AG 1 exam 4

Upper GI bleed presentation

-hematemesis -"coffee ground" emesis -melena

nonspecific GI bleed presentation

-hemodynamic instability -epigastric pain -fatigue/lethargy -syncope -anemia

GI bleed info

-most common cause of anemia in adults -rate increases with age and comorbidities

what foods can affect the guaiac test?

-red meat -cantaloupe -uncooked broccoli -turnips -radish -horseradish

Guaiac test

-tests for blood in stool -most common type of fecal occult blood test (FOBT) -positive for blood will turn blue -can be used for: screening of colon cancer, abdominal pain, changes in bowel movements, lost weight, anemia or blood in stool -test is perfrmed by collecting a sample three consecutive times

what medications can interfere with this test?

-vitamin C -aspirin -NSAIDS (ibuprofen, naproxen)

A client is recovering GI surgery and an ileostomy was placed. During discharge teaching, the nurse should stress the importance of: a. increasing fluid intake to prevent dehydration b. wearing an appliance pouch only at bedtime c. consuming a low-protein, high-fiber diet d. taking only enteric-coated medications

A. Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy

The nurse can expect a 60-year old patient with ischemic bowel to report a history of: a. asthma b. diabetes mellitus c. cancer of the bowel d. addison's disease

B. Ischemic bowel disease commonly occurs in patients with a background of cardiac or peripheral vascular disease, diabetes mellitus or hypertension due to lack of blood flow to the intestine.

what labs are needed to detect a GI bleed?

CBC - checking Hgb and Hct as well as coagulation for clotting times stool tests- if there is any blood

The client has a bleeding ulcer. Despite multiple blood transfusions, the HGB is 7.5g/dl and HCT is 27%. The physician determines that surgical intervention is necessary and the client undergoes a partial gastrectomy. Postoperative nursing care includes: a. giving pain medication Q6H b. flushign NG tube with sterile water c. positioning client in high fowler's position d. keeping the client NPO until the return of peristalsis

D. After surgery, the client remains NPO until peristaltic activity returns. This decreases the risk for abdominal distention and obstruction. Flushing the NG tube will cause the sutures in the stomach to open up. Pain medication should be prescribed every 4 hours. High-Fowler's is not necessary, a client with an NG tube should be positioned 30-45 degrees.

During initial assessment of a patient post-endoscopy, the nurse notes absent bowel sounds, tachycardia, and abdominal distention. The nurse would anticipate: a. ischemic bowel b. peritonitis c. hypovolemic shock d. perforated bowel

D. Invasive diagnostic testing can cause perforated bowel. Ischemic bowel is usually not related. Peritonitis can be a complication after initial perforation. Hypovolemic shock can occur if peritonitis is allowed to continue.

potential causes for upper GIB

H. pylori PUD Esophageal varices alcohol abuse malignancy Mallory-Weiss tear NSAIDS SSRIS anticoagulant antiplatelets

treatment UGIB

PPIs

Medications that can cause GIB

aspirin, NSAIDS, coumadin

A client has undergone a colon resection. While turning the client, wound dehiscence with evisceration occurs. The nurse's first response is to: a. call the physician b. place saline-soaked sterile dressing on the wound c. perform BP and pulse check d. pull the dehiscence closed

b. The nurse should first place saline-soaked sterile dressings on the open wound to prevent tissue drying and possible infection. Then the nurse should call the physician and take the client's vital signs. The dehiscence needs to be surgically closed, so the nurse should never try to close it. Note the difference between Dehiscence and Evisceration.

treatment for LGIB

colonoscopy

The nurse caring for a client with a small-bowel obstruction would plan to implement which nursing intervention first? a. administer pain med b. obtaining a blood sample c. preparing to insert an NG tube d. adminsiter IV fluids

d. adminsiter IV fluids I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance. For the client's comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to aid in the diagnosis of bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication often is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility.

potential causes for lower GIB

hemorrhoids angiodysplagia ischemic post biospy or polypectomy infectious process IBD ulcer diversticulosis polyp carcinoma

Diagnostics for GI bleed

upper endoscopy: can cauterize bleed colonoscopy: colon