3 days. Acute gastritis is also managed by instructing the client to refrain from alcohol and food until symptoms subside. When the client can take nourishment by mouth, a nonirritating diet is recommended.
A client taking metronidazole for the treatment of H. pylori states that the medication is causing nausea. What teaching should the nurse provide to the client to alleviate the nausea? - Discontinue the use of the medication. - Ask the healthcare provider to prescribe another type of antibiotic. - Take the medication with meals to decrease the nausea. - Crush the medication and put it in applesauce.
Correct response: Take the medication with meals to decrease the nausea. Explanation: Metronidazole (Flagyl) should be administered with meals to decrease GI upset. The client should not stop the medication without discussing it with a prescribing healthcare provider. Crushing the medication will not help the nausea because it is the same medication.
The Zollinger-Ellison syndrome (ZES) consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. The nurse recognizes that an agent that is used to decrease bleeding and decrease gastric acid secretions is - nizatidine (Axid) - omeprazole (Prilosec) - vasopressin (Pitressin) - octreotide (Sandostatin)
Correct response: octreotide (Sandostatin) Explanation: For patients with ZES, hypersecretion of acid may be controlled with high doses of H2 receptor antagonists. These clients may require twice the normal dose, and dosages usually need to be increased with prolonged use. Octreotide (Sandostatin), a medication that suppresses gastrin levels, also may be prescribed.
Which of the following is the most common complication associated with peptic ulcer? - Hemorrhage - Vomiting - Elevated temperature - Abdominal pain
Correct response: Hemorrhage Explanation: Hemorrhage, the most common complication, occurs in 28% to 59% of patients with peptic ulcers. Vomiting, elevated temperature, and abdominal pain are not the most common complications of a peptic ulcer.
The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is: - stress and anxiety. - gram-negative bacteria. - alcohol and tobacco. - ibuprofen and aspirin.
Correct response: gram-negative bacteria. Explanation: The nurse should include that the most common cause of peptic ulcers is gram-negative bacteria (Helicobacter pylori).
A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? Three meals and 120 ml fluid daily Three meals and three snacks and 120 mL fluid daily Six small meals and 120 mL fluid daily Six small meals daily with 120 mL fluid between meals
Correct response: Six small meals daily with 120 mL fluid between meals Explanation: After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals.
A nurse is monitoring a client with peptic ulcer disease. Which assessment findings would most likely indicate perforation of the ulcer? Select all that apply. - Tachycardia - Hypotension - Mild epigastric pain - A rigid, board-like abdomen - Diarrhea
Correct response: Tachycardia Hypotension A rigid, board-like abdomen Explanation: Signs and symptoms of perforation include sudden, severe upper abdominal pain (persisting and increasing in intensity); pain, which may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (board-like) abdomen; and hypotension and tachycardia, indicating shock. Perforation is a surgical emergency.
The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement? - "I should stop all my medications if I develop any side effects." - "I should continue my treatment regimen as long as I have pain." - "I have learned some relaxation strategies that decrease my stress." - "I can buy whatever antacids are on sale because they all have the same effect."
Correct response: "I have learned some relaxation strategies that decrease my stress." Explanation: The nurse assists the client to identify stressful or exhausting situations. A hectic lifestyle and an irregular schedule may aggravate symptoms and interfere with regular meals taken in relaxed settings along with the regular administration of medications. The client may benefit from regular rest periods during the day, at least during the acute phase of the disease. Biofeedback, hypnosis, behavior modification, massage, or acupuncture may be helpful.
A patient asks the home health nurse from what the distressing symptoms of dumping syndrome result. What physiological occurrence should the nurse explain? - Irritation of the phrenic nerve due to diaphragmatic pressure - Chronic malabsorption of iron and vitamins A and C - Reflux of bile into the distal esophagus - Osmotic transport of extracellular fluid into the gastrointestinal tract
Correct response: Osmotic transport of extracellular fluid into the gastrointestinal tract Explanation: Following gastric surgery, the gastric remnant is anastomosed to the jejunum. When substances high in carbohydrates and electrolytes are ingested rapidly, they pass directly into the jejunum. Extracellular fluid from the bloodstream is drawn into the jejunum to dilute these hypertonic intestinal contents. Irritation of the phrenic nerve causes hiccups. Reflux of bile is an etiologic factor associated with the development of gastroesophageal reflux disease (GERD). Patients who have undergone partial gastrectomy or bariatric surgery may absorb vitamins and minerals less effectively; however, this change is unrelated to the occurrence of dumping syndrome.
The nurse advises the patient who has just been diagnosed with acute gastritis to: - Take an emetic to rid the stomach of the irritating products. - Refrain from food until the GI symptoms subside. - Restrict food and fluids for 12 hours. - Restrict all food for 72 hours to rest the stomach.
Correct response: Refrain from food until the GI symptoms subside. Explanation: It usually takes 24 to 48 hours for the stomach to recover from an attack. Refraining from food until symptoms subside is recommended, but liquids should be taken in moderation. Emetics and vomiting can cause damage to the esophagus.
