COTAC Exam 5 review
Which statement indicates that a client with esophageal reflux disorder understands the dietary teaching?
"I won't drink any carbonated drinks."
The nurse is preparing to discontinue a client's nasogastric tube. The client ispositioned properly, and the tube has been flushed with 15 mL of air to clearsecretions. Before removing the tube, the nurse should make which statement tothe client?
"Take a deep breath when I tell you and hold it while I remove the tube."
The client was recently diagnosed with a hiatal hernia. The healthcare provider orders an antacid that has reduced adverse effects. What should the nurse include in the client's teaching about the side effects of antacids?
"The major side effect of an antacid is diarrhea."
If someone has a gastrectomy, they will need to take additional vitamins including:
(especially B12) but also calcium, iron, folic acid
What are contraindications of Zenker Diverticulum?
(increased risk of perforation)• EGD• Blind insertion of NG tube
What is post necrotic cirrhosis?
- Broad bands of scar tissue - Late result of a previous bout of acute viral hepatitis (B or C)
What are the risk factors of hepatic cirrhosis?
- Chronic viral hepatitis (B or C) - NASH (non-alcoholic steatohepatitis) - Exposure to toxins
What education should be given for an open cholecystectomy?
- Gradually increase mobility, no lifting for 4-6 weeks - Check for bowel sounds, then start with clear fluids, if tolerated then progress to solid food - Monitor for wound infections, wound dehiscence - Avoid baths with any tubes left in place, showers are better - Monitor stool color for return of normal appearance - Monitor for any jaundice
What are the causes of ascites?
- Portal HTN - Hypoalbuminemia
What is biliary cirrhosis?
- Scarring occurs in the liver around the bile ducts - Results from chronic biliary obstruction and infection (i.e., cholangitis) - Much less common
What are the clinical findings of a biliary colic?
- Subjective: right upper quadrant pain, nausea, vomiting, radiation to right shoulder - When the stone falls back into the gallbladder, the symptoms resolve
What symptoms or signs should thenurse expect with a perforated peptic ulcer?
-Abdominal rigidity -Tachycardia -Rebound tenderness
The nurse is preparing to administer medication using a client recently inserted nasogastric tube. What actions should the nurse take before administering the medication?
-Check the residual volume -aspirate the stomach contents -Turn off the suction to the NG tube -Test the stomach contents for a pH indicating acidity
How do you manage cancer of the larynx?
-Chemotherapy -Radiation -Surgery
How would you diagnose cancer of the larynx?
-Endoscopy -Fine-need aspiration biopsy -CT or MRI -PET scan
The nurse is caring for a client diagnosed with aphthous ulcers (canker sores). Which food will the nurse recommend that the client avoid?
-Pasta -Baked potato -Nuts -Cheese
The nurse is teaching a client how to maintain effective oralhealth. Which measure does the nurse include in theteaching plan?
-Regular dental checkups -Eating a balanced diet. -Managing stress as much as possible.
What are early signs of dumping syndrome?
-Sweating -Tachycardia -Flushing -Dizziness -Abdominal pain -Diarrhea -Nausea
What are late signs of dumping syndrome?
-Sweating -Tachycardia -Somnolence -Unconsciousness -Tremors -Irritability
What are esophageal cancer warning signs?
-Unexpected weight loss -Difficulty swallowing -Heart burn -Regurgitation of undigested food -Hoarse voice -Vomiting blood -Persistent cough -Pain between the shoulder blades
Liver damage can cause up to __ liters or more of albumin-rich fluid to accumulate in the peritoneal cavity.
20
What is the usual wearing time of an ostomy appliance before leakage occurs and needs to be changed?
5-10 days
A client with a surgical repair of a perforated esophagus will require enteral or parenteral nutritional supplementation for at least ___ days post-operatively.
7
What is the difference between acute and chronic pancreatitis?
A C U T E • 80% of cases result from cholelithiasis or sustained ETOH abuse • Ranges from mild to severe (necrotizing) • Mortality rate increases with age • Hemorrhagic pancreatitis is usually a late sign - Hemorrhage results in necrotizing pancreatitis C H R O N I C • Usually caused by recurrent episodes of acute pancreatitis • Often results in diabetes mellitus and malabsorption of nutrients from the GI tract
What is hepatic encephalopathy?
A condition resulting from excessive ammonia in blood due to an inability to convert to urea
What is Celiac Disease?
A disorder of malabsorption caused by an autoimmune response to consumption of products that contain the protein gluten. Gluten sensitivity is a small intestine disease resulting in loss of normal villi function. Lack of normal villi results in malabsorption symptoms
Diverticular disease increases with age and is associated with:
A low fiber diet.
What is Pilonidal sinus or cyst?
A sinus or cyst found in the intergluteal cleft on the posterior surface of the lower sacrum.
Peptic Ulcer Disease can result in:
Abdominal pain, bleeding (melena, hematemesis), or worst-case scenario a perforation (causing peritonitis)
Acute vs Chronic Gastritis?
Acute: Usually caused by something irritating the stomach lining resulting in inflammation of the stomach, short duration, resolves with removing the irritant. (Alcohol, Coffee, NSAID's......etc) Chronic: Usually caused by an autoimmune disease called atrophic gastritis resulting in pernicious anemia due to lack of intrinsic factor production (the reason many elderly client's need Vit. B12 injections)
What are IBS Manifestations?
Alteration in bowel patterns (Diarrhea or constipation) Intermittent cramping abdominal pain Abdominal bloating/distention
What is Appendicitis?
An inflammatory and infectious condition of the appendix in the right lower quadrant of the abdomen. Caused by an obstruction of appendix opening, resulting in a swollen, inflamed and infected appendix Most common around the age of puberty or early adulthood but can occur at any age. Most frequent cause of acute abdomen in the United States, most common reason for emergency abdominal surgery
Pharmacological management of Ulcerative Colitis:
Anti inflammatory meds -Oral Sulfasalazine Corticosteroids Immunosuppressants: Cyclosporine, Methotrexate, Azathioprine Biologics immunomodulators: Infliximab Loperamide, diphenoxylate/atropine
A client with an esophageal diverticulum is at risk for:
Aspiration
How are biliary colic's treated?
At the hospital, biliary colic is treated with NSAID's, opioids, and ondansetron until the symptoms resolve.
A client undergoes a barium swallow fluoroscopy that confirms gastroesophageal reflux disease (GERD). Based on this diagnosis, the client should be instructed to take which action?
Avoid caffeine and carbonated beverages. Stop smoking. Take antacids one hour and three hours after meals.
A nurse is caring for a client with a hiatal hernia who states that abdominal and sternal pain occurs after eating and when lying down. Which instructions would the nurse recommend when teaching this client?
Avoid constrictive clothing around the abdomen. Decrease intake of caffeine and spicy foods. Sleep in semi-Fowler's position. Maintain a normal body weight.
A client is receiving an aluminum-based antacid for acute gastritis. Which information topic should the nurse include?
Avoid medication for 1 hour before
How is Zenker Diverticulum diagnosed?
Barium swallow
What are complications of Gastritis?
Bleeding: can be a slow trickle of bleeding, causing anemia and occult positive stools, or heavy bleeding resulting in melena or hematemesis. Gastric outlet obstruction: same as in PUD Pernicious anemia: usually with chronic gastritis and loss of parietal cells, we have around 6 months of vitamin B12 stored in the liver. Remember** Megaloblastic anemia PLUS the neurological changes of B12 deficiency. Dumping syndrome: Same as in a gastrectomy.
What is Grey Turner's Sign?
Blue discoloration on the flanks. A sign of retroperitoneal hemorrhage, or bleeding behind the peritoneum, which is a lining of the abdominal cavity
What are complications of Diverticulitis?
Bowel obstruction from severe inflammation, will usually need surgical repair to remove diseased area Perforation of diverticulitis can result in peritonitis, and abscess formation from the pus leaking out of the diverticula into the peritoneal cavity Gastrointestinal bleeding presenting as rectal bleeding
What are complications of parenteral nutrition?
CVAD complications • Air embolism • Clotted or displaced catheter •Sepsis •Changes in blood glucose •Fluid overload •Liver failure
Celiac management
Celiac disease is chronic, non-curable, lifelong. No medications to treat. Refrain from exposure to gluten in foods Consult with dietician. Can be completely controlled with removal of gluten in diet.
What is hepatic cirrhosis?
Chronic disease characterized by replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver.
What is IBS?
Chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may include diarrhea, constipation, or both
Abdominal pain, enlarged liver, intermittent mild fever and ankle edema are all signs of compensated:
Cirrhosis of the liver.
Both ulcerative colitis and Crohn disease put the client at risk for developing:
Colon cancer
What is GERD?
Common disorder characterized by backflow of Gastric or duodenal contents into the esophagus. This causes symptoms or mucosal damage to the esophagus.
Nursing interventions for IBS:
Complimentary medicine Dietary changes Food diary Adequate fluid intake Avoid alcohol and smoking Relaxation techniques
An Anal Fistula is a complication of:
Crohn Disease
What is patchy inflammation throughout the small and large bowel?
Crohns disease
How do you diagnose a liver abscess?
D I A G N O S T I C S • Liver biopsy plus culture/sensitivity • Blood cultures: • Ultrasound, CT, MRI, and liver scans to identify abscess • Objective - Fever - Vomiting - Weight loss - Hepatomegaly - Jaundice may occur - Pleural effusion may occur - Septic shock may occur
What is the purpose of GI Intubation?
Decompress the stomach. Lavage the stomach Diagnose GI disorders. Administer medications and feeding. Compress/cauterize a bleeding site. Aspirate gastric contents for analysis
Serum transaminase levels such as AST _______ as liver cells heal and regenerate.
Decrease
What is the management for hepatic cirrhosis?
Decrease gastric distress and possibility of GI bleeding • Promote healing of damaged liver cells and improve nutritional status • Decrease ascites and fluid retention • Decrease fibrotic activity • To treat jaundice and other symptoms • Promote rest to permit the liver to reestablish its functional ability • Provide skin care • Reduce risk of injury
The nurse checks the gastric residual of an unconscious client receiving nasogastrictube feedings continuously at 50 mL/hr. The nurse notes that the residual is 250 mLat 0800 and 300 mL at 0900. The nurse determines that the client is experiencingwhich complication?
Delayed gastric emptying
While undergoing radiation treatment for oral cancer, a client develops xerostomia. What collaborative resource does the nurse suggest for this client's care?
Dentist
Manifestations of Celiac Disease:
Diarrhea Steatorrhea Abdominal pain Abdominal distention Flatulence Weight loss
What is diverticular disease?
Diverticulum: sac-like herniation of the lining of the bowel that extends through a defect in the muscle layer May occur anywhere in the large intestine but most common in the sigmoid colon
A nurse is administering oral prednisone to a client with an exacerbation of ulcerative colitis. Which of the following is the priority assessment finding?
Elevated Body Temperature
Viral Hepatitis: Prevention and Treatment
Encourage abstinence from alcohol (prevents more damage) • Administer antivirals and immunoglobulins as prescribed - A: immune globulin during incubation period or prevention during travelling - B: entecavir (ETV), tenofovir (TDF): not a cure - C: simeprevir (Olysio) plus sofosbuvir (Sovaldi), ledipasvir-sofosbuvir (Harvoni) and ombitasvir- paritaprevir-ritonavir packaged with dasabuvir (Viekira Pak) have fewer side effects, shorter treatment durations and higher cure rates than previously used peginterferon and ribavirin - D: interferon alfa
What is the Diverticulosis management?
Encourage fluid intake of at least 2 L/day Soft foods with increased fiber, such as cooked vegetables Individualized exercise program Bulk laxatives (psyllium) and stool softeners
What is peptic Ulcer disease?
Erosion of mucous membranes in the stomach or duodenum •The epithelial layer is exposed to pepsin and acid, resulting in an ulcer
Barrett Esophagus leads to:
Esophageal cancer
What are the risk factors for Cholelithiasis?
Female: due to circulating estrogen (a cholesterol-based hormone) • Estrogen therapy: a BCP or post-menopausal estrogen • Family history is a big risk factor for developing gallstones • Age: elderly clients have had more time to form gallstones • Type-2 diabetes: often have increased circulating cholesterol and triglycerides • Diets causing rapid fluctuations in weight: especially rapid weight loss • Obesity: increased estrogen levels and cholesterol levels • Native American ethnicity • Crohn disease: bile doesn't get reabsorbed in the distal ileum, causing more bile production in the liver, which increases risk of gallstones. • Pregnancy: especially multiple pregnancies • Hemolysis: such as sickle cell disease
How can we manage peritonitis?
Fluid and electrolyte replacement, usually 0.9% N/S or Lactated ringers' solution Analgesic medications are prescribed for pain. Antiemetic agents are given as prescribed for nausea and vomiting. Intestinal intubation (N/G) and suction assist in relieving abdominal distention and in promoting intestinal function. Oxygen therapy by nasal cannula or mask generally promotes adequate oxygenation. Antibiotic therapy is initiated early in the treatment of peritonitis Surgical intervention depending on which condition caused the peritonitis 3/30/2023
Which of the following findings would the nurse expect with a gastric ulcer? (Select all that apply) a. Food aggravates the abdominal pain b. Abdominal pain is often at night-time c. Increased bloating and indigestion d. Pain occurs 2-3 hours after a meal e. Pain is in the epigastric area of abdomen
Food aggravates the abdominal pain Increased bloating and indigestion Pain is in the epigastric area of abdomen
What food should be avoided with liver cirrhosis?
Foods high in protein should be avoided since the client's ammonia level is elevated above the normal range.
How can we help to manage hiatal hernia's?
Frequent small feedings• No reclining for 2 hours after eating• Elevate the head of bead 4-8 inches•Surgical hernia repair indicated forclients with symptomatic GERD
What is the primary risk factor of Barrett Esophagus?
GERD
All blood from the ___ _______ flows through the liver.
GI tract
What is the 5th most common cancer diagnosis worldwide?
Gastric cancer
The nurse should educate clients with Celiac disease to avoid food products that contain:
Gluten, Weat, barley, rye, and toothpastes, communion wafers, and cosmetic and art supplies that contain gluten.
Pilonidal Sinus or Cyst: Clinical Manifestations:
Hair protruding from opening Hairs in epithelium and subcutaneous tissue Irritated by perspiration and friction Asymptomatic Until: Adolescence or early adult life Infection (drainage from a fistula, or abscess formation occur) Very painful and recurrent condition
A nurse is caring for a client who has just returned from surgery to treat a fractured mandible. The jaws are wired. What should the nurse do if the client begins to vomit?
Have client sit up, bend over, and spit into an emesis basin.
What are the stages of liver disease in hepatitis?
Healthy liver--acute hepatitis--Chronic Hepatitis--cirrhosis liver---liver cancer
What are potential complications with jaw surgery?
Hemorrhage •Infection •Tooth damage •Nerve injury •Problems with bite fit and jaw joint pain
What are the types of bowel obstructions?
Herniation, adhesions, intussusception, volvulus
What diet should be implemented for a client who is in the early stages of cirrhosis?
High-calorie, high-carbohydrate
A client with severe inflammatory bowel disease is receiving total parenteral nutrition(TPN). When administering TPN, the nurse must take care to maintain the ordered flowrate because giving TPN too rapidly may cause which of the following complications?
Hyperglycemia
Where is cancer of the esophagus primarily found?
In the distal esophagus and gastroesophageal junction
What non-pharmacological things can be done for Pilonidal Sinus or Cyst?
Incision and drainage of cyst (temporary fix)Excision of cyst and secondary sinus tract (long-term repair)Absorptive dressing in wound to heal from inside out (packing ofwound)
The health care provider prescribes metoclopramide hydrochloride for the client with hiatal hernia. The nurse should assess the client to determine which expected outcome?
Increase tone of the esophageal sphincter.
What is portal hypertension?
Increased pressure throughout the portal venous system that results from obstruction of blood flow into and through damaged liver
What is pancreatitis?
Inflammation of the pancreas, can be caused by HLD damaging pancreatic cells
What is Peritonitis?
Inflammation/infection of the peritoneum Usually, a result of bacterial infection but may occur secondary to a fungal or mycobacterial infection Peritonitis can also result from external sources such as abdominal surgery or trauma (e.g., gunshot wound, stab wound) or from continuous ambulatory peritoneal dialysis
What is crohn disease?
Inflammatory disorder that affects any part of the G.I tract from the mouth to the anus
The pain associated with a duodenal ulcer is relieved by:
Ingestion of food
What are clinical manifestations of hepatic dysfunction?
Jaundice: yellow skin and conjunctiva Ascites: distended fluid filled abdomen (from portal hypertension) Esophageal/gastric varices: dilated veins in esophagus/stomach (from portal hypertension) Hepatic encephalopathy or coma: Inability to convert ammonia to harmless urea within the liver Nutritional deficiencies: lack of protein synthesis and glycogen storage Risk of Bleeding: loss of ability to produce clotting factors in the liver, and low platelets (lack of thrombopoeitin) Peripheral edema: loss of ability to produce albumin to provide oncotic pressure
What is dumping syndrome?
Loss of stomach reduces storage capacity; food is dumped rapidly into the small intestines
What are the nursing goals of care for parenteral nutrition?
Maintain optimal nutrition Maintain fluid and electrolyte balance Prevent infection Provide client and family education
A client has recently developed acute sialadenitis. Whichintervention does the nurse include in this client's care?
Massage the salivary gland.
What are clinical manifestations of a hiatal hernia?
May be asymptomatic• Pyrosis (i.e., heart burn) • Dysphagia• Intermittent epigastric pain or fullness after eating• Intolerance to food (large hiatal hernias) • N/V (large hiatal hernias) • GERD (sliding hiatal hernias)
How can we manage acute gastritis?
May be self-limiting •Pharmacotherapy •Antacids • H2 antagonists • PPIs •Nursing management • Promoting nutrition • Reducing pain • Promoting fluid balance • Client education
GERD Causes and contributing factors?
Most common cause is an incompetent lower esophageal sphincter. •Pyloric stenosis •Hiatal hernia •Motility disorders •Aging •Irritable bowel syndrome •Obstructive airway disorders (asthma, cystic fibrosis •Peptic ulcer disease •Helicobacter pylori bacteria
Digestion begins in the ______.
Mouth
What is pyogenic liver abscesses?
Much less common, but they are more common in developed countries than the amebic type.
Does Ulcerative colitis cause malabsorption?
No, because it does not involve the small intestine.
What is a hiatal hernia?
Opening of the diaphragm becomes enlarged, and a part of the upper stomach moves up into the lower portion of the thorax.
What is the management for Diverticulitis?
Oral or IV antibiotics are used depending on the severity of the diverticulitis Antibiotics that are used to treat diverticulitis: Ciprofloxacin: risk of tendon rupture, avoid if less than 18 years, photosensitivity Metronidazole: avoid all alcohol consumption due to disulphiram reaction, gastrointestinal side effects are common, darkens urine color (harmless) Trimethoprim-sulfamethoxazole: drink fluids to avoid crystals in urine, photosensitive rashes, severe SJS (Steven Johnson Syndrome) rashes All can cause c. difficile, oral thrush or vaginal yeast infection During the infection, the diet is fluids and low fiber/residue, then gradually increased to solid food and increased fiber intake
How can we manage hemorrhoids?
PHARMACOLOGIC •Good personal hygiene •Avoid excessive straining during defecation •High residue diet • Fruit • Bran •Increased fluid intake •Warm compresses •Sitz bath NON-PHARMACOLOGIC •Hydrophilic bulk-forming agents - psyllium •Analgesic ointments •Laxatives if constipated • Avoid overuse
What are manifestations of Peritonitis?
Pain is diffuse but then becomes constant, localized, and more intense over the site of the pathologic process. Abdomen becomes extremely tender and distended, and the muscles become rigid. Rebound tenderness may be present. Usually, anorexia, nausea, and vomiting occur, and peristalsis is diminished, followed by paralytic ileus. An initial temperature of 37.8° to 38.3°C (100° to 101°F) can be expected, along with an increased pulse rate. With progression of the condition, patients may become hypotensive and oliguric or anuric. (sepsis is likely occurring)
What are disorders of the salivary glands?
Parotitis - Inflammation of parotid gland •Sialadenitis - Inflammation of the salivary glands •Sialolithiasis - Salivary calculus •Neoplasms (rare)
H. Pylori is a small, hardy bacterium and is the most common cause of:
Peptic Ulcer Disease
A client with a flare-up of ulcerative colitis is diagnosed with toxic megacolon. Which of the following is of greatest concern with this condition?
Perforation of bowel
Which practice does the nurse include when teaching a client about proper oral hygiene?
Perform self-examination of the mouth every week and report any unusual findings.
Varices in the upper stomach and esophagus are caused by collateral circulation due to_______ _________
Portal hypertension
The liver breaks down _______, which results in the formation of ammonia.
Protein
The nurse is inserting a nasogastric tube in an adult client. During the procedure, the client begins to cough and has difficulty breathing. What is the most appropriate action?
Pull back on the tube and wait until the respiratory distress subsides.
What are clinical manifestations of an anal fistula?
Purulent drainage or stool may leak constantly from the cutaneous opening Untreated fistulas may cause systemic infection with related symptoms Passage of flatus or feces from the vagina or bladder, depending on the location of the fistula tract (bladder-bowel fistula or vaginal-bowel fistula) Crohn disease can frequently develop fistulas from colon to bladder, vagina or skin
What portion of the abdomen is the liver located?
RUQ
Most common procedure is modified radical neck dissection. What does this include?
Removal of cervical lymph nodes, some neck tissue, nerves, blood vessels, and muscles
What are complications of appendicitis?
Ruptured appendix: ◦ If pain suddenly resolves during appendicitis, this may indicate a ruptured appendix and peritonitis ◦ If RLQ pain suddenly resolves, this can indicate a ruptured appendix and the start of peritonitis Peritonitis if the appendix ruptures prior to surgery; usually only occurs after at least 15 hours of symptoms. ◦ Peritonitis can be caused by any process that infects or inflames the peritoneal lining ◦ Usually requires surgery and IV antibiotics
What are pharmacological management of Gastritis?
Same as for PUD: takes days to be effective H2 blockers: (famotidine), well tolerated, occasional GI symptoms Proton-pump inhibitors (PPIs): such as pantoprazole, omeprazole (c.diff, osteoporosis) Aluminum/Magnesium antacids: (mixture to prevent diarrhea or constipation) Prostaglandins: increases mucosal lining of stomach so protects it from acid (misoprostol), never take with pregnancy and causes abdo.cramps/diarrhea Mucosal barriers (sucralfate): coats the stomach with a paste-like material If H. pylori positive: Same antibiotics as peptic ulcer disease can be used (clarithromycin, amoxicillin, tetracycline or metronidazole), usually a combination of 2 of them, plus PPI
In alcoholic cirrhosis hepatocellular damage is caused by:
Scar tissue characteristically surrounds the portal areas - Most frequently caused by chronic alcoholism
What are causes of fecal incontinence?
Severe constipation with overflow diarrhea Traumatic (e.g., after surgical procedures involving the rectum) and nontraumatic (e.g., scleroderma) Neuropathies both peripheral (e.g., pudendal) and generalized (e.g., diabetes) Disorders of the pelvic floor (e.g., rectal prolapse) Inflammation (radiation proctitis, IBD) Central nervous system disorders (e.g., dementia, stroke, spinal cord injury, multiple sclerosis) Severe diarrhea Behavioral disorders
___________ can be asymptomatic unless they become infected or obstruct the gland's duct.
Sialolithiasis (salivary calculi)
Which assessment in a client that has just returned from having a modifiedradical neck dissection with skin flap would require a nurse to takeimmediate action?
Skin flap appears white.
What is a biliary colic?
Stone temporarily obstructing the cystic duct. • Usually lasts for hours then resolves, often triggered by a fatty meal
What are clinical presentation of acute Gastritis?
Subjective • Anorexia, nausea, vomiting • Indigestion: irritated by spicy foods, alcohol, smoking, and caffeine • Upper abdominal pain Objective • Hematemesis • Melena
Liver cancer clinical presentation:
Subjective • Continuous dull ache in the right upper quadrant, epigastrium, or back • Anorexia • Weakness • Weight loss Objective • Enlarged liver • Jaundice only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the liver • Ascites develops if such nodules obstruct the portal veins or if tumor tissue is seeded in the peritoneal cavity
What is the clinical presentation for Diverticulitis?
Subjective • Left lower quadrant pain • Anorexia • Nausea Objective • Fever/chills
What are clinical manifestations of pancreatitis?
Subjective • Severe epigastric abdominal pain with radiation through to back or left shoulder • Nausea, vomiting • Polyuria (if hyperglycemia present) • Fruity breath (if DKA occurs) • Diarrhea (malabsorption) • Muscle spasms (low calcium levels) Objective • Anorexia • Scleral icterus and jaundice • Severe tenderness to epigastric area with palpation • Grey turners' sign and Cullen's sign • Absent bowel sounds and distended abdomen from a paralytic ileus • Steatorrhea • Chvostek's sign and Trousseau's sign (hypocalcemia) • Ill appearing client, often curled up in fetal position, asking for analgesia
What are clinical manifestations of Crohn disease?
Subjective: RLQ abdominal pain unrelieved by defecation Pain described as crampy after meals Can have painful anal fissures Can have painful anal abscesses Objective: Chronic diarrhea Scar tissue, granulomas, ulcers in the intestine Constriction of parts of the intestine Weight loss Malnutrition Secondary anemia (malabsorption) Anorexia Steatorrhea (fat in stools) Fistula
What is the clinical presentation of Ulcerative Colitis?
Subjective: • Abdominal pain and cramping • fatigue Objective: • Pallor and anemia • Fever • Diarrhea may be severe; stools have mucous, pus and blood • Abdominal distension because colon can be full of gas
The nurse is caring for a client with gastroesophageal reflux disease (GERD). The nurse knows that breakfast is served for clients at 0800. Which prescribed medication will the nurse administer at 0730?
Sucralfate
What medication coats the stomach and forms a barrier to protect the ulcer from stomach acid?
Sucralfate
What is the treatment for Zenker Diverticulum?
Surgery
What medication management is used for anal fistulas?
Surgical Procedure Fistulectomy Wound packed with gauze Postoperative medications Analgesics Antibiotics. *Fistula recurrence occurs in up to half of clients
What is the treatment for Appendicitis?
Surgical removal of the appendix is the definitive treatment In high-risk elderly clients, a trial of IV antibiotics may be tried but not very common yet
The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence?
Sweating and Pallor
What is viral hepatitis?
Systemic viral disease that primarily affects the liver
A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention?
The client lying in a lateral position, with the head of bed flat
A physician orders lactulose 30 ml three times daily for a client with cirrhosis. The nurse will know that this medication is effective by which finding?
The client's LOC would improve
What is fulminant hepatic failure?
The clinical syndrome of sudden and severely impaired liver function in a previously healthy person. • The generally accepted definition is that fulminant hepatic failure develops within 8 weeks after the first symptoms of jaundice.
Pain from a gastric ulcer is exacerbated by:
The ingestion of food
What is the largest internal organ of the body?
The liver
A client with a history of a hiatal hernia presents to the clinic with reports of worsening pain, and the health care provider orders an endoscopy. Which nursing actions will be provided after upper endoscopy?
The nurse should watch for sudden pain, decreased blood pressure, rapid pulse, and shock after endoscopy; these are all signs of perforation and blood loss.
What is Barrett's Esophagus?
Tissue changes to the esophageal lining
What are risk factors of Crohn disease?
Tobacco (all forms) Medications: antibiotics, birth control pills, NSAIDs High fat diet Family history of the disease Start of symptoms usually in adolescence and young adulthood
What are pancreatitis risk factors?
Top 3 are most common causes: 1) Alcoholism: toxic to the pancreas, resulting in inflammation 2) Gallstones: if the stone travels down the common bile duct and obstructs the pancreatic duct 3) Hypertriglyceridemia: elevated levels of lipids irritate the pancreas. Often associated with a diet high in fats, but can be genetic as well 4) ERCP procedure: the scope enters the sphincter of Oddi, this can result in acute pancreatitis as a complication 5) Cigarette smoking, penetrating ulcers, and direct abdominal trauma can also result in pancreatitis 6) Medications: certain medication has this adverse effect, such as valproic acid 7) Family history of pancreatitis
What are complications of Ulcerative Colitis?
Toxic megacolon: distended colon that can perforate Perforation leading peritonitis Profuse bleeding and diarrhea Colon cancer.
What is the pharmacological management for Peptic Ulcer disease?
Triple therapy for treatment of H. pylori • 2 antibiotics and a PPI or H2 antagonist • May also give bismuth salicylate •Sucralfate • Coats the stomach and forms a barrier to protect the ulcer from stomach acid •Misoprostol • Used for PUD caused by NSAID use • Contraindicated in pregnancy
What are potential complications of Peptic Ulcer Disease?
Ulcer, bleeding, perforation of the ulcer
What is continuous and uniform inflammation of the large bowel?
Ulcerative Colitis.
A hiatal hernia occurs when the _____ part of the stomach is displaced upward into the esophagus.
Upper
The nurse is caring for a client who is receiving parenteral nutrition. Which assessment is most important for the nurse to make to detect early signs of metabolic complications?
Urine output
What are surgical management of PUD?
Vagotomy (CN X): cutting of the vagal nerve reduces acid production in the stomach Pyloroplasty: dilates the gastric outlet, allowing for faster stomach emptying (often done with a vagotomy)
What vitamin will be needed with pernicious anemia?
Vitamin B12 injections
Barrett Esophagus is more likely in:
White men aged 50 years or older
Cancer of the esophagus is more common in:
Women
What is the most common type of esophageal diverticulum?
Zenker Diverticulum (ZD)
A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further questioning and teaching? a) "My partner had an affair years ago that caused us a lot of problems." b) "I'll be sure to wash my fresh fruits and vegetables more carefully." c) "Sometimes I forget to wash my hands when I help in my child's preschool classroom." d) "I'll be sure to take all my medications as ordered."
a) "My partner had an affair years ago that caused us a lot of problems."
A nurse is managing the care of a client 10 days after a liver transplant. What assessments may indicate organ rejection? Select all that apply. a) Fever b) Tachycardia c) Elevated liver enzymes d) Amber colored urine e) Brown stool
a) Fever b) Tachycardia c) Elevated liver enzymes
Which of the following laboratory results should the nurse expect to be abnormal in a client with acute pancreatitis? (Select all that apply) a) Hyperglycemia b) Hypercalcemia c) Increased lipase d) Decreased amylase e) Reduced ESR or CRP
a) Hyperglycemia c) Increased lipase
Which of the following dietary instructions are appropriate for a client recovering from acute pancreatitis? (Select all that apply) a) I will eat smaller meals more frequently b) I will switch from whole milk to skim milk c) I will only have 2 coffees with my breakfast d) I will reduce my alcohol consumption to 2 drinks daily e) I will report any fevers that develop upon discharge f) I will have easily digestible food that is low in fat
a) I will eat smaller meals more frequently b) I will switch from whole milk to skim milk e) I will report any fevers that develop upon discharge f) I will have easily digestible food that is low in fat
Which of the following are considered risk factors for developing gallstones? (Select all that apply) a) Obesity b) Use of estrogen products c) Male sex d) Sickle cell anemia e) Multiple pregnancies f) Family history of gallstones g) Rapid weight loss h) Peptic ulcer disease i) Ulcerative colitis
a) Obesity b) Use of estrogen products d) Sickle cell anemia e) Multiple pregnancies f) Family history of gallstones g) Rapid weight loss
The nurse is caring for a client with cirrhosis of the liver. Which laboratory results are consistent with the disease process? Select all that apply. a) PT = 22 seconds (range 11-13 seconds) b) K+ = 4.0 mEq/L (range 3.5-5.0 mEq/L) c) Albumin 7.2 g/dL (range 3.5-5.2 g/dL) d) Ammonia 96 mg/dL (range 15-60 mcg/dL) e) Platelets 75,000 cells/mm3 (range 140,000-400,000/mcL)
a) PT = 22 seconds (range 11-13 seconds) d) Ammonia 96 mg/dL (range 15-60 mcg/dL) e) Platelets 75,000 cells/mm3 (range 140,000-400,000/mcL)
Which of the following are potential findings or complications of acute pancreatitis? (Select all that apply) a) Pancreatic pseudocysts b) Biliary flow obstruction c) Chvostek's sign d) Respiratory failure e) Hyperkalemia f) Bruising of flanks g) Periumbilical bruising
a) Pancreatic pseudocysts b) Biliary flow obstruction c) Chvostek's sign d) Respiratory failure f) Bruising of flanks g) Periumbilical bruising
An unvaccinated nurse has been exposed to hepatitis B through a needlestick injury. Which actions should be included in the postexposure management plan? Select all that apply. a) Wash the injection site with soap and water b) Wipe the site with undiluted bleach solution c) Administer hepatitis B immune globulin d) Administer hepatitis B vaccine e) Notify the nurse's supervisor
a) Wash the injection site with soap and water c) Administer hepatitis B immune globulin d) Administer hepatitis B vaccine e) Notify the nurse's supervisor
A client has received a prescription for sulfasalazine. Which of the following should be included in the client teaching? (Select all that apply) a. Avoid direct sunlight if possible b. Drink with a large glass of water c. Report any new rash to the HCP d. Contact the HCP with a fever or cough e. Black stools are a side effect of the medication f. Report yellow, orange-tinged urine color g. A folate supplement may be needed
a. Avoid direct sunlight if possible b. Drink with a large glass of water c. Report any new rash to the HCP d. Contact the HCP with a fever or cough f. Report yellow, orange-tinged urine color g. A folate supplement may be needed
A nurse is caring for a client with a recent diagnosis of a duodenal ulcer. Which of the following statements are correct? (Select all that apply) a. Discontinue using ibuprofen. b. H. pylori is the most common cause. c. Black, tarry stools may indicate intestinal bleeding. d. Yellow, jaundiced eyes occur with this condition. e. Prednisone is a safe medication to administer.
a. Discontinue using ibuprofen. b. H. pylori is the most common cause. c. Black, tarry stools may indicate intestinal bleeding.
A nurse is caring for a client with acute gastritis receiving clear liquid diet orally. Which of the following should be included in the plan of care? (Select all that apply) a. Monitor electrolyte lab values b. Monitor fluid input and output c. Encourage smaller meals d. Indomethacin for pain or headaches e. Monitor stools for blood
a. Monitor electrolyte lab values b. Monitor fluid input and output c. Encourage smaller meals e. Monitor stools for blood
A nurse is caring for a client with a small bowel obstruction requiring an NGT insertion. Which of the following interventions are appropriate by the nurse? (Select all that apply) a. Obtain a chest x-ray following NGT insertion b. Document the output of gastric secretions from NGT c. Irrigate the NGT every 8-12 hours to prevent occlusion d. Provide oral hygiene every 2 hours for the client e. Auscultate the bowel sounds for the quality of the sound
a. Obtain a chest x-ray following NGT insertion b. Document the output of gastric secretions from NGT d. Provide oral hygiene every 2 hours for the client e. Auscultate the bowel sounds for the quality of the sound
A client with a small bowel obstruction is being assessed by a nurse. Which of the following would be consistent with a small bowel obstruction? (Select all that apply) a. Recurrent vomiting with a fecal odor b. Episodic crampy abdominal pain c. High-pitched abdominal sounds d. Rigid flat abdomen with rebound tenderness e. A lab test showing a K+ of 3.2 mg/dl f. Metabolic alkalosis on ABG testing
a. Recurrent vomiting with a fecal odor b. Episodic crampy abdominal pain c. High-pitched abdominal sounds e. A lab test showing a K+ of 3.2 mg/dl f. Metabolic alkalosis on ABG testing
What is ascites?
accumulation of fluid in the peritoneal cavity
Decompensated cirrhosis results when the damage to the liver has progressed to the point where functionality is significantly compromised, as evidenced by:
ascites, jaundice, hypotension, weight loss and spontaneous bruising.
A client is prescribed pancrelipase for chronic pancreatitis. Select the correct education for administering the medication. a) Educate the client to chew the capsules prior to the meals b) Educate to drink a glass of water after taking the capsules c) Take the capsules only with the large meals of the day d) Sprinkle the capsules on protein-based foods like meat
b) Educate to drink a glass of water after taking the capsules
Which of the following are correct nursing instructions to a client following a laparoscopic cholecystectomy? (Select all that apply) a) Take a bath instead of showers for a week b) Resume your regular diet when discharged c) Clean the wound puncture sites with a mild soap d) Remove the steri-strips and bandage the next day e) Report any fevers or increasing abdominal pain
b) Resume your regular diet when discharged c) Clean the wound puncture sites with a mild soap e) Report any fevers or increasing abdominal pain
A client with chronic gastritis is being educated about pernicious anemia. Which of the following educational topics should be included? (Select all that apply) a. Caused by loss of acid production in the stomach b. Requirement for monthly vitamin B12 injections c. Results in neurological symptoms like ataxia and confusion d. Vitamin B12 is needed for production of platelets e. Caused by a loss of intrinsic factor production
b. Requirement for monthly vitamin B12 injections c. Results in neurological symptoms like ataxia and confusion e. Caused by a loss of intrinsic factor production
While the route of transmission for hepatitis B&C is the _____, hepatitis A and E are transmitted via fecal: _____ route
blood, oral
Two days after the donation of the right lobe of the liver to a parent, a client tells the nurse, "I was pressured by my family to donate a piece of my liver." What is the nurse's priority intervention in this situation? a) Provide written documentation of the conversation to the ethics committee. b) Inform all the surgeons who harvested and transplanted the liver. c) Explore the client's statement to obtain additional, detailed information. d) Notify the supervisor to determine if a psychiatric evaluation is necessary.
c) Explore the client's statement to obtain additional, detailed information.
A client is receiving education prior to a laparoscopic cholecystectomy. Which of the following should be included in the teaching? (Select all that apply) a) A scope will be inserted into your stomach b) A 1-2-day hospitalization will be required c) Right shoulder pain may occur after the surgery d) A JP drain will be inserted during the surgery e) Mobilization can occur immediately after surgery
c) Right shoulder pain may occur after the surgerys e) Mobilization can occur immediately after surgery
Which of the following lab tests would the nurse expect in a client with a persistent flare-up of Crohn's disease?
c. Increased WBC count d. Reduced serum albumin e. Reduced serum folate
A client reports ongoing episodes of "heartburn." Which food will the nurse recommend that the client eliminate from the diet?
chocolate
What are triggers of IBS?
chronic stress, depression/anxiety, sleep deprivation and some foods (coffee, alcohol, fatty foods)
What is a amoebic liver abscess?
commonly caused by entamoeba histolytica. Most amebic liver abscesses occur in the developing countries of the tropics and subtropics because of poor sanitation and hygiene.
Diseases of the mouth may interfere with:
communication.
Considerations of acute gastritis?
dentify irritants, including foods, medications, alcohol Eat smaller meals, more frequently Eat slowly to help digest Reduce stress in life Report black stools or vomiting of blood
Clinical manifestations of esophageal cancer include:
dysphagia, painfulswallowing, halitosis and hiccups.
What is Cullen's sign?
ecchymosis at the umbilicus due to retroperitoneal bleed
Select the most likely clinical finding in a client with acute pancreatitis. a) Right upper quadrant tenderness (Murphy's sign) b) Cyanosis of the lips and oral mucosa (central cyanosis) c) Hyperactive bowel sounds (excessive peristalsis) d) Abdominal pain that worsens with leaning forward e) Expiratory wheezing noted in both lung fields f) Epigastric pain radiating through to the back
f) Epigastric pain radiating through to the back
What are other S/S of compensated Cirrhosis?
flatulent dyspepsia, palmar erythema, unexplained epistaxis and vascular spiders
What are the manifestations of an esophageal varices?
hematemesis, melena, general deterioration, and hemorrhagic shock
Where does most diverticula develop?
in the descending colon and sigmoid colon
What is Diverticulitis?
infection and inflammation of diverticula
What is Gastritis?
inflammation of the gastric mucosa
What is pernicious Anemia?
lack of intrinsic factor secretion from the stomach.
Clients with inflammatory bowel disease (IBD) should follow what type of diet?
low-residue, high- protein, high-calorie diet; especially during an acute phase.
The earliest symptoms of hepatic encephalopathy include
mental status changes and motor disturbances. Early symptoms include forgetfulness, anxiety, irritability, short attention span and coordination and balance problems
Cancerous tumors in the liver are more likely to be _________ from other primary sites such as breast and lung, than to be primary liver cancer.
metastases
What is Diverticulosis?
multiple diverticula without inflammation
Does diverticulosis ususally cause symptoms?
no
What are S/S of peptic ulcer disease?
pain in epigastric region (gnawing, burning, aching, hunger-like) occurs 2-3 hours after a meal or in middle of night (TELL TALE SIGN) eating helps decrease pain temporarily hemoptysis (vomiting blood) may occur
Manifestations of periapical abscess (Abscessed tooth)
pain, halitosis, fever,facial edema, and cellulitis
When is a neck dissection surgery performed?
patients with head and neck cancers (salivary tumors, who are at high risk for lymph node metastasis
An appropriate nursing intervention for a client with Xerostomia (dryness of the mouth) is to:
provide the client with sipping water and saliva substitutes
What are S/S of GERD?
retrosternal "burning", burping, hiccoughs, dysphagia, bitter taste in mouth, Nausea, dry cough, weight loss, hoarseness, regurgitation.
What is the preferred treatment for malignancies of the head and neck that have metastasized to the cervical lymph nodes??
surgical neck dissection
What is an anal fistula?
tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus in the perianal skin
The primary risk factors for the development of laryngeal cancer are:
tobacco use combined with regular alcohol consumption.
What are manifestations of Dumping syndrome?
vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down
_____ hepatitis is the most common type of hepatitis.
viral
What are the priority nursing assessments for a client with ascites?
• Breathing pattern • Abdominal girth • Generalized appearance of abdomen -Striae -Distended abdominal veins • Assess for fluid wave • Monitor for potential fluid and electrolyte imbalances
Liver cancer diagnostics:
• CBC: Hgb, Hct and WBC • LFTs: Bilirubin, alkaline phosphatase, AST, GGT, and LDH • Glucose • Calcium • Cholesterol • Cancer markers • X-rays, liver scans, CT scans, ultrasound studies, MRI, arteriography, and laparoscopy • Positron emission tomography (PET) scans • Biopsy
How are hiatal hernia's diagnosed?
• Chest x-ray• Barium swallow• Esophagogastroduodenoscopy (EGD)• Esophageal manometry• Chest CT scan
What is the treatment for cholelithiasis?
• Cholecystectomy - Removal of gallbladder is curative for biliary colic and cholecystitis - LaparoscopIc approach is the most common surgical treatment • Less common treatments include lithotripsy and bile acid medications
What are risk factors of cancer in the esophagus?
• Chronic esophageal irritation • GERD/Barrett's esophagus • Smoking • ETOH ingestion
How is GERD diagnosed?
• Client history • Ambulatory 12- or 36-hour esophageal pH monitoring with a wireless capsule
What are complications of colorectal cancer?
• Complete large bowel obstruction • GI bleeding • Bowel perforation • Peritonitis, abscess, and sepsis • Anemia • Metastases
What are factors that decrease ammonia?
• Decreased dietary protein • Antibiotics, such as neomycin, which reduces the number of intestinal bacteria capable of converting urea to ammonia • Lactulose orally or as enemas reduce ammonia level - Nursing: anticipated effects of lactulose; client should NOT have diarrhea
What are risk factors of gastric Cancer?
• Diet high in smoked, pickled, and salted foods • Diet low in fruits and vegetables • H. pylori infection • Smoking • Genetics
What are factors that increase ammonia?
• Digestion of dietary proteins in the GI tract • Digestion of blood proteins in the GI tract - This is why it is important to do gastric lavage for upper GI bleeding - get the blood out of the gut! • Bacterial infection • Uremia (renal failure) • Ingestion of ammonium salts
How can we manage bleeding with esophageal varices?
• Endoscopic sclerotherapy (scar/fibrose the veins) • Endoscopic variceal ligation (esophageal banding therapy) • Trans-jugular intrahepatic portosystemic shunt (TIPS) • Surgical bypass procedures to reduce portal pressures
Nursing Management of the Client with Bleeding Esophageal Varices
• Frequent monitoring of VS • Application of supplemental oxygen • Administration of vasoactive drugs as prescribed • Adminstration of IV fluids, electrolytes, and blood products as prescribed • Preparation for EGD or surgery • Balloon tamponade (infrequently used) - ICU setting only • Education and support of client and family • Review Table 43-2 (pg. 1380): Select Modalities and Nursing Care for the patient with Bleeding Esophageal Varices
What are the functions of the liver?
• Glucose Metabolism and storage of glycogen • Ammonia Conversion to urea • Protein Metabolism • Fat Metabolism • Vitamin and Iron Storage (fat soluble vitamins and vitamin B12) • Bile Formation • Bilirubin Excretion (RBC breakdown) • Drug Metabolism • Production of clotting factors for coagulation
What are complications of a hiatal hernia?
• Hemorrhage • Obstruction • Strangulation
Pharmacological management of pancreatitis?
• IV Opioids: Morphine/hydromorphone to control the severe pain • Injectable NSAID like ketorolac to treat pain and inflammation • Antibiotics are only used if a bacterial infection is suspected (infected cyst or necrotizing pancreatitis) • H2 antagonists or PPIs to reduce acid secretion in the stomach • Pancrelipase: enzyme replacement since pancreas may not be producing digestive enzymes. Capsules can be sprinkled on non-protein food, drink water following the medication, rinse mouth to eliminate the enzyme from mouth or skin. Take with all meals & snacks to aid digestion • Insulin: if hyperglycemia is present or diabetes is present, insulin therapy may be required
What is the management for hepatic encephalopathy?
• Identify and eliminate precipitating cause (excessive protein in diet) • Monitor and reduce ammonia (lactulose orally or rectally) • Maintain nutrition (low protein) • Prevent complications • Treat cerebral edema
What is a open cholecystectomy?
• Incision to abdomen, removal of gallbladder, usually 1-2 days needed in hospital to recover. • May need a Jackson Pratt drain to help drain any fluid within the surgical site. • Sometimes a T-tube is inserted in the bile duct if blocked or cut by accident
How do you care for a T-Tube?
• Inserted during the surgery to stent open the bile duct. • If no output of bile from T-tube with nausea and vomiting, may indicate a blocked T-tube • May need to elevate the T-tube above the abdomen to allow some bile to flow through the common bile duct • Clamp the tube 1 hour prior and after meals, to allow bile to flow for digestion • Monitor the color of the stools, normal or clay colored? • Monitor for an internal bile leak causing peritonitis. • Removal of tube in weeks (1-3 weeks) to allow the common bile duct to heal.
How is GERD treated?
• Lifestyle modifications • Pharmacotherapy • Review Hickle, Cheever, Overbaugh (2022) Table 39- 4: Nursing Process: Pharmacologic Management of GERD
What is the treatment for a periapical abscess?
• Needle aspiration • I&D • Antibiotics
Nursing management of pancreatic cancer includes:
• Pain management • Nutrition • Skin care • Self-care • Palliative care and hospice referrals
How can we manage ascites?
• Pharmacotherapy with diuretics • Diet - Strict sodium restriction • Procedures - Paracentesis - Transjugular intrahepatic portosystemic shunt (TIPS)
What are nursing priorities in the care of a client with an ostomy?
• Preoperative preparation • Immediate postoperative care • Stoma care • Skin integrity • Nutrition • Knowledge deficit
Viral Hepatitis: Prevention and Treatment
• Prevent transmission of the virus: appropriate for type of hepatitis - Vaccines for A and B - Universal precautions + • Scrupulous hand hygiene, safe water supplies, and proper control of sewage disposal for A and E • Blood and body fluids precautions for B, C, D - Immune globulin for household members and sexual contacts for HAV • Provide adequate rest during the acute phase • Provide adequate nutrition: - Small, frequent meals - IV fluids with glucose - Favorite food - Enteral feeds may be required
Clinical presentation of liver abscess:
• Subjective - Chills - Malaise - Anorexia, nausea - Dull abd pain - Tenderness in RUQ
What are clinical manifestations of hepatic failure
• Subjective - Profound anorexia • Objective - Jaundice - Bruising and bleeding - Neurologic signs with hepatic encephalopathy
How do we manage colorectal cancer?
• Surgery • Bowel resection with anastomosis • Bowel resection with creation of an ostomy • Chemotherapy • Radiation therapy
What is gallstone pancreatitis?
• The stone has travelled further down the common bile duct, resulting in blockage of the pancreatic duct, causing pancreatitis with severe inflammation and autodigestion of the pancreas. • Results in severe epigastric pain radiating to the back, increased lipase and amylase • One of the most common causes of pancreatitis
How do you manage a liver abscess?
• Treat infection: IV antibiotic specific to microorganism; percutaneous drainage; open surgical drainage if IV antibiotics or percutaneous drainage infective • Provide post-op management - Containing and monitoring drainage while protecting skin - Monitoring of vital signs and WBC closely for indications of sepsis and septic shock • Provide discharge instructions - Importance of continuing to take antibiotics as prescribed
What are pancreatic cancer clinical manifestations?
• Typical client presentation is initially a symptom of painless jaundice • Other symptoms/signs associated with pancreatic cancer: - Abdominal pain that radiates to your back (enlarging cancer) - Loss of appetite or unintended weight loss (any cancer) - Light-colored stools (lack of bilirubin) - Dark-colored urine (bilirubin spilling in the urine) - Itchy skin from the build of bilirubin in the skin - Undiagnosed fatigue
What are the different types of hernias?
• Umbilical • Inguinal • Incisional • Reducible • Irreducible • Strangulated
What are the causes of fulminant hepatic failure?
• Viral hepatitis • Hepatotoxic medications, such as acetaminophen overdose - Note that this is a common drug for suicide gesture in adolescents and young adults; they may believe it is a benign drug • Chemical exposure, such as carbon tetrachloride • Metabolic disturbances, such as Wilson disease, which is a hereditary syndrome with deposition of copper in the liver
What are the fat soluble vitamins?
• Vitamin A • Vitamin D • Vitamin E • Vitamin K
What is Jaundice?
• Yellow sclera and skin caused by increased serum bilirubin levels from liver disease - Hemolytic (excessive RBC breakdown) - Hepatocellular (liver disease) - Obstructive (biliary obstruction) • Hepatocellular and obstructive jaundice are most associated with liver disease • Elevated total bilirubin level - Usually exceeds 2 mg/dL - Normal values = 0.3 - 1.2 mg/dL
How can we manage a chemical burn of the esophagus?
•Airway maintenance •Avoid vomiting and gastric lavage; will increase esophageal injury •NPO •IV fluids •Pain management •Corticosteroids •Surgery • Emergency esophagectomy and gastrectomy may be required •Enteral or parenteral nutritional support
How can we manage Sialolithiasis?
•Conservative• Massage• Heat application• Waiting for spontaneous stone passage •Surgical extraction of stone
What are post-op management for jaw surgery?
•Dietary restrictions, depending upon injury•Client and family education
How is Barrett Esophagus diagnosed?
•EGD • Initial diagnostic tool • Repeat frequency depends upon grade of cellular changes
What testing is performed in a client with Peptic Ulcer Disease?
•EGD (most accurate) • Obtain a direct biopsy testing during procedure •CBC • Non-specific, but may show iron deficiency anemia from persistent low-grade bleeding •H. pylori testing • Urea breath test (most accurate) • Detects carbon dioxide in inhaled breath after providing a drink rich in urea • H. pylori antibody testing • Stool sampling • Detects H. pylori antigen in the stools
How would you diagnose cancer of the esophagus?
•EGD with biopsy and brushings •Double-contrast esophagography •CT of chest and abdomen assessing for metastasis •PET scan assessing for metastasis •Endoscopic ultrasound to assess for spread to lymph nodes and mediastinum
What are the nursing goals of a client that is undergoing a neck dissection?
•Maintenance of airway and respiratory status •Increased knowledge of surgical procedure and treatment plan •Pain management •Maintenance of adequate intake of food and fluids •Wound care •Effective coping strategies (for client and caregivers) •Effective communication •Maintenance of shoulder and neck motion •Absence of complications
How can we manage an esophageal perforation?
•NPO •IV fluids •Broad-spectrum antibiotics •Surgical repair ASAP •Nutritional support crucial because client will be NPO for approximately 7 days • Enteral • Parenteral •Testing (esophagram) before NG tube removed and oral intake allowed
What is an esophageal diverticulum?
•Out pouching of mucosa/submucosa that protrudes through a weak portion of the esophageal musculature
What are manifestations of a chemical burn of the esophagus?
•Subjective manifestations • Anxiety • Pain especially on swallowing • Dyspnea (related to edema of pharynx and mucus in the pharynx) •Objective manifestations • May see severe burns of the lips, mouth, and pharynx • Hypotension • Fever
What clinical presentation is present with Sialolithiasis?
•Subjective• May be asymptomatic or painful •Objective• Swelling of salivary gland• Stone may be palpable
What is an ileostomy/colostomy?
•Surgical opening into the ileum/colon by means of a stoma •Allows drainage of bowel contents •May be temporary or permanent
How is Barrett Esophagus treated?
•Treatment of GERD •Surveillance EGD •Esophageal resection
What is done if a client with Peptic Ulcer disease is unstable?
•Urgent EGD to attempt stopping of bleeding by injection of epinephrine or a coagulant into site. •Gastrectomy: Billroth I and II • Only with ulcers nonresponsive to triple therapy, hemorrhaging or perforation
Pharmacological management of IBS:
◦ Loperamide: slows down the bowel, may cause fatigue/drowsy ◦ Psyllium: bulking agent to firm up the stools ◦ Alosetron ◦ Only for severe IBS in females, slows down bowel ◦ Not used in males because increased death rate ◦ Only a last resort medication; can cause ischemic bowel, so report any bleeding in stools Prominent constipation symptoms: Lubiprostone: increases fluid in the bowels to reduce constipation, used in females