Ch 44-48 Med Surg

A patient is in the outpatient recovery area after having colonoscopy and informs the nurse of abdominal cramping. What is the best response by the nurse?

"The cramping is caused by the air insufflated in the colon during the procedure."

The nurse is educating a patient about the discharge medication. When should the nurse instruct the patient to take the antacid medication?

1 to 3 hours after the meal.

The stomach, which derives its acidity from hydrochloric acid, has a pH of approximately_____.

1.0

The nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows what minimal daily intake of fluids is required?

1.5L

A patient has had a gastrostomy tube inserted. What does the nurse anticipate the initial fluid nourishment will be after the insertion of the gastrostomy tube?

10% glucose & tap water

The nurse is irrigating a colostomy. The catheters should be advanced into the stoma _______ to ______ inches.

2 to 3

The stomach pouch created by gastric bypass surgery can hold up to ______mL of food and fluids.

30

A nasally placed feeding tube is for short term use & should stay in place for no more than _____ weeks before being replaced with a new tube.

4

Peptic ulcers occur with the most frequency in those between the ages of ______ and _______.

40; 60

It takes _______ hours after eating for food to pass into the terminal ileum. It takes _______ hours for food to reach & distend the rectum.

4; 12

A patient tells the nurse that it feels like food is 'sticking' in the lower portion of the esophagus. What motility disorder does the nurse suspect these symptoms indicate?

Achalasia

The nurse is performing an assessment for a patient who presents to the clinic with a lip lesion. The lesion is erythemic, is fissuring, & has white hyperkeratosis. What does the nurse suspect that these findings are characteristic of?

Actinic cheilitis

The nurse is caring for a patient who has dumping syndrome from high carbohydrate foods being administered over a period of less than 20 minutes. What is a nursing measure to prevent or minimize the dumping syndrome?

Administer the feeding with the patient in semi-fowler's position to decrease transit time influenced by gravity.

The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion?

Allow the patient to sip water as the tube is being inserted.

Facilitates the production of dextrin & maltose

Amylase

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

Approx. 80-120 ml

Intrinsic factor is a gastric secretion necessary for the intestinal absorption of vitamin _____, which prevents pernicious anemia.

B12

How does bariatric surgery work?

Bariatric surgery works by restricting a patient's ability to eat and by restricting ingested nutrient absorption.

Secreted by the gallbladder, responsible for fat emulsion.

Bile

Intestinal rumbling

Borborygmus

During a colonoscopy with moderate sedation, the patients groans with obvious discomfort & begins bleeding from the rectum. The patient is diaphoretic & has an increase in abdominal girth from distension. What complication of the procedure is the nurse aware may be occurring?

Bowel perforation

Polysaccharides and cellulose mix with intestinal contents

Bulk forming- Mineral oil

A food to avoid for a patient with an ileostomy

Celery

Reddened circumscribed lesion that ulcerates & becomes encrusted

Chancre

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 patient has a BMI range greater than 40kg/m2. What would this patients obesity classification be?

Class III

A patient is suspected to have diverticulosis without symptoms of diverticulosis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling?

Colonoscopy

Another food to avoid for a patient with an ileostomy

Corn

Another name for regional enteritis

Crohn's disease

A patient sustained second- and third- degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcers should the nurse be alert for while caring for this patient?

Curling's ulcer

What is the difference between Cushing and Culring's ulcer in terms of cause and location?

Cushing's ulcers, which are common in patients with brain trauma, usually occur in the esophagus, stomach, or duodenum. Curling's ulcers occur most frequently after extensive burns and usually involve the antrum of the stomach and duodenum.

A patient is complaining if diarrhea after having bariatric surgery. What non-pharmacologic treatment can the nurse suggest to decrease the incidence of diarrhea?

Decrease the fat content in the diet.

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 most common bacteria associated with peritonitis

E. coli

Another term for fecal matter

Effluent

The nurse is investigating a patient's complaint of pain in the duodenal area. Where should the nurse perform the assessment?

Epigastric area & consider possible radiation of pain to the right subscapular region.

List the common bacteria found in a patient who has developed peritonitis.

Escherichia coli, Klebsiella, Proteus, and Pseudomonas

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)

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.

A patient describes a burning sensation in the esophagus, pain when swallowing, & frequent indigestion. What does the nurse suspect that these clinical manifestations indicate?

GERD

What is the visual difference between the color of gastric aspirate & the color of intestinal aspirate?

Gastric aspirate is most frequently cloudy & green, tan, off white, or brown & may be large volume. Intestinal aspirate is primarily clear & yellow to bile colored & typically smaller volume.

Double-lumen, plastic nasogastric tube about 20cm in length

Gastric-Sump tube

Painful, inflamed, swollen gums

Gingivitis

Famotadine (Pepcid)

Histamine-2 receptor antagonist

Helps form galactose

Lactase

The most popular over-the-counter medication purchased in the United States

Laxatives

Surfactant action hydrates stools.

Lubricant- Milk of Magnesia

Glucose is a product of this enzymes action

Maltase

Triple-lumen nasogastric tube that also has a duodenal lumen for postoperative feedings

Moss tube

A frequently prescribed proton pump inhibitor of gastric acid is _______.

Nexium

A patient has been taking a 10 day course of antibiotics for pneumonia. The patient has been having white patches that look like milk curds in the mouth. What treatment will the nurse educate the patient about?

Nystatin (Mycostatin)

Describe what results from obstruction of the GI tract

Obstruction from the GI tract increases the force of intestinal contraction. Distension occurs above the point of obstruction, causing pain & a sense of bloating.

The most common complication of colon cancer

Peritonitis

Misoprostol (Cytotec)

Prostaglandin

A patient has a Class II classification of obesity. What level of health risk does this pose for the patient?

Severe risk.

Helps convert protein into amino acids

Trypsin

Straining at stool

Valsalva maneuver

A common lesion of the mouth that is also referred to as a 'canker sore' is _____.

aphthous stomatitis

A patient is admitted to the hospital after not having a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem?

bowel perforation

The stomach's 4 anatomic regions

cardia, fundus, body, pylorus

The most common bacteria found in antibiotic-associated diarrhea is _______.

clostridium difficile

Describe the physiological response that occurs when a patient has a Valsalva maneuver while straining during defecation.

forcible exhalation against a closed glottis followed by a rise in intrathoracic pressure and subsequent possible dramatic rise in arterial pressure.

Chyme, partially digested food that is mixed with gastic contents, stimulates segmented contractions, which are ___________ & intestinal peristalsis, which is ____________.

mixed waves that move the intestinal contents back & forth in a churning motion; a movement that propels the contents of the small intestine toward the colon

Digestion normally begins in the _____.

mouth

The most common site for cancer of the oral cavity is the _____.

mouth

The digestion of starches begins in the mouth with the secretion of this enzyme

ptyalin

Nasogastric feeding tubes are used for patients who have the ability to _____ & _____ nutrition, fluids, & medications adequately by the gastric route.

receive, process

A hormonal regulatory substance that inhibits stomach contraction & gastric secretions

secretin

The most common site for the presence of diverticulitis is the ________.

sigmoid

The incidence of most dental caries is directly related to an increase in the dietary intake of _____.

sugar

Malabsorption diseases may affect the ability of the digestive system to absorb the major water-soluble ________.

vitamin B12

What does the term "stress ulcer" mean?

A stress ulcer refers to acute mucosal ulceration of the duodenal or gastric area that occurs after a stressful event.

Name at least four factors that may be associated with the development of irritate bowel syndrome.

Although no anatomic or biochemical abnormalities have been found that account for its common symptoms, various factors are associated with the syndrome: heredity, psychological stress or conditions such as depression and anxiety, a diet high in fat and stimulating or irritating foods, alcohol consumption, and smoking.

Clarithromycin (Biaxin)

Antibiotics

A patient arrives in the emergency department with complaints of right lower abdominal pain that began 4 hours ago and is getting worse. The nurse assesses rebound tenderness at McBurney's point. What does this assessment data indicate to the nurse?

Appendicitis

A nurse inspects the Stensen duct of the parotid gland to determine inflammation & possible obstruction. What area in the oral cavity would the nurse examine?

Buccal mucosa next to the upper molars

Shallow ulcer with a red border & white or yellow center

Canker sore

Reddened area or rash associated with itching

Contact dermatitis

What is the Sengstaken-Blakemore tube used for?

Control of bleeding esophageal varices

A patient is complaining of abdominal pain associated with digestion. What is characteristic of this type of pain?

Described as crampy or burning

The most common site for peptic ulcer formation is the _________.

Duodenum

Hyperkeratotic white patches usually in buccal mucosa

Leukoplakia

Nasoenteric feeding tube about 6 ft. in length

Levin tube

Ulcerative & painful, white papules

Lichen plantus

_____ percent of adults 45-64 years of age have severe periodontal disease.

15

A flexible sigmoidoscope permits how much of the lower bowel to be viewed?

16-20 inches

Digests protein & helps form polypeptides

Pepsin

Pantoprazole (Protonix)

Proton pump inhibitors

Digests carbohydrates & helps form fructose

Sucrase

Intravenous nutrition used for inflammatory bowel disease

TPN

A patient taking metronidazole (Flagyl) for the treatment of H. pylori states that the medication is causing nausea. What suggestion can the nurse provide to the patient to alleviate this problem?

Take the medication with meals to decrease the nausea.

The nurse is collecting a stool specimen from a patient. What characteristic of the stool indicates to the nurse that the patient may have an upper GI bleed?

Tarry & black

Name the hallmark signs of malabsorption syndrome.

The hallmarks of malabsorption syndrome from any cause are diarrhea or frequent, loose, bulky, foul-smelling stools that have increased fat content and are often grayish (steatorrhea).

3 pancreatic secretions that contain digestive enzymes

Trypsin, Amylase, Lipase

The majority of large bowel obstructions are caused by ___________.

adenocarcinoid tumors

Reflux of food into the esophagus from the stomach is prevented by contraction of the _____________.

cardiac sphincter

The major carbohydrate that tissues use for fuel

glucose

When giving an initial tube feeding, the nurse would be looking for _____ around the tube site on the abdomen.

leakage of fluid

The nurse is assessing a patient with appendicitis. The nurse is attempting to elicit a Rovsing's sign. Where should the nurse palpate for this indicator of acute appendicitis?

left lower quad

Prokinetic agents can be administered to facilitate _____ movement of the feeding tube into the duodenum.

peristaltic

Feeding patients through tubes placed beyond the _____ or using _____ agents can decrease the frequency of feeding regurgitation & aspiration.

pylorus, prokinetic

A dressing over the tube outlet & the gastrostomy tube protects the skin around the incision from _____ & _____.

seepage of gastric acid, spillage of feeding

The recommended dietary intake of fiber is _____ grams per day. This intake, along with 1.5 to 2 L of fluids daily, should prevent constipation that occurs with fewer than _____ bowel movements per week.

25 to 30 g/day; three

Preventative orthodontics for malocclusion can start as early as age _____.

5

A chemotherapeutic agent used to treat colon cancer

5-FU

The nurse inserts a nasogastric tube into the right nares of a patient. When testing the tube aspirate for pH to confirm placement, what does the nurse anticipate the pH will be if placement is in the lungs?

6

The average adult weight loss after bariatric surgery is about ______% of previous body weight.

60

If detected early, prior to lymph node involvement, the 5 year survival rate for oral cancer is about _____ percent.

60%

A patient is schedule 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.

White overgrowth of horny layer of epidermis

Actinic cheilitis

Bismuth subsalicylate (Pepto Bismol)

Antidiarrheal

A patient is brought to the ER by a family member, who states that the patient 'drank drain cleaner'. What intervention does the nurse anticipate providing to treat this patient? Select all that apply.

Aspirating secretions from the pharynx if respirations are affected, Neutralizing the chemical, & washing the esophagus with large volumes of water.

A patient is being prepared for esophageal manometry. The nurse should inform the patient to withhold what medication for 48 hours prior to the procedure?

Aspirin

The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's note?

Borborygmus

What role do the sympathetic & parasympathetic portions of the ANS play in GI function?

Both portions innervate the GI tract. Sympathetic nerves exert an inhibitory effect on the GI tract, decreasing gastric secretion & motility & causing the sphincters & blood vessels to constrict. Parasympathetic nerve stimulation causes peristalsis & increases secretory activities. The sphincters relax under the influence of parasympathetic stimulation, except for the sphincter of the upper esophagus & the external anal sphincter, which are under voluntary control.

A patient comes to the clinic with the complaint, "I think I have an ulcer." What is a characteristic 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.

A highly reliable blood study used to diagnose appendicitis

CEA

A patient is scheduled for a fiberoptic colonoscopy. What does the nurse know that fiberoptic colonoscopy is most frequently used to diagnose?

Cancer screening

Why must extra caution be taken when inserting a feeding tube with a stylet?

Caution is required when inserting feeding tubes with a stylet because there is a risk of tissue puncture or placement error.

A patient is having a diagnostic workup for complaints of frequent diarrhea, right lower abdominal pain, and weight loss. The nurse is reviewing the results of the barium study and notes the presence of "string sign." What does the nurse understand that this is significant of?

Crohn's disease

Describe the priority intervention that should be used to treat the ingestion of a corrosive acid or alkali.

Dilute and neutralize the offending agent. To neutralize a corrosive acid, use common antacids such as milk and aluminum hydroxide. To neutralize an alkali, use diluted lemon juice or diluted vinegar.

The physician ordered a nasoenteric feeding tube with a tungsten-weighted tip. The nurse knows to obtain what kind of tube?

Dobbhoff

Single-lumen, plastic, or rubber nasogastric tube about 4 ft in length

Dobbhoff or EnteraFlo tube

The nurse is educating a patient with peptic ulcer disease about the disease process. What decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum?

Drinking carbonated beverages.

A patient who had a Roux-en-Y bypass procedure for morbid obesity ate a chocolate chip cookie after a meal. After ingestion of the cookie, the patient complained of cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the patient be educated about regarding this event?

Dumping syndrome

The nurse is performing an assessment of a patient. During the assessment the patient informs the nurse of some recent "stomach trouble". What does the nurse know is the most common symptom of patients with DI dysfunction?

Dyspepsia

The nurse is caring for a patient who has malabsorption syndrome with an undetermined cause. What procedure will the nurse assist with that is the best diagnostic test for the illness?

Endoscopy with mucosal biopsy

Colon is irritated and sensory nerve endings stimulated

Fecal softener- Metamucil

A tubular fibrous tract that extends from an opening beside the anus into the anal canal

Fistula

The nurse assesses a patient who recently had a nasoenteric intubation. Symptoms of oliguria, lethargy, & tachycardia in the patient would indicate to the nurse what common complication?

Fluid volume deficit

The nurse is caring for a comatose patient & administering gastrostomy feedings. What does the nurse understand is the reason that gastrostomy feedings are preferred to nasogastric feedings in the comatose patient?

Gastroesophageal sphincter is intact, lessening the possibility of regurgitation

A patient is experiencing painful, inflamed, & swollen gums, & when brushing the teeth, the gums bleed. What common disease or the oral tissue does the nurse understand these symptoms indicate?

Gingivitis

A patient who is HIV positive comes to the clinic & is experiencing white patches with rough hairlike projections. The nurse observes the lesions on the lateral border of the tongue. What abnormality of the mouth does the nurse determine these lesions are?

Hairy leukoplakia

White patches with rough, hairlike projections usually found on the tongue

Hairy leukoplakia

______ is the bacillus commonly associated with the formation of gastric, and possibly duodenal, ulcers.

Helicobacter Pylori

The most common complication of peptic ulcer disease that occurs in 10% to 20% of patients is _______.

Hemorrhage

What potential postoperative complications may be involved with the patient who has had a radical neck dissection?

Hemorrhage, chyle fistula, nerve injury

_______, _________, __________, and _______ are some of the major potential complications of a peptic ulcer.

Hemorrhage, perforation, penetration, pyloric obstruction

The nurse is caring for a patient who has had an appendectomy. What is the best position for the nurse to maintain the patient in after the surgery?

High Fowler's

Name 2 conditions that are specifically related to peptic ulcer development.

Hyper secretion of acid pepsin and a weakened gastric mucosal barrier predispose to peptic ulcer development.

List several findings characteristic of Zollinger-Ellison syndrome.

Hyper secretion of gastric juice, multiple duodenal ulcers, hypertrophied duodenal glands, and gastricnomas (islet cell tumors) in the pancreas.

The nurse auscultates the abdomen to assess bowel sounds. She documents 5-6 sounds heard in less than 30 seconds. How does the nurse document the bowel sounds?

Hyperactive

A nurse prepares a patient for insertion of a nasoenteric tube. What position should the nurse place the patient in?

In high fowler's position

What intervention can be provided to relieve the discomfort of a patient with a tooth abscess in the early stage?

In the early stages of an infection, a dentist or oral surgeon may perform a needle aspiration or drill an opening into the pulp chamber to relieve pressure & pain, & to provide drainage.

The nurse is performing an abdominal assessment for a patient in the hospital with complaints of abdominal pain. What part of the assessment should the nurse perform first?

Inspection

What will occur if there is a lack of intrinsic factor secreted by the gastric mucosa?

Intrinsic factor, also secreted by the gastric mucosa, combines with dietary vitamin B12 so that the vitamin can be absorbed in the ileum. In the absence of

A patient has been diagnosed with acute gastritis and asks the nurse what could have cause it. What is the best response by the nurse? (select all that apply)

It can be caused by ingestion of strong acids; you may have ingested some irritating foods; is it possible that you are overusing aspirin.

A patient with irritable bowel syndrome has been having more frequent symptoms lately and is not sure what lifestyle changes may have occurred. What suggestion can the nurse provide to identify a trigger for the symptoms?

Keep a 1- to 2- week symptom and food diary to identify food triggers.

The nurse is managing a gastric (Salem) sump tube for a patient who has an intestinal obstruction & will be going to surgery. What interventions should the nurse perform to make sure the tube is functioning properly?

Keep the vent lumen above the patient's waist to prevent gastric content reflux

The nurse is caring for an older patient experiencing fecal incontinence. When planning the care of this patient, what should the nurse designate as a priority goal?

Maintaining skin integrity

What measures can the nurse encourage patients to take to prevent & control dental caries?

Measures used to prevent & control dental caries include practicing effective mouth care, reducing the intake of starches & sugars (refined carbohydrates), applying fluoride to the teeth or drinking fluoridated water, refraining from smoking, controlling diabetes, & using pit & fissure sealants. Regular dental visits are an important method of preventative dental maintenance.

Dilated and anionic colon caused by a fecal mass

Megacolon

_____ or _____ feeding is indicated when the esophagus & stomach need to be bypassed or when the patient is at risk for aspiration.

Nasoduodenal, nasojejunal

The nurse is performing an initial assessment of a patient complaining of increased stomach acid r/t stress. The nurse knows that the physician will want to consider that influence of what neuroregulator?

Norepinephrine

The nurse is admitting a patient with a diagnosis of diverticulitis and assess that the patient has a birdlike abdomen, no bowel sounds, and complains of severe abdominal pain. What is the nurse's first action?

Notify the physician

Hydrocarbons soften fecal matter

Osmotic agent- Dulcolax

A patient complains about an inflamed salivary gland below his right ear. The nurse documents probable inflammation of which gland?

Parotid

Explain why patients who have gastritis due to vitamin deficiency usually have malabsorption of vitamin B12.

Patients with gastritis due to vitamin deficiency exhibit antibodies against intrinsic factor, which interferes with vitamin B12 absorption.

The nurse is assisting the physician with a gastric acid stimulation test for a patient. What medication should the nurse prepare to administer subcutaneously to stimulate gastric secretions?

Pentagastrin

A patient is in the hospital for the treatment of peptic ulcer disease. The nurse finds the patient vomiting and complaining of a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate?

Perforation of the peptic ulcer

The nurse is caring for a patient who has a gastrostomy tube feeding. Upon initiating her care, the nurse aspirates the gastrostomy tube for gastric residual volume & obtains 200 mL of gastric contents. What is the priority action by the nurse?

Place the patient in a fowler's position with the head of the bed at 45 degrees.

The nurse is caring for a patient who is suspected to have developed a peptic ulcer hemorrhage. What action would the nurse perform first?

Place the patient in a recumbent position with the legs elevated.

Name three common causes of constipation for a patient who is receiving enteral feedings.

Possible causes for constipation include: concomitant use of opiods; administration of fiber free tube feeding formulas; & inadequate water intake (tube feedings typically do not meet total fluid needs, so additional water must be administered).

When the patient is to perform a Hemoccult II test, what should the nurse inform the patient to avoid in order to prevent a false positive result?

Red meats, aspirin, NSAIDs, turnips, & horseradish should be avoided 72 hours prior to the study because they may cause a false positive result. Ingestion of vitamin C from supplements or foods can cause a false negative.

Electrolytes induce diarrhea

Saline agent- Colyte

Triple-lumen, rubber nasogastric tube (2 lumens are used to inflate the gastric & esophageal balloons)

Sengstaken-Blakemore tube

What is the difference between sialadenitis & sialolithiasis?

Sialadentitis is an inflammation of the salivary gland; Sialolithiasis are calcui in the submandibular gland.

The nurse is caring for a patient after drainage of a dentoalveolar or periapical abscess. What should the care of the patient include in the postoperative phase? Select all that apply.

Soft diet after 24 hours, External heat by pad or compress to hasten the resolution of the inflammatory swelling, & warm saline mouthwashes every 2 hours while awake.

An older adult patient who has been living at home alone is diagnosed with parotitis. What causative bacteria does the nurse suspect is the cause of the parotitis?

Staphylococcus aureus

Magnesium ions alter stool consistency

Stimulant- Colace

An ileal outlet on the abdomen

Stoma

The nurse has been directed to position a patient for an examination of the abdomen. What position should the nurse place the patient in for the exam?

Supine position with the knees flexed to relax the abdominal muscles

A patient has been diagnosed with Zenker's diverticulum. What treatment does the nurse anticipate educating the patient about?

Surgical removal of the diverticulum

A patient comes to the clinic complaining of a sore throat. When assessing the patient, the nurse observes a reddened ulcerated lesion on the lip. The patient tells the nurse that it has been there for a couple of weeks but it does not hurt. What should the nurse consult with the physician about testing for?

Syphilis

Painful straining at stool

Tenesmus

The nurse is inserting a Levin tube for a patient for gastric decompression. The tube should be inserted to 6-10 cm beyond what length?

The distance measured from the tip of the nose to the earlobe & from the earlobe to the xiphoid process

The nurse is inserting a nasogastric tube & the patient begins coughing & is unable to speak. What does the nurse suspect has occurred?

The nurse has inadvertently inserted the tube into the trachea.

Explain the theory about diet modification for peptic ulcer disease.

The objective of the ulcer diet is to avoid over secretion and hyper motility in the gastrointestinal tract. Extremes of temperature should be avoided, as well as overstimulation by meat extractives, coffee (including decaf), alcohol, and diets rich in milk and cream. Current therapy recommends 3 regular meals per day if an antacid or histamine blocker is taken.

The nurse is providing instructions to a patient scheduled for a gastroscopy. What should the nurse be sure to include in the instructions? Select all that apply.

The patient must fast for 8 hours before the examination. The throat will be sprayed with a local anesthetic. After gastroscopy, the patient cannot eat or drink until the gag reflex returns (1-2 hours).

Describe the purpose of gastric intubation.

The purpose of gastric intubation is to decompress the stomach & remove gas & fluid; lavage (flush with water & other fluids) the stomach & remove ingested toxins or other harmful materials; diagnose GI disorders; administer tube feedings, medications, & fluids; compress a bleeding site; & aspirate GI contents for aspirate.

The nurse is inserting a sump tube in a patient with Crohn's disease who is suspected of having a bowel obstruction. What does the nurse understand is the benefit of the gastric (Salem) sump tube in comparison to some of the other tubes?

The tube is radiopaque

A patient is being seen in the clinic for complaints of painful hemorrhoids. The nurse assess the patient and observes the hemorrhoids are prolapsed but able to be placed back in the rectum manually. The nurse documents the hemorrhoids as what degree?

Third degree

The nurse is assisting the physician with a colonoscopy for a patient with rectal bleeding. The physician requests the nurse to administer glucagon during the procedure. Why is the nurse administering the medication during the procedure?

To relax colonic musculature & reduce spasm

How does tooth decay begin?

Tooth decay is an erosive process that begins with the action of bacteria on fermentable carbohydrates in the mouth, which produces acids that dissolve tooth enamel.

The nurse is inserting a nasoenteric tube for a patient with a paralytic ileus. How long does the nurse anticipate the tube will be required? Select all that apply.

Until bowel sound is present Until flatus is passed Until peristalsis is resumed

Describe the clinical manifestations associated with a peptic ulcer perforation.

When peptic ulcer perforation occurs, the patient experiences severe upper abdominal pain, vomiting, fainting, and an extremely tender abdomen that can be board-like in rigidity; signs of shock will be present (hypotension and tachycardia).

When is a MRI contraindicated?

When the patient has any of the following: permanent pacemakers, artificial heart valves, & implanted insulin pumps.

The nurse checks residual content before each intermittent tube feeding. When should the patient be reassessed?

When the residual is greater than 200 mL

The nurse is assigned to care for a patient 2 days after an appendectomy due to a ruptured appendix with resultant peritonitis. The nurse has just assisted the patient with ambulation to the bedside commode when the patient points to the surgical site and informs the nurse "something gave way." What does the nurse suspect may have occurred?

Wound dehiscence has occurred.

A disorder of malabsorption that inactivates pancreatic enzymes is ___________.

Zollinger-Ellison syndrome

Common clinical manifestations of Crohn's disease are ______ and ________.

abdominal pain & diarrhea

The three most common causes of small bowel obstruction are _______, ________, and _______.

adhesions, hernias, neoplasms

What medications may be prescribed for the patient with constipation that will enhance colonic transit by increasing propulsive motor activity?

cholinergic agents (bethanechol [urecholine]), cholinesterase inhibitors (neostigmine [prostigmin]), or prokinetic agents (metoclopramide [reglan]). Prokinetic agents including serotonin (5-HT4) receptor agonists like prucalopride (reseller) and protons like lubiprostone (amities) stimulate chloride channels in the gut. Medical probiotics (ingested live organisms) may help some constipated individuals by creating improved bacterial balance.

Structural changes in the esophagus that occur as the result of aging

decreased motility & emptying, weakened gag reflex, decreased resting pressure of the lower sphincter

List six risk factors for colorectal cancer that the nurse can educate the public about.

increasing age; family history of colon cancer (Lynch syndrome) or polyps (familial adenomatous polyposis (FAP); previous colon cancer or adenomatous polyps; high consumption of alcohol; cigarette smoking; obesity; history of gastrectomy; history of IBD; high- fat, high- protein (with high intake of beef), low fiber diet; genital cancer (endometrial cancer, ovarian cancer) or breast cancer (in women).

The 2 diseases of the colon that are commonly associated with constipation are ______, & ________.

irritable bowel syndrome and diverticular disease

A patient is not having daily bowel movements and has begun taking a laxative for this problem. What should the nurse educate the patient about regarding laxative use?

laxatives should not be routinely taken due to destruction of nerve endings in the colon

Mumps, a viral infection affecting children, is usually an inflammation of the _____ gland.

parotid

Name four complications associated with diverticulitis.

peritonitis, abscess formation, fistulas, and bleeding