ADH GI

Diverticulitis

LLQ pain nausea anorexia fever bloating leukocytosis distention interventions: fluid intake, exercise, soft fiber food, avoid triggers, laxatives

barium enema

LOWER GI Shows filled colon must tolerate bowel cleansing and hold barium in rectum identifies polyps, tumor, lesions, fistulas do not do in patients with IBD or bowel perforation interventions: prep, low reside diet for 1-2days, clear liquids day before, use laxative night before, NPO after midnight(except prep), use cleaning enema education: inform abt prep, increase in bowel movements after procedure, eliminate barium in stool that is white, increase fluid intake pt must be able to change position on their own

A 66-year-old African-American client has recently visited a physician to confirm a diagnosis of gastric cancer. The client has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of cancer because he was asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On the basis of knowledge of disease progression, the nurse assumes that organs adjacent to the stomach are also affected. Which of the following organs may be affected? Choose all that apply. You Selected:

Liver Pancreas Duodenum

Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following?

Mental confusion

A client is preparing for discharge to home following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal?

Slows gastric emptying

A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which statement best indicates that the disease process is under control?

The client exhibits signs of adequate GI perfusion.

A client tells the nurse, "I am not having normal bowel movements." When differentiating between what are normal and abnormal bowel habits, what indicators are the most important?

The consistency of stool and comfort when passing stool

A nurse is teaching a client with gastritis about the need to avoid the intake of caffeinated beverages. The client asks why this is so important. Which explanation from the nurse would be most accurate?

"Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery."

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult?

"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread."

After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching?

"I need to drink 8 ounces of water before eating."

A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required?

"I need to use laxatives regularly to prevent constipation."

A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching?

"I will have to take vitamin B12 shots up to 1 year after surgery."

A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen?

"The medications will kill the bacteria and stop the acid production."

which statement by client may indicate a precipitating factor for acute gastritis?

"i really enjoy tequila"

peritonitis manifestations

1.) *Abdominal pain*, rebound tenderness 2.) As progresses, *muscle rigidity*, distention, spasm in abdomen (described as *"board like" since abdomen is very hard*) 3.) Fever, tachycardia, tachypnea, N/V

bariatric surgery

10-35% total body weight loss within 2-3 years restrict ability to wat/interferes with nutrient absorption post-op: clear liquid pre and post, slow progression to full food/soft to prevent nausea/vomiting, provide small meals to prevent dumping syndrome never insert NG tube after surgery to prevent damage to suture line (cause leak or hemorrhage)

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

A nurse caring for a client who has had radical neck surgery notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. What is an expected, normal amount of drainage?

Approximately 80 to 120 mL

The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer?

Awakening in pain

CLIENT IS ADMITTED WITH SUSPECTED APPENDICITIS. THE PATIENT STATES HE IS HAVING PAIN AROUND THE BELLY BUTTON THAT EXTENDS INTO THE LOWER RIGHT PART OF HIS ABDOMEN. THE PATIENT POINTS TO HIS ABDOMEN AT A LOCATION WHICH IS ABOUT A ONE-THIRD DISTANCE BETWEEN THE ANTERIOR SUPERIOR ILIAC SPINE AND UMBILICUS. THIS AREA IS KNOWN AS WHAT? A. Rovsing's Point B. McBurney's Point C. Murphy's Point D. Hamman's Point

B. McBurney's Point

The nurse is assessing a client with advanced gastric cancer. The nurse anticipates that the assessment will reveal which finding?

Bloating after meals

you are preparing to educate a group at the community center about peptic ulcers, when discussing risk factors, mention? A: Alcohol use and history of acute renal failure B: History of hemorrhoids and diabetes C: Alcohol abuse and smoking D: Sedentary lifestyle and smoking

C.

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:

CAD

Which ulcer is associated with extensive burn injury?

CURLING

Ulcerative coltiis

Chronic disease of mucosal and submucosal layers of colon and rectum with unpredictable period of remission and exacerbation with abdominal cramps and bloody diarrhea Anorexia, weight loss, fever, vomiting, dehydration, 6 loose stools a day Diarrhea with mucus, us, blood, LLQ pain Begin in rectum and progress through colon Fluids, low residue, high protein, high calories diet Ostomy/colectomy if all else fails

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse?

Clamp the tubing and give the patient a rest period.

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

An elderly client seeks medical attention for a vague complaint of difficulty swallowing. Which of the following assessment findings is most significant as related to this symptom?

Esophageal tumor

A client with gastric cancer is having a resection. What is the nursing management priority for this client?

Correcting nutritional deficits

which ulcer is associated with extensive burn injury?

Curling

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

acute abdomen

Defined: acute onset of abdominal pain with no traumatic etiology, requires surgery yo prevent sepsis, includes appendicitis, severe diverticulitis, intestinal obstruction Diverticulitis: older adults wait to report in fear of cancer, common in sigmoid, occurs when inflamed or perforation like fistula/obstruction/peritonitis/hemorrhage/abscess. Diverticulum is saclike herniation of lining in bowel that extends through muscle layer Nursing Interventions: fluid intake, soft fiber filled food, exercise, laxative for bowel regularity, avoiding food triggers Symptoms: LLQ Pain Nausea Anorexia Bloating Distention Fever leukocytosis

CT

Detects appendicitis, ulcerative colitis, liver, spleen, pancreatic disease contrast may be enhancing pictures check if pregnant, check creatinine, check for shellfish allergies and iodine

IBD cont

Diagnostic Testing: blood studies (CBC, serum electrolytes, serum protein level), stool exam (blood, pus, mucus), stool cultures Manifestations: fever, fatigue, weight loss, diarrhea, abdominal pain Management: Acute Exacerbation: bowel rest, NPO, IV fluid, TPN, electrolyte replacement After resolution: clear liquid, low residue diet, high protein high calorie diet, iron/vitamin supplement, avoid triggers Drug therapy: Sulfa-Free 5-ASA Pentasal Dipentum Sulfasalazine Headache, nausea, fatigue, abnormal sperm production, yellowish orange discoloration of skin/urine, avoid sunlight 5-ASA: Achieve and maintain remission Prevent flare ups Immunosuppressants Corticosteroids Biologics Integrin receptor antagonists Low residue diet: fiber restricted, involves eating easily digestible foods, reduces number of bowel movements

Which is the primary symptom of achalasia?

Difficulty swallowing

A client with active schizophrenia has developed acute gastritis after ingesting a strongly alkaline solution during a psychotic episode. Which emergency treatments should the nurse anticipate using with the client? Select all that apply.

Diluted lemon juice Diluted vinegar

Clients with Type O blood are at higher risk for which of the following GI disorders?

Duodenal ulcers

The nursing student approaches his instructor to discuss the plan of care for his client diagnosed with peptic ulcer disease. The student asks what is the most common site for peptic ulcer formation? The instructor would state which one of the following?

Duodenum

When caring for a client with the impaired swallowing related to neuromuscular impairment, what is the nurse's priority intervention?

Elevate the head of the bed 90 degrees during meals.

A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist?

Endoscopy

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening?

Familial polyposis

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate?

Gently washing the area surrounding the stoma using a facecloth and mild soap

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

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.

A nurse has agreed to draft a medication teaching plan for a patient who is taking the hormonal agent, Aromasin, an aromatase inhibitor for postmenopausal women with breast cancer. The nurse knows that a major teaching point is to tell the patient to:

Increase her intake of calcium-rich foods.

IBD

Inflammatory Bowel Disease IBD- group of chronic disorders that result in inflammation of GI tract/ulceration of colon, auto-immune response. TWO TYPES: Crohn's and Ulcerative Colitis.

what to avoid giving peptic ulcer patient?

NSAID

The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order?

Nasogastric tube insertion

gastritis

Nursing Interventions: maintain fluid balance and nutrition, give IV fluids for acute attack, supportive therapy (NG tube, antacid, pepcid, proton pump inhibitor/protonix) Defined: inflammation of gastric/stomach mucosa Diagnosed with biopsy and endoscopy Symptoms: bleeding from erosive gastritis (blood in vomit or bright red bloody stool), fatigue, pyrosis, belching, sour taste in mouth, early satiety, anorexia, nausea, vomiting, epigastric pain, dyspepsia, hiccups

A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer.

Omeprazole

endoscopic nursing interventions

Pre-procedure: NPO at least 8 hours prior to procedure, make sure pt understands and consents signed, verify allergies Post procedure: assess LOC, NPO until gag reflex returns, aspiration can occur, cough and deep breathing, assess O2 sat/resp/breath sounds, monitor vitals, monitor for signs of perforation like bleeding/elevated temp/difficulty swallowing/pain in throat or back

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?

Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs)

A nurse is preparing to discharge a client newly diagnosed with peptic ulcer disease. The client's diagnostic test results were positive for H. pylori bacteria. The health care provider has ordered the "triple therapy" regimen. Which medications will the nurse educate the client on?

Proton-pump inhibitor and two antibiotics

Appendicitis: cause of acute abdomen, dull and poorly localized pain with anorexia in RLQ that is severe, rebound tenderness at McBurneys point when there is pressure, constipation but laxative causes rupture

Traits: appendix is inflamed and edematous from hardened mass of stool, edema of appendix, increased pressure causes ischemia/gangrene/rupture/peritonitis/sepsis SIgns: increased WBC, rebound pain in RLQ, low grade fever, anorexia, nausea, begins as dull steady pain

The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation?

Usual pattern of elimination

H pylori intervention

antibiotics and bismuth salts

colonoscopy

clear liquid diet day before , NPO after midnight, golytely prep, Bowels should be clear/straw colored contraindicated in bowel perforation/IBD pre: finish bowel prep, NPO after midnight, ensure understanding post: assess for potential bowel perforation, rectal bleeding, sudden onset abdominal pain, fever, rebound tenderness, mild gas pain, cramping, increased HR, decreased BP

The nurse is creating a discharge plan of care for a client with a peptic ulcer. The nurse tells the client to avoid

decaffeinated coffee.

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome?

diarrhea

appendicitis

dull localized pain in RLQ/anorexia rebound tenderness constipation tenderness McBurney's point appendix edematous/inflamed increased WBC increase in pressure leads to: 1) ischemia, 2) gangrene, 3) rupture. 4)peritonitis, 5) sepsis

Endoscopy intervention

pre: NPO 8 hours prior to procedure, make sure pt understands consent, verify allergies post: assess LOC, NPO until gaga reflex returns (aspiration concern), deep breathing/cough, assess adventitous breath sounds/O2 sat, monitor vitals, monitor for perforation (bleeding/pain in throat/dysphagia/elevated temp)

Which client requires immediate nursing intervention? The client who:

presents with a rigid, board-like abdomen.

Which of the following is the most common symptom of a polyp?

rectal bleeding

crohn's disease

severe diarrhea/low grade fever/steatorrhea/malabsorption/N/V/distention/RLQ tenderness/weight loss/dehydration/anemia/ electrolyte imbalance cramp after meals remission and exacerbation

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for:

hypokalemia

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following?

low residue

A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist?

endoscopy

In women, which of the following types of cancer exceeds colorectal cancer?

breast

peritonitis complications and interventions

cause obstruction sepsis shock/hypervolemia check vitals q4h daily weight I&O antibiotics fluid/electrolyte replacement assess abdomen NPO give antiemetics position: knees flexed on side assess incision site

The nurse is obtaining a history on a patient who comes to the clinic. What symptom described by the patient is one of the first symptoms associated with esophageal disease?

dysphagia

The nurse cares for a client who receives parenteral nutrition (PN). The nurse notes on the care plan that the catheter will need to be removed 6 weeks after insertion and that the client's venous access device is a

nontunneled central catheter.

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?

A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.

ulcerative colitis

a chronic condition of unknown cause in which repeated episodes of inflammation in the rectum and large intestine cause ulcers and irritation, bloody diarrhea anorexia, weight loss, fever, vomiting, dehydration, 6 stools a day, diarrhea with mucus/pus/blood, LLQ pain

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?

agitation

acute abdomen conditions

appendicitis severe diverticulitis intestinal obstruction peritonitis no traumatic etiology requires prevention of sepsis

endoscopic procedure

A procedure performed through an existing orifice with a scope to visualize an abnormality or to determine the extent of a disease.

Clients with Type O blood are at higher risk for which of the following GI disorders?

duodenal ulcers

the nurse is caring for the pt with bleeding gastric ulcer. what is the appropriate diet for pt 24 hrs after admission? \ A. regular diet B. Nothing by mouth C. Clear liquid D. Full liquid

B. NPO

The nurse is caring for a client with chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency?

B12

Barium swallow

Barium swallow: Upper GI series, X-ray done using barium as contrast agent, allows for view of esophagus/stomach/small vowel, pt must be able to swallow barium. Test aids in diagnosing ulcers, esophageal varices, tumors, regional enteritis, extend into small intestine, swallowing function Nursing interventions: clear liquids day before, NPO after midnight, hold PO meds, adjust insulin doses, after procedure monitor for constipation and increase fluid intake to pass barium

As a nurse completes the admission assessment of a client admitted for gastric bypass surgery, the client states, "Finally! I'll be thin and able to eat without much concern." How should the nurse intervene?

Evaluate the client's understanding of the procedure.

Postoperatively, a client with a radical neck dissection should be placed in which position?

FOWLER

The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program?

It is the third most common cancer in the United States.

A nurse is providing care for a client recovering from gastric bypass surgery. During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. What will the nurse suspect?

Vasomotor symptoms associated with dumping syndrome

After a client received a diagnosis of gastric cancer, the surgical team decides that a Billroth II would be the best approach to treatment. How would the nurse explain this procedure to the family?

Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach

A nursing student is preparing a teaching plan about peptic ulcer disease. The student knows to include teaching about the percentage of clients with peptic ulcers who experience bleeding. The percentage is

15%

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to?

hypo kalemia

Crohn's disease

RLQ pain and diarrhea unrelieved by defecation Distal ileum and ascending colon Crampy abdominal pain and spasm Subacute and chronic inflammation of GI tract Crampy pain after meals Weight loss from malnutrition Chronic symptoms= diarrhea, abdominal pain, steatorrhea, anorexia, weight loss, nutritional deficiencies LATE SIGNS; electrolyte imbalance, dehydration, weight loss, anemia

When interviewing a client with internal hemorrhoids, what would the nurse expect the client to report?

Rectal bleeding

barium swallow

UPPER GI pts must be able to swallow barium shows esophagus, stomach, and small bowel X-ray done using barium as a contrasting agent diagnoses: ulcers, tumors, esophageal varices, enteritis, swallowing nursing interventions: clear liquid day before, NPO after midnight, hold PO meds, adjust insulin, monitor for constipation, increase fluid intake for barium

inflammatory bowel disease

the general name for diseases that cause inflammation in the intestines Crohn's and Ulcerative colitis auto immune response manifestations: weight loss, fatigue, fever, abdominal pain, diarrhea diagnostic testing: blood studies, stool exam, stool cultures management: bowel rest (IV, NPO, electrolytes), low residue diet, clear liquid, high protein, high calorie diet, avoid triggers, iron supplement

colonoscopy

Clear liquid diet day before, NPO after midnight except for prep, GoLytely for prep, bowels should be clear and straw colored. CONTRAINDICATED IN BOWEL PERFORATION AND IBD Pre-procedure: finish bowel prep, keep NPO after midnight, ensure pt understanding Post-procedure: assess for bowel perforation like rectal bleeding, onset abdominal pain, abdominal distention, fever, focal peritonitis sign, rebound tenderness, guarding, increased HR, decreased BP, mild gas and cramping is normal

barium enema

Lower Gi series, allow observation of filled colon, must tolerate bowel cleansing and hold barium inside rectum, identify polyps/tumor/lesions/fistulas, CONTRAINDICATED IN anyone with IBD/ppl with bowel perforation Nursing intervention: prep for procedure with low reside diet 1-2 days, clear liquids day before, laxative or GoLytely night before, NPO after midnight except for prep, may need cleansing enema the morning of test until stool is clear. PT NEEDS TO BE ABLE TO CHANGE POSITION Barium enema patient education: Inform about prep, will increase in bowel movements after procedure, will eliminate barium in stoool (white), increase fluid intake to prevent constipation,

Obesity

Obesity management: lifestyle modification is diet and exercise Anti obesity drugs exist but often recalled Dumping Syndrome: occurs after15-30 min of eating, weakness, dizziness, vertigo, diaphoresis, epigatsirc fullness, tachycardia, abdominal cramping Bariatric surgery: restrict ability to eat, covered for class 3 and 2 2ith medical condition like OSA/DM, typically result in 10-35% body weight in 2-3 years, Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding Post Bariatric Surgery: ensure dietary restriction, pain relief, fluid volume balance, infection prevention, adequate nutritional status, managing bowel habit, small frequent meals to prevent dumping syndrome, NEVER INSERT NG TUBE POST-OP TO PREVENT DAMAGE TO SUTURE LINE OR CAUSE HEMORRHAGE

CT/Computed tomography

help detect and localize conditions, not limited by gas/obesity like ultrasound, contrast may be used to enhance picture. Check for allergies to shellfish and iodine, check creatine level, check pregnancy status

endoscopic procedures

flexible scope used to visualize GI tract, camera attached, biopsy and cytology obtained, TYPES INCLUDE:ERCP (liver, gallbladder, bile, duct, pancreas), endoscopy, esophagus, stomach, duodenum, colonoscopy,

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

rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following?

mental confusion

The nurse working in the ED is evaluating a client for signs and symptoms of appendicitis. Which of the client's signs/symptoms should the nurse report to the physician?

nausea

intestinal obstruction

occurs mostly in small intestine manifests as: vomiting/acidosis/dehydration/spetic shock/distention/high pitched sounds above obstruction, no flatus/may pass blood/crampy wavelike colicky pain due to peristalsis interventions: nutrition, monitor hydration status, electrolyte replacement, I&O, maintain NG tube

Peritonitis: inflammation of peritoneum from bacterial infection, result from external source like surgery/trauma or dialysis, fluid in peritoneum is filled with protein/white cells/debris/blood

Manifestations: tender, distended muscle become rigid with rebound tenderness, increased pulse/low grade temp, nausea, vomiting, anorexia, peristalsis followed by ileus, hypotensive, surgery to remove infected material Nursing considerations: Complications: intestinal obstruction, sepsis cause death, shock from hypervolemia or septicemia Priority Interventions: vital signs every 4 hours, fluid/electrolyte replacement, daily weight, antibiotics, strict intake and output Interventions: assess abdomen (board like rigid abdomen, bowel sounds, masses, tenderness on palpation), nutritional support (NPO/TPN), Comfort with opioid/positioning/antiemetics, assess incision for infection/monitor wound post-op

The nursing student approaches his instructor to discuss the plan of care for his client diagnosed with peptic ulcer disease. The student asks what is the most common site for peptic ulcer formation? The instructor would state which one of the following?

duodenum

low residue diet

eat easily digestible foods restrict fiber (raw fruits, seeds, nuts, cereals, whole grain) reduces #/size of bowel movements,

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a:

fissure

peptic ulcer disease

Causes: NSAID use, H. pylori infection Associated with COPD, cirrhosis, chronic kidney disease Hollow out area that forms and erodes mucosa Manifestations: silent peptic ulcer in older adult with aspirin use, bleeding accompanied with sharp severe upper back to shoulder pain, dull/gnawing/burring pain in mid-epigastrium, vomiting, constipation, diarrhea, sour burps when stomach empty Complications: bright red or coffee ground emesis, large amount vomited, tachycardia, hypotension, tachypnea, hematocrit, dark tarry or frank blood Diagnoses/treatment: arteriography/embolization for bleed, endoscopy cauterizes or clips ulcer, treated with upper endoscopy Treatment: Medical: antibiotics, bismuth salts for H. pylori, proton pup inhibitor, avoid NSAID/aspirin, smoking cessation (decrease bicarb from pancreas into duodenum—increased acidity), diet change ( extreme temp in food/beverages, coffee, alcohol cause overstimulation of acid production Nursing Intervention: Painr elief but not NSAID, relaxed regularly timed meals, anxiety related to bleed/pain/procedures, therapeutic communication, ensure patient understanding of procedure Types of ulcers Duodenal: pan 2-3 hrs after eating that wakes pt up at night, relief from antacid Gastric: pain after eating, antacid does not help Esophageal: occur from backup of HCI from stomach into esophagus (GERD)

Intestinal Obstruction: 1)Mechanical, 2) Functional, partial or complete obstruction in mostly small intestine

Mechanical: foreign objects created by ingesting unusual substances, tumors, adhesion, structure, intussusception, stenosis Functional: diabetes/muscular dystrophy/Parkinson's disease, musculature cannot propel contents along bowel Manifestations: Crampy, colicky, wavelike pain May pass blood or mucus—no fecal ,atter and will not pass flatus Abdominal distention Vomiting: stomach contents- bile—fecal contents High pitched bowel sound ABOVE obstruction Absent sounds everywhere else Dehydration and acidosis lead to hypovolemic/septic shock Nursing Interventions: Insertion/maintain function of NG tube, measure output, mouth/nose care Assess NG placement to low intermittent wall suction Electrolyte replacement Nutritional support Monitor hydration status