upper GI disorders - week 4 day 1
what does hypertension activate?
RAAS system
immobility, cognitive, cant get to the bathroom
Reflex incontinence
Key symptom of gastric ulcer
Worsens after the ingestion of food
esophageal stricture
abnormal narrowing of the esophagus
what is the most common calculi for kidneys?
calcium
E-coli
causes 90% of UTI's
After reviewing the health records for the following patients assigned today, the nurse understands that which patient would benefit from Total enteral nutrition (TEN)? PT A. 65 m , 5"10, 200Ib, GERD, Pyrosis PT B. 65 f, 5"5, 167Ib, CAD, intermittent angina PT C. 70 m, 6"0, 150Ib, Aspiration pneumonia, Dysphagia PT D. 70 f, 5"7, 140Ib, Cholelithiasis, Right upper quadrant pain
3. PT C Rationale: Pt C would benefit from TEN as he has aspiration pneumonia because of dysphagia. This patient is also underweight for height. The nurse should collaborate with the health care provider and registered dietitian nutrionist (RDN) to discuss this option. There is no need for TEN for pt A as he is overweight adn has GERD and Pyrosis. Patient B has intermittent angina and CAD but no evidence of nutritional deficiences or an inability to swallow. Patient D has gall stones but is of normal weight and does not need TEN.
oliguria
less than 20 ml/hr or 400ml a day
Main manifestations of Urinary Calculi?
Renal colicky pain (spasmodic) Nausea and vomitting, hematuria
where does appendicitis cause the most pain?
Right lower quadrant
what ulcer causes patients to wake up at 1-2 am from pain
duodenal
what does hypoalbuminemia cause?
edema prevalent in the periorbital region
what kind of surgery is a hernia repair?
elective surgical procedure
azotemia
elevation of BUN and serum creatine levels
what kind of surgery is an appendectomy?
emergent surgery
When do you assess respiratory rate and level of consciousness after abdominal surgery?
every hour immediately after surgery
signs and symptoms of Pyelonephritis
flank pain, CVA tenderness, fever and chills, N/V, malaise, dysuria, frequency, hematuria
Aspiration pnuemonia
food, saliva, liquid, or vomit going into the lungs
leakage of urine caused by factors other than disease of the lower urinary tract
functional incontinence
Main manifestations of polycystic kidney disease (PKD)?
hereditary/ genetic, Enlarged kidneys or abdominal growth, flank pain, CVA tenderness, hypertension- 1st sign, hematuria
what kind of procedure is an incision and drainage?
minor elective procedure
pyloric obstruction
narrowing or blocking the opening between the stomach and the duodenum
Based on the health record of a patient with a paraesophageal hiatal hernia, Which cue indicated a need for immediate intervention by the nurse? -alert adn oriented x4 -Temp: 99.2 -HR: 78bpm -RR: 22 bpm -BP: 132/88 -O2 86% -diminished lungs sounds BiL -Feeling of fullness after meals -Chest pain level 10
-Chest pain -O2:86% Rationale: -Chest pain and O2:86% on room air requires immediate intervention as these factor indicate teh hernia has strangulated. The feeling of fullness is normal, continue monitoring Bp (normal)
Which pt statement demonstrates a correct understanding of follow up care for a hemorrhoidectomy? 1. "I will need to eat a diet high in fiber." 2. "Limiting my fluids will help with constipation." 3." To help with the pain, Ill apply ice to the surgical area." 4." I should take Ex-Lax after the surgery to keep thing moving"
1. "I will need to eat a diet high in fiber." Rationale: A diet in fiber severes as a natural stool softener and will prevent irritation to hemorrhoids.
The nurse is educating a pt with hemorrhoids about ways to promote regular bowelmovements to prevent straining what should the nurse say? 1. Avoid spicy foods 2. Eat a high-fiber diet 3. Use a stool softeners 4. Refrain from crossing legs 5. Consume nuts and legumes
1. Avoid spicy foods 2. Eat a high-fiber diet 3. Use a stool softeners Rationale: The nurse would instruct to avoid spicy foods, coffee, and alcohol as they can be irritating. A high fiber diet and stool softeners prevent straining with bowel movements. A patient would refrain from crossing the legs to prevent blood clots. Nuts should be avoided as they can irritate the hemorrhoids.
Which abnormal assessment finding indicated the pt may have an obstruction or strangulation in a painful section of the abdomen where the patient reports feeling bumps? 1. Bowel sounds are absent upon auscultation 2. The hernia disappears when patient is lying flat 3. A palpable herniation can be noted when patient cough. 4. The hernia is present when the patient is lying and also when patient is standing
1. Bowel sounds are absent upon auscultation Rationale: Absent bowel sounds may indicate obstruction nad strangulation. this is consisdered a medical emergency that must be reported immediately to the health care provider. Reducible hernias disappear when the patient is lying flat, so this is not abnormal and does not neccessarliy indicate obstruction or strangulation. Hernias can be palpated when the patient coughs; this is not a sign of obstruction or strangulation. it is common for a hernia to be felt when the patient is lying and standing
While providing care for a patient with abdominal hernia, the nurse understands that which cue noted during assessment would indicated the hernia is strangulated? 1. Distended abdomen 2. Pain level of 9 on a scale of 0-10 3. Temperature 101.0 4. 4 episodes of emesis 5. Heart rate 112 bpm
1. Distended abdomen 2. Pain level of 9 on a scale of 0-10 3. Temperature 101.0 4. 4 episodes of emesis 5. Heart rate 112 bpm Rationale: Signs of strangulated hernia include abdominal distention, pain, fever, nausea, vomiting, and tachycardia. upon assessment the nurse notices the distended abdomen, a pain of 9, a temp of 101, 4 episodes of emesis, heart rate of 112 bpm the nurse would correlate all of these signs to conclude teh hernia is most likely strangulated
Which finding would the nurse assess in a patient with acute peritonitis? 1. Fever 2. Diarrhea 3. Vomitting 4. Tachycardia 5. Rigid abdomen
1. Fever 3. Vomitting 4. Tachycardia 5. Rigid abdomen Rationale: Fever, vomitting, tachycardia, and a rigid, board like abdomen accompany the diagnosis of peritonitis from the inflammation of the peritoneal cavity. Diarrhea would not be present. As bowel motility slow, bowel sounds become more distant, and the passage of flatus and feces cease.
Which action promotes safety for a patient preparing to undergo a roux-en-Y gastric bypass procedure? 1. Keep skin folds and areas clean and dry 2. Administer patient-controlled analgesia 3. Use several people for postioning patient 4. Obtain a large bed that holds extra weight 5. Make sure side rails are not touching patient
1. Keep skin folds and areas clean and dry 3. Use several people for postioning patient 4. Obtain a large bed that holds extra weight 5. Make sure side rails are not touching patient Rationale: PT safety is the priority in the post-op period for any bariactric pt. Therefore the nurse should keep the skinfolds and areas clean and dry to prevent skin breakdown. The nurse should also plan to use several people to move and reposition the patient to prevent injury to the nursing staff and the patient. The nurse should also obtain a larger bariatric bed that would hold extra weight to decrease risk for injury. It is imprtatn to make sure the bed is large enough so the side rails are not touhcing the patient as this can cause pressure ulcers. Patient-controlled analgesia manages pain, but not promote safety
Which sign or symptom would the nurse asses in a patient with a perforated appendix? 1. Pain that increases with coughing 2. relief of pain with bending the right knee 3. Nausea and vomitting followed by abdominal pain 4. Orthostatic hypotension 5. WBC of 25,000/mm3
1. Pain that increases with coughing 2. relief of pain with bending the right knee 5. WBC of 25,000/mm3 Rationale: Symptoms of perforation include relief from pain by flexing the right knee or hip and increased pain with coughing along with a WBC above 20,000. Gastroenteritis is characterized by N/V that precede pain. Orthostatic hypotension would be seen because of dehydration associated with gastroenteritis
When the nurse is reviewing the health records of four patients scheduled to be seen today in an ambulatory care clinic, Which patient would the nurse identify as having the highest risk for developing a hiatal hernia? 1. 50-yr old man, 5'10, 250, smokes 1 pack a day 2. 55- yr old. woman, 5'6, 140 ib, drinks 1 glass of wine daily 3. 60-yr old man, 5'9, 158 ib, consumes carbonated drinks 4. 65-yr old woman, 5'4, 124 ib, follows keto diet
1. patient A Rationale: Obesity and cigarette smoking are two factors that increase the incidence of hiatal hernias.
Which is an appropriate intervention for a patient with IBS? 1. take 30 to 40 g of fiber each day 2. Chew gum to decrease gastric acid 3. Drink 8 to 10 glasses of prune juice. 4. eat a light breakfast and a heavy dinner.
1. take 30 to 40 g of fiber each day Rationale: Fiber helps regualte elimination patterns, chewing gums produces more gastric acid, regular meals
Which assessment finsing would nurse observe in a patient with peritonitis? 1. Diarrhea 2. Anorexia 3. Low-grade fever 4. Distended abdomen 5. Increase urine output
2. Anorexia 4. Distended abdomen Rationale: A patient with peritonitis present with a distended abdomen and anorexia. urine output is decreased, high grade fever, no diarrhea because the patient is unable to pas gas
Which behavior would be beneficial for a patient with constipation-predominate irritable bowle syndrome (IBS-C)? 1. Chewing food minimally 2. Consuming reguarly schedule meals 3. Reducing fiber content in diet 4. Drinking 8 to 10 cups of liquid daily 5. Practicing meditation and yoga regularly
2. Consuming reguarly schedule meals 4. Drinking 8 to 10 cups of liquid daily 5. Practicing meditation and yoga regularly Rationale: IBS-C pt should recieve health teaching and stress reduction.
Pt with peptic ulcer disease has developed a pyloric obstruction, and the health care provider orders placement of NG tube. For which purpose would the nurse place a NG in this patient? 1. Prevention of peritonitis 2. Decompression of the stomach 3. Irrigation to remove blood clots 4. Provision of fluids and nutrients
2. Decompression of the stomach Rationale: Pt's who develop pyloric obstruction are at risk for gastric distention. The NG tube is used to be decompress the stomach
Which information would the nurse include in the discharge teaching for a patient who underwent bariatric surgery? 1. Report any constipation after surgery 2. Keep the wound clean and cover it while bathing 3. Limit the diet to liquid or pureed foods for 2 weeks 4. Start with solid, nutrient-dense foods after second week
2. Keep the wound clean and cover it while bathing Rationale: After bariatric surgery, the pt must keep the wound clean and cover it during a shower or bath to prevent infections. Bowel changes are common after surgery, including constipation, so there is no need to report this. The patient's diet is limited to liquid or pureed foods for 6 weeks or until they are tolerated well. After 6 weeks, teh patient's diet progresses to regular, solid food with an emphasis on nutrient- dense foods.
The nurse reviews a patient's medical record and recognizes which risk factor for Osteoarthritis? 1. Low body mass index 2. Obesity 3. Childbearing age 4. Male sex
2. Obesity Rationale: Secondary OA occurs less often than primary disease and can result from joint injury and obesity. OA occurs in people who are obese much more commonly than those who are not; low BMI means a patient is underweight. For pt with Primary OA, The disease is caused by aging and genetic factors. Being male is not a risk factor
When assessing a patient with diverticulitis, which finding would the nurse expect to see? 1. WBC of 11,000 2. Temp of 101 3. Tachycardia 4. Abdominal pain in LLQ 5. N/V
2. Temp of 101 3. Tachycardia 4. Abdominal pain in LLQ 5. N/V Rationale: Diverticulitis is the inflammation of diverticula. A patient with diverticulitis may have a low grade fever to 101 with an increased heart rate. Abdominal pain is often localized in the left lower quadrant, begins as intermittent, and progressively becomes steadier. N/V are commonly seen in a pt with diverticulitis would have an elevated WBC; 11,000 is normal range
The nurse is providing instructions to a patient with gastroenteritis regarding personal hygiene. Which statement made by the patient indicates a need for further teaching? 1. " I can use incontinent pads at night" 2."I should use toilet paper and soaps after each defecation. 3. "I can take a sitz bath for ten minutes twice daily" 4." I should apply creams or oils on a damp cloth to remove stools."
2."I should use toilet paper and soaps after each defecation. Rationale: Frequent stools by the patient with Gastroenteritis may lead to skin irritation at the anal region due to wiping and washing with soaps or toilet paper. Therefore the pt should use warm water or absorbent material to dry anal region. Use of incontent pads at night allows the air circulate to the skin and prevent irritation. Sitz bath for 10 minutes two times a day can relieve the pt discomfort. Application of cream, oil, or gel to a damp, warm washcloth helps remove stool that sticks to skin.
A pt who has undergone a laparoscopic cholecystectomy reports mild post-op abdominal bloating and discomfort. Which nursing action is correct? 1. NOtify the health care provider of possible peritonitis 2. Administer an opiod analgesic medication 3. Encourage patient to ambulate in the hall 4. Withhold oral fluids until symptoms have passed
3. Encourage patient to ambulate in the hall Rationale: Early ambulation can help promote absorption of the carbon dioxide (CO2) used to inssufflate abdomen.
Which assessment finding would the nurse anticipate for a patient suspected of having gastroesophageal reflux disease (GERD) 1. Diarrhea 2. Vommiting 3. Eructation 4.Weight loss
3. Eructation Rationale: Eructation is a common finding in patients with GERD. Vomiting and diarrhea rarely occur. Weight loss is not common finding.
While assessing a pt with paint in the right lower quadrant, the nurse finds the pt has a body temp. of 39C and a pulse of 100bpm. about which surgical intervention would the nurse anticipate teaching the patient that will control the patient condition? 1. Illeostomy 2. Total proctocolectomy 3. Exploratory laparotomy 4. Uncomplicated appendectomy
3. Exploratory laparotomy Rationale: pt with pain in the RLQ, BT of 39C and a pulse of 100bpm may have a perforated appendix with peritonitis. An exploratory laparotomy is used to treat the patients condition, which involves the drainage of fecal material into a pouching system worn on the abdomen of a patietn with ulcerative colitis. A total proctocolectomy is performed in a patient who does not want th riley-anal pouch. The procedure involves the removal of the colon, rectum, and anus with surgical closure of the anus. Uncomplicated appendectomy involves the removal of the inflammed appendix.
A pt is admitted to the Icu w/ perforation of a duodenal ulcer. Which prescribed action would the nurse implement first? 1. Apply antiembolic stockings 2. Insert an indwelling urinary catheter, and check output hourly. 3. Place NG tube and connect it to suction 4. Start famotidine 20 mg IV every 12 hours
3. Place NG tube and connect it to suction Rationale: to decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis. Antiembolic stockings will need to be applied, monitoring output is important, and famotidine will need to be adminitsered, but the nurses first priority is to minimize risk for peritonitis
Which statement describes internal hemorrhoids? 1. They are noticeable to the eye 2. They lie below the anal sphincter 3. They cannot be seen upon inspection 4. They fall down and portrude the anus
3. They cannot be seen upon inspection Rationale: Internal hemorrhoids are located inside the body and cannot be seen upon inspection of the anal are. External hemorrhoids are noticable to the eye and lie below the anal sphincter. Prolasped hemorrhoids fall down and protrude through the anus.
The nurse is teaching a pt with gastroenteritis regarding self-managment and hygiene. Which statement made by the patient indicates effective learning? 1. "It is safe to cook meals for my family" 2." it is necessary to clean my bathroom once a month" 3. " I should wash my hands fro 2 mintues with antimicrobial soap." 4. " I must keep my toothbrush and toothpaste seperate from others"
4. " I must keep my toothbrush and toothpaste seperate from others" Rationale: Pt with gastroenteritis may have either a bacterial or viral infection. The pt must maintain personal hygiene to prevent transmission of disease to other memebers of the family. Therefore the patient must keep a toothbrush and toothpaste and eating utensils away from those of family members. The patient should maintain clean bathroom facilities to prevent exposure to stool. The patient should wash hands for 30 seconds with an antimicrobial soap after Bowel movement and should maintain good personal hygiene.
Which symptom would alert the nurse that a patient may have a paraesophageal hiatal hernia? 1. Dysphagia 2.Eructation 3. Regurgitation 4. Breathlessness
4. Breathlessness Rationale: Because paraesophageal hiatal hernia involves protrusion of the fundus and other parts of the stomach into the thorax, patients often report breathlessness after a meal. The lower esophageal sphincter remains in place, so regurgitation is often not present. Dysphagia and eructation are associated with sliding hiatal hernia.
Which organ would the nurse expect to be affected when a patient reports pain in the upper right quadrant after a high-fat diet? 1. Spleen 2. Stomach 3. Appendix 4. Gallbladder
4. Gallbladder Rationale: Gallbladder is located in the RUQ
Which factor predisposes a patient to gastroesophageal reflux disease? 1. Belching 2. Flatulence 3. Water brash 4. Large meals
4. Large meals Rationale: eating large meals causes gastric distention, which can lead to GERD. Belching, flatulence, and water brash do not lead to gastric distention.
Which patient should the nurse attend to first? 1. Pt with hepatitis A reporting severe and ongoing itching 2. Pt with cirrhosis who has had a 3-Ib weight gain over 2 days 3. Pt with esophageal varies and mild right upper quadrant pain 4. Pt with severe ascites who has a temperature of 101.4
4. Pt with severe ascites who has a temperature of 101.4 Rationale: Pt with ascites and an elevated temperature may have spontaneous bacterial peritonitis; the nurse should attend to this patient first. Itching is anticipated with jaundice; this patient may be seen last. Weight gain with cirrhosis is not uncommon owing to low albumin levels. Cirrohosis may cause mild right upper quadrant pain; this patient should be seen after the patient with severe ascites.
how many cups are required to promote normal bowel function?
8-10 cups daily
what is a direct inguinal hernia?
A direct inguinal hernia passes through a weak point in the abdominal wall
Most effective way to manage diverticulitis?
A low fiber diet while inflammation is present followed by high fiber when inflammation is gone
Classic symptom of peritonitis?
Abdominal wall rigidity
Signs/ symptoms consistent with appendicitis?
Anorexia, N/V, Rebound tenderness (others= abdominal pain that is aggravated by coughing, and increased WBC
Illness associated with RLQ pain?
Appendicitis
What is the most common casues of peritonitis?
Bacteria and chemicals
Symptoms suggesting hiatal hernia?
Belching, Heartburn, Dysphagia, backward flow of food into the throat, feeling of fullness, and worsening of symptoms when lying down.
Chronic inflammatory bowel diseases?
Crohn's disease and ulcerative colitis
what is a sign of hypertension in PKD
Cysts are forming
what findings with gastroenteritis indicate hospitilization?
Dehydration, hypovolemia, Cardiac dysrhythmias Rationale:
What manefestation on a patient with peritonitis shows progression?
Diminishing bowel sounds ( heart rate also rises and abdominal distention due to reduce GI motility UO decrease and dehydration)
What ulcer is in the right epigustrum
Duodenal
what ulcer is common with pain 90min-3 hours after eating
Duodenal
Symptoms consistent with IBS
Fatigue, Abdominal Pain, Change in bowel pattern
what hernia occurs more in obese people and pregnant women?
Femoral hernia
what ulcer is common with pain 30-60 minutes after eating
Gastric
for patient who develop pyloric obstruction what are they at risk for?
Gastric distention
What teaching should IBS-C patients recieve?
Health and stress reduction
what are reduccible hernias?
Hernias that can be placed back into he abdominal cavity by gentl pressure or disappear when laying supine.
What does IBS-D mean
IBS with diarrhea
what urine does calcium stone form?
In alkaline urine
Nursing intervention included in the care plan for a pt with appendicitis?
Keeping them in semi-fowlers
What is CVA a classic symptom of?
Kidney infection
Where would a patient with inflamed spleen or gastritis experience pain?
LUQ
what quadrant are the spleen and stomache?
LUQ
Medication for excessive diarrhea
Loperamide
A patient who has GERD asks the nurse what an esophageal manometry test will measure. Which factor would the nurse include in an explanation 1. pH 2. Reflux 3. Motility 4. Inflammation
Manometry testing is performed to assess motility and is used when the diagnosis is uncertain. It does not evaluate inflammation, pH, or reflux.
Which characteristic of IBS is indicated if IBS-M is noted on patient chart
Mix of diarrhea and constipation
Which symptom is usully seen first in Gastroenteritis?
N/Vomiting (followed by diarrhea and abdominal cramping. Hypotension is a later sign and occurs from the F/E loss.
Which organism cause gastroenteritis and is possibly transmitted through teh respiratory route in addition to the fecal-oral route? 1. Shigella 2. Norovirus 3. Escherichia coli 4. Campylobacter enteritis
Norovirus Rationale: Norovirus is transmitted through the fecal-oral route and possible respiratory route. Shigella is through direct contact and indirect fecal-oral routes. Escherichia coli transmits through fecal contamination of food, water, or fomites. Campylobacter enteritis causes gastroenteritis through the fecal-oral route or by contact with infected animals or infants.
Acute inflammatory bowel disorders?
Peritonitis, Appendicitis, Gastroenteritis
How can a nurse prevent gastric distention?
Placing a NG tube on Providers order
What quadrant is the spleen located?
RLQ
conclusion about a hernia pushing downward at an angle into the inguinal canal that disappears when the patient lies in supine
Reducible indirect inguinal hernia Rationale: An indirect inguinal hernia pushes downward the inguinal canal.
Patients who undergo a open fundoplication for a larger hiatal hernia are at an increase risk of?
Respiratory complications
What position promotes drainage of peritoneal contents?
Semi-fowlers
What bacteria causes gastroenteritis?
Shigella species
struvite stones commonly cause what? that fill entire renal pelvis?
Staghorn calculi
happens with physical movement or activity (coughing, sneezing, laughing)
Stress incontinence
Main manifestations of cystitis?
Suprapubic pain, Cloudy & smelly urine, Dysuria, hematuria, frequency and urgency
Overactive bladder, involuntary loss of urine associated with strong desire to urinate can't suppress signal from the bladder to brain
Urge incontinence
what kind of surgery is an acute cholecystectomy?
Urgent surgery
why are warm compresses not applied on the abdomen for appendicitis?
Warm compress increase circulation to the abdomen. Increasing the inflammation and perforation
What is a hernia?
Weakness in a teh abdominal muscle wall through which a segment of the bowel or other abdominal structures protrude
what classifies a hernia as reducible?
When the contents of the hernia sac can be placed back into the abdominal cavity with gental pressure.
diet for a patient with diverticulitis?
Whole-grain diet avoid foods containing seeds
What are signs of CO2 retention?
abdominal bloating and dsicomfort
anuria
absence of any urine output
Fist sign of gastroenteritis in older adults?
acute confusion
What is peritonitis?
acute inflammation of the visceral or parietal peritoneum and endothelial lining of the abdominal cavity.
what is appendicitis?
an acute inflammation of the appendix
What do nurses do to alleviate pain and itching from hemorrhoids?
apply topical anesthetic
what is an intervention for decreased GFR?
assess hydration status
eructation
belching
what is Cystitis?
bladder infection/inflammation
what can happen if acute cholecystectomy does happen urgently?
can lead to possible peritonitis secondary to perforation and possibly septic shock.
what does acute mean
conditions are severa and sudden in onset
when should a truss be assessed?
daily
Nursing care for PKD
daily temp, daily weight, and decrease sodium intake.
Barret esophagus
damage to the lower part of the esophagus (heartburn)
Hesitancy
difficulty starting urination
nocturia
excessive urination at night
Which findings in a patient with Gastroenteritis indicates dehydration?
fever, oliguria, poor skin turgor Rationale:
What is a tricyclic antidepressant?
given to control pain r/t IBS
Labs to assess with a pt with diverticulitis?
hct and hob along (decrease ) with WBC (elevation)
What are irreducible hernias?
hernias that cannot be placed back into the abdominal cavity
what do kegel exercises do?
improves pelvic floor muscles
diet intervention for calcium stones
increase acidic foods and drinks
Osteoarthritis
inflammation of the bones and joints caused by wear down
urethitis
inflammation/infection of the urethra
What is true about a hernia?
it is caused by muscle weakness, weakness in abdominal wall, and its caused by increased intra-abdominal pressure
Staghorn calculi
large, solid growths that form in the kidneys where urine is formed
what is a ventral hernia?
occurs at the site of a previous surgical incision
Incisional hernia
occurs at the site of a surgical incision from inadequate healing
when should a patient wear their truss?
only during the day while awake.
over-distention of bladde, when bladder capacity has received maximum detusor under activity bladder outlet obstruction
overflow incontinence
what does chronic mean?
persistant, long-lasting in its effects or a disease that comes with time.
What is ciprofloxacin used for?
reduces inflammation
Major signs and symptoms of kidney stones?
severe pain ( renal colicky )
What is gastroenteritis?
stomach flu; intestinal infection
periorbital edema
swelling around the eyes
symptoms of dumping syndrome?
tachycardia, nausea, abdominal pain shortly after a meal
when should you take a tricyclic antidepressant if the pain occurs after eating?
take the drug 30-45 minutes before meals
perforated ulcer
untreated ulcer has burned through the mucosal wall (stomach or GI tract)
what do parvovirus-type organisms cause?
viral gastroenteritis
hydronephritis
water in the kidney
main manifestation of acute glomerulonephritis?
proteinuria, periorbital edema, hypoalbuminemia, oliguria, azotemia, hematuria, hypertension, flank pain
what helps stress incontinence?
kegel exercises
Kidney ischemia
poor blood flow into kidneys
Which dietary modification would the nurse recommend for a patient newly diagnosed with gastroesophageal reflux disease (GERD)? 1. Avoidance of chocolate 2. Incorporation of citrus fruits in the diet 3. increased intake of protein rich foods 4. Avoidance of tomatoes and tomato based foods 5. Switching to a soft diet of pureed vegetables 6. Avoidance of coffee and other caffeinated beverages
1. Avoidance of chocolate 4. Avoidance of tomatoes and T based foods 6. Avoidance of coffee and other caffeinated beverages Rationale: Patients with GERD should avoid chocolate, tomato products, as well as caffeinated beverages. theses foods contribute to decreased lower esophageal sphincter pressure, which occurs in GERD. The patient with GERD should avoid citurs fruits becasue the amotun of citric acid containde in them. Protein rich foods should be maintained for a balanced diet but do not need to be increased. A soft diet is not a necessary dietary modifications for a diagnosis of GERD
Which nutritional information would the nurse include in the teaching plan for a patient diagnosed with gastroesophageal reflux disease? 1. Limit caffeine 2. Eat a peppermint 3. Decrease chocolate intake 4. Eat three small meals a day 5. Avoid drinking fluids at meals
1. Limit caffeine 3. Decrease chocolate intake Rationale: Caffeine and chocolate should be limited with GERD. Peppermint may contribute to relfux and should be limited or avoided. The patient should eat six small meals a day not three. Drinking fluids with meals is not restricted for patients with GERD.
A patient diagnosed with gastrophageal reflux disease (GERD) is learning about lifestyle changes to decrease the chance of developing esophageal cancer. Which patient outcome indicates that the teaching was effective? 1. Losing 15 Ib of excess weight 2. Sleeping with the head of bed elevated 3. Drinking one glass of wine each night 4. Chewing tobacco instead of smoking cigarettes 5. Using a continues positive airway pressure machine to sleep (CPAP)
1. Losing 15 Ib of excess weight 2. Sleeping with the head elevated 5. Using a continuous positive airway pressure machine to sleep (CPAP) Rationale: Pt's with GERD who are at risk for developing esophageal cancer are encouraged to lose weight, elevate their head while sleeping, and use a CPAP machine if indicated. One glass of wine per night will not decrease teh risk for esophageal cancer chewing tobacco will not decrease the risk for esophageal cancer.
Which information would the nurse include in discharge instructions for a patient with a new diagnosis of gastroesophageal reflux disease about ways to decrease acid production? 1. Low- fat diet 2. Smoking cessation 3. Alcohol abstinence 4. Flat sleeping position 5. Three larger meals daily
1. Low- fat diet 2. Smoking cessation 3. Alcohol abstinence Rationale: Nurse should instruct the patient to consume a low-fat diet, refrain from alcohol consumption, and stop smoking as these can make the symptoms of GERD worse. The patient would sleep with the HOB elevated, to prevent reflux. The patient would need to eat smaller, more frequent meals to decrease pressuree adn improve gastric emptying
Which nursing intervention would be included in the plan of care in the immediate postoperative phase for a patient who had emergency surgery for peritonitis? 1. Monitor vital signs hourly 2. Monitor level of consciousness hourly 3. encourage patient to take small sips of water 4. Maintain the patient in a semi-fowler position 5. Monitor intake and output every 4 hours
1. Monitor vital signs hourly 2. Monitor level of consciousness hourly 4. Maintain the patient in a semi-fowler position Rationale: In the immediate posteroperative phase, the nurse should monitor the patients vital signs and level of consciousness hourly. Any change in the level of consciousness would indicate surgical complications. The patient should be maintained in semi-fowler position to promote drainage of peritoneal contents to a lower region of the abdominal cavity. The patient is not permitted to take oral fluids until bowel sounds return. Intake and output should be monitored hourly in the immediate postoperative phase after abdominal surgery.
The nurse is performing a health history on a patient who is newly diagnosed with PUD. Which condition in the patients history may be related to a cause of PUD? 1. Osteoarthritis 2. Hyperlipidemia 3. Uriniary tract infections 4. Cardiovascular disease
1. Osteoarthritis Rationale: NSAIDs are a major cause of PUD and are often used by patients who have arthritis; a report of osteoarthritis should prompt the nurse to explore types of treatments the patient is using . Cardiovascular disease, hyperlipidemia, and urinary tract infections do not predispose patients to PUD.
Which common complication is associated with gastrophageal reflux disease (GERD) in the older adult? 1. Sleep apnea 2. Barret esophagus 3. Esophageal strictures 4. Aspiration pneumonia 5. Esophageal diverticula 6. Esophageal perforation
1. Sleep apnea 2. Barret esopagus 3. Esophageal strictures 4. Aspiration pneumonia Rationale: In older adults with GERD the incidence of heartburn decreases, and instead they develop more severe complications such as sleep apnea, Barret esophagus, esophageal strictures, adn aspiration pneumonia. Esophageal diverticula can occur because surrounding tissue. Esophageal perforation may occur when excessive force is exerted on the esophageal mucosa
A portion of a patient's fundus and the esophagogastric junction has moved upward through the esophageal hiatus. Which condition does this decribe 1. Sliding hernia 2. Esophageal reflux 3. Esophageal diverticula 4. Paraesophageal hernia
1. Sliding hernia Rationale: In a sliding hiatal hernia, the esophagogastric junction. of the esophagus and part of the fundus od the stomach move upward into the chest through the esophageal hiatus. Esophageal reflux is the reflux of teh GI contents into the esophagus, which observed in GERD and sliding hiatal hernias. In a paraesophageal hernia, but the fundus and a portion of the greater curvature of the stomach moves into the chest through the esophageal hiatus. Esophageal diverticula are sacs that occur because of the herniation of teh esophageal mucosa and submucosa into surrounding tissue.
which statement about appendicitis is accurate? 1. it occurs mostly in young adults 2. it is mostly caused by parvirus-type organisms 3. it causes pain in the left lower quadrant 4. it is a chronic inflammation of the appendix
1. it occurs mostly in young adults Rationale: Appendictis occurs mostly in young adults. It causes pain in the right lower quadrant and is an acute inflammation of the appendix. It is caused primarily by the obstruction of lumen of the appendix with hard pieces of feces composed of calcium phosphate rich mucus and inorganic salts. Parvovirus organisms cause viral gastroenteritis
Which nutritional recommendation would the nurse provide to the patient with peptic ulcer disease 1. Reducing caffeine intake 2. Consuming marshmallows 3. Taking a dose of syrup of ipecac with each meal 4. Increasing spicy food to destroy Helicobacter pylori bacteria
1. reducing caffeine intake Rationale: Caffeine, specifically coffee, stimulates gastrin release, which worsen PUD. Marshmallow root is recommended for PUD treatment, but marshmallows do not contain marshmallow root. Ipecac induces vomitting, which is not beneficial to the paitent withPUD. Spicy foods worsen stomach disorders.
A patient is admitted to the ICU with perforation of a duodenal ulcer. Which prescribed action would the nurse implement first? 1. Apply antiembolic stockings 2. Insert an indwelling urinary catheter, and check output hourly. 3. Place nasogastric (NG) tube, and connect it to suction. 4. Start famotidine 20 mg IV q. 12 hours
3. Place nasogastric (NG) tube, and connect it to suction. Rationale: To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis. Antiembolic stockings will need to be applied, monitoring outout is important, and famotidine will need to be administered, but teh nurse's first priority is to minimize risk for peritonitis
which teaching would be provided for a patient who has been prescribed a truss? select all that apply 1. use a belt to hold it in place 2. use a light powder under the truss 3. assess the skin around the truss daily 4. put the truss on at night while sleeping 5. apply the truss after pushing in the protruding hernia
1. use a belt to hold it in place 2. use light powder under the truss 3. assess the skin around the truss daily Rationale: the truss is held on with a belt to keep the abdominal contents from protruding into the hernial sac. Light powder can be used under the truss to help protect the skin beneath it. Th eskin around the truss should be assessed daily. The patient should apply the truss when awake during the day, not while sleeping. The patient should not push the hernia.
The Nurse is caring for a patient with PUD. Which assessment finding suggest a surgical emergency? 1. Black tarry stool 2. Assuming the knee-chest position 3. tender, rigid, board-like abdomen 4. Sudden sharp pain in the mid-epigastrum 5. Vomitting bright red or coffee-ground fluid
2. Assuming knee-chest position 3. tender, rigid, board-like abdomen 4. Sudden sharp pain in the mid-epigastrium Rationale: Perforation of a peptic ulcer is a life-threatening surgical emergency. Perforation causes a sudden, sharp pain in the mid-epigastric region. The patient becomes apprehensive, and the abdomen becomes tender, rigid, and board-like. To decrease the tension of the abdominal muscles, the patient usually assumes a knee-chest position. Black, tarry stool (melena) and vomiting blood (hematemesis) are common symptoms of PUD, but they do not indicate a surgical emergency.
A patient with GERD who is overweight consumes several cups of cofee and two soft drinks daily. Which recommendation would the nurse first make.? 1. Begin a weight loss program 2. Change to decaffeinated coffee 3. Eat only two meals each day. 4. Drink caffeine- free carbonated drinks.
2. Change to decaffeinated coffee Rationale: Caffeine decreases lower esophageal sphincter pressure, worsening the symptoms of GERD. Changing to decaffeinated coffee could be a relatively easy first step in minimizing symptoms. Th patient needs to lose weight, but this is a slower process and will not produce immediate improvement. The patient should be taught to spread small meals out 5 or 6 time daily. All carbonated beverage should be avoided
A patient being treated for gastrophageal reflux disease with pantoprazole reports continued symptoms. While reviewing the patient's 24 hour dietary recall, the nurse understands that which dietary choice would likely be a contributing factor? 1. Milk 2. Coffee 3. Apples 4. Red meat
2. Coffee Rationale: Caffeinated product such coffee can increase the risk for GERD symptoms. Milk, apples, and red meat do not exacerabte symptoms.
Which condition may result from Helicobacter pylori infection? 1. Stress ulcer 2. Gastric ulcer 3. Crohn disease 4. Inflammatory bowel disease
2. Gastric ulcer Rationale: This infection causes the activation of inflammatory cells cells such as cytokines and nuetrophils that cause epithelial cell necrosis of the mucous membrane. Stress ulcers are less common and occur from lengthened hospital stays in criticall ill patients, some evidence shows H. Pylori having a protective effect against inflammatory bowel disease, including Crohn disease.
The nurse is assessing the nature of abdominal pain in a patient with a suspected gastric ulcer. Which feature of the patients pain is consistent with a gastric ulcer? 1. Located on the right of the epigastrium 2. worsens with the ingestion of food 3. Occurs about 2 hours after a meal 4. Often awakens the patient around 1 am
2. Worsens with the ingestion of food Rationale: Pain from a gastric ulcer usually worsens after the intake of food. Pain on the right of the epigastrium is oftendue to a duodenal ulcer. Pain due to a gastric ulcer is often in the upper epigastrium with localization to the left of the midline. It usually occurs 30 to 60 minutes after a meal and is rare at night. Pain associated with a duodenal ulcer occurs 90 minutes to 3 hours after a meal, and the patient often wakes up between 1:00 and 2:00 a.m. because of pain.
Which postoperative action would be implements for a patient who just had abdominal surgery for peritonitis? 1. Monitor level of consciousness every 4 hours 2. Irrigate peritoneal drain using sterile technique 3. maintain the patient in a supine position 4. Monitor respiratory rate every 2 hours
2. irrigate peritoneal drain using sterile technique Rationale: Sometimes manual irrigation of teh peritoneum must be performed through a drain prescribed by the health care provider. The postoperative patient is maintained in semi-fowler position to promote drainage of peritoneal contents into the lower region of the abdominal cavity. Resipratory rate and level of consciousness are monitored every hour immediately after abdominal surgery.
A patient is scheduled to have ambulatory pH monitoring for diagnosis of GERD. WHich statement by teh patietn indicates a need for further teaching? 1. They will put a catheter through my nose into my esophagus 2. I will have a little capsule attached to the wall of my esophagus 3. The pH is monitered when i press the button on the monitoring device 4. I will have to keep a diary of my activities and symptoms for 24 to 48 hours
3. The pH is monitored when i. press the button on teh monitoring device Rationale: The pH is continuously monitored; therefore the patient will not need to push a button on the device. The patient may have a small catheter placed through the nose into the distal esophagus. The patient may also have a small capsule attached to the esophagus that will monitor the pH levels. The patient will be asked to keep track of activites and symptoms for 24 to 48 hours.
A nurse in a surgical unit is planning care for the patient assignment. In which order would the nurse visit each patient? 1. 88 year-old who underwent an acute cholecystectomy 2. 62- year-old who under went hernia repair 3. 24-year-old who underwent an appendectomy 4. 19 year-old who underwent an incision and drainage
3. 24 year-old who underwent an appendectomy 1. 88 year-old who underwent an acute cholecystectomy 2. 62 year- old who underwent a hernia repair. 4. 19 year-old that underwent an incicison and drainage Rationale: Appendectomies are emergent surgies that require immediate intervention before septic shock secondary to perforation and possibly death. An acute cholecsysctomy is an urgent surgery that, if not performed quickly, can also lead to peritonitis secondary to perforation and possibly septic shock. Hernia repair is an elective procedure that requires sedation nad surgical preparation. An incision and drainage is minor elective procedure that rarely uses sedation and instead requires application of local anesthetic, which does not require recovery.
Which location is common for gastric ulcers? 1. Muscularis propria 2. Proximal duodenum 3. Antrum of the stomach 4. Upper portion of the duodenum
3. Antrum of the stomach Rationale: Gastric ulcers appear in the antrum of the stomach. Stress ulcers may be found on the proximal duodenum. Duodenal ulcers occur in the upper portion of the duodenum and penetrate through the mucosa and submucosa into the muscular propria
A hospitalized patient who obese and has gastroesophageal reflux disease is at risk aspiration pneumonia. Which nursing action is the priority? 1. Teach the patient to avoid alcohol and smoking 2. Educate the patient about weight-loss strategies. 3. Elevate the HOB to a 30-degree angle. 4. Perform a dietary history to identify problem foods.
3. Elevate the HOB to a 30-degree angle. Rationale: Patient with GERD have increased risk for aspiration, and symptoms are worse at night becasue of the supine position that allows prolonged contact of acid reflux with esophagus. The nurse should elevated the HOB to 30 degrees to minimize this. The other actions should be performed, but they will not ahve an imediate effect on this patient's symptoms and risk.
Which action made by a patient with gastroesophageal reflux disease indicates an understanding of behaviors that need to be modified? 1. Consumes a snack before bed 2. Decreases alcohol consumption 3. Elevates the head of bed at night 4. Uses peppermint cnady for reflux
3. Elevates the head of the bed at night Rationale: Pt's with Gerd should sleep with the HOB elevated at night to decrease the amount of gastric acid that can reflux into the esophagus. This behavior indicates an understanding of changing behaviors. The pt should avoid consuming alcohol, not just decrease the intake. Peppermint actually makes the reflux worse and should be avoided.
Which sphincter would be assessed with gastroesophageal disease (GERD) is suspected? 1. Pyloric sphincter 2. Sphincter of Odd 3. Lower esophageal sphincter (LES) 4. Upper esophageal sphincter (UES)
3. Lower esophageal sphincter Rationale: The LES is located just above the gastroesophageal junction. When at rest, the LES is normally closed to prevent reflux of gastric contents into the esophagus. Abnormal functioning of LES results in GERD. The distal portion of the stomach is separated from the duodenum by the pyloric sphincter. The pyloric sphincter aids in transporting food through the Gl tract and prevents backflow. The sphincter of Oddi is a muscle surrounding the opening of the duodenal papilla. The pancreatic duct and the common bile duct merge to form the ampulla of Vater, and the secretions from these ducts are released into the duodenum at the duodenal papilla. The upper esophageal sphincter is located at the upper end of the esophagus and prevents the entry of air into the esophagus during respiration.
The nurse is reviewing the medications prescribed for a patient with PUD. Which drug treats Helicobater pylori? 1. Nizatidine 2. Pantoprazole 3. Metronidazole 4. Aluminum hydroxide
3. Metronidazole Rationale: Metronidazole is an antimicrobial that treats H. pylori infection. Aluminum hydroxide is an antacid that deactivates pepsin and buffers the acid produced in the stomach. Pantoprazole is a proton pump inhibitor that surpasses the H, K-ATPase enzyme system and regulates gastric acid secretion. Nizatidine is an H2 antagonist that blocks histamine receptors in parietal cells and decreases gastric acid secretion
A patient is admitted with chronic peptic ulcer disease (PUD). Which finding suggests a possible pyloric obstruction? 1. Hyperkalemia 2. Metabolic acidosis 3. Nausea & Vomitting 4. Tender and board-like abdomen
3. Nausea and Vomitting Rationale: Nausea and vomitting are symptoms of chronic PUD due to stasis and gastric dilation associated with pyloric obstruction. Abdominal bloating is another symptom of obstruction. A tender, board-like abdomen is a sign of peritonitis because peptic ulcer perforation. The patient may have metabolic alkalosis because of the loss of large quanities of acid gastric juice in the vomitus. Vomitting or metabolic alkalosis may cause hypokalemia
A patient with gastroesophageal reflux disease reports pain with swallowing. Which term is used for this finding? 1. Eructation 2. Dysphagia 3. Odynophagia 4. Regurgitation
3. Odynophagia Rationale: Odynophagia (painful swallowing) can manifest as severe chest pain tht persists fro several hours after swallowing as a result of spasms in the esophagus. Dysphagia refers to diffuculty swwalloing not associated with pain. Eructation is belching. Regurgitation is reflux of stomach contents into the esophagus.
The nurse is reviewing the clinical data of four patients. Which patient is at high risk for peptic ulcer? 1. Patient A- increased calcium, increased PTH, normal gastrin, normal phosphorus 2. Patient B- Decreased calcium, normal PTH, normal gastrin, increased phosphorus 3. Patient C- increased calcium, increased PTH, increased gastrin, decreased phosphorus 4. Patient D- increased calcium, normal PTH, decreased gastrin, normal phosphorus
3. Patient C- increased calcium, increased PTH, increased gastrin, decreased phosphorus Rationale: Excessive levels of PTH may increase the levels of serum calcium levels. Hypercalcemia causes elevated serum gastrin levels, Which causes GI problems such as peptic ulcers. Therefore patient C with hyperthyroidism, increased calcium levels, and increased gastrin levels is at high risk for developing peptic ulcers. Patient A has normal gastrin levels, so this patient may not be at risk for developing peptic ulcers. Patient B has normal gastrin levels, so this patient also may not be at risk for developing peptic ulcers. Additionally patient D with decreased gastrin levels may not be at risk for developing peptic ulcers.
A patient is diagnosed with a duodenal ulcer caused by Helicobacter pylori infection. The patient asks the nurse how this infection was contracted. Which response would the nurse provide? 1. "it was contracted by the fetus during gestation." 2. "It is usually spread by the respiratory route via inhaled droplets." 3. "H. pylori is a bloodborne pathogen contracted by contact with body fluids." 4. " H. pylori infection is spread by the oral to oral route or fecal to oral routes."
4. " H. pylori infection is spread by the oral to oral route or fecal to oral routes." Rationale: The most common route of H. Pylori infection transmission is either oral to oral ( stomach contents are transmitted from mouth to mouth) or fecal to oral ( from stool to mouth) contact. H. pylori is not contracted during gestation. Human immune deficiency virus is contracted through contact with infected blood or body fluids. Mycobacterium tuberculosis, the organism that casues tuberculosis, is typically contracted via inhaled droplets.
Which lifestyle modification would the nurse teach the patient with gastroesophageal reflux disease? 1. Sleep in the supine position with your HOB flat 2. Consume no more than 3 meals a day 3. Eat atleast 1 hour before bed 4. Remain upright for 1 to 2 hours after meals.
4. Remain upright for 1 to 2 hours after meals. Rationale: Lifestyle modifcations can help control reflux and promote health in a patient with GERD. It is recommended that the patient with GERD remain upright 1-2 hours after meals, this will reduce acidic stomach contents. The patient should not sleep flat in bed; instead the patient should elevate HOB of the bed 6 to 12 inches to prevent reflux. Four to Six small meals a day are recommended instead of fewer heavier meals. The patient should not eat for 2 to 3 hours before going to bed.
The nurse is caring for an older-adult man who reports stomach pain and heartburn. Which characteristic would lead the nurse to suspect th ulcer was duodenal rather than gastric in location? 1. The patient is a man older than 50 years 2. The pain is worsened by the ingestion of food 3. The patient has a malnourished appearance 4. The pain occurs 3 hours after meals and at night.
4. The pain occurs 3 hours after meals and at night. Rationale: A key symptom of duodenal ulcers is that pain usually awakens the patient between 1:00 and 2:00 am, occuring 1 1/2 to 3 hours after a meal. Pain is worsened with ingestioned of food and malnourished appearance are key features of gastric ulcers. A man older than 50 years is a finding that could apply to eihter tyoe of ulcer.
Urolithiasis
kidney calculi/ kidney stones
most common manifestation of stone formation
Dehydration
cant supress signal from brain to urinate and happens with physical movement or activity
Mixed incontinence
