GI Quiz #2

S/S of hemorrhoids in general ?

bleeding (could be a drop on toilet paper or extensive & continuous); extensive bleeding can lead to anemia

S/S of Hepatitis C

fatigue, itching, jaundice, pain RUQ and loss of apetite

A low-residue diet is ordered for a client. Which food would be contraindicated for this person?

fresh peas

What is Hepatitis?

liver inflammation accompanied by tissue damage, can be acute or chronic

Hepatitis A is transmitted through?

oral-anal sexual practices, contaminated water, infected food handlers and contaminated foods

Who can get Hepatitis C?

people who received blood products before changes in lab testing for HCV, health care workers exposed to blood, unprotected sex, blood bbody fluid exposure and IV drug users

A client has had a liver biopsy. After the procedure, the nurse should position him on his right side with a pillow under his rib cage. What is the primary reason for this position?

to reduce the likelihood of bleeding

Causes of Hemorrhoids?

uterine pressure in rectum during pregnancy, portal hypertension, congestive heart failure, obesity, constipation, diarrhea, and intrabdominal tumors

Tx of Hepatitis A

- immune serum globulin (as a prophlactic measure) - recover fully in 4 - 6 weeks with rest and supportive care

S/S of Pancreatitis

- jaundice (may exist if common bile duct is obstructed) - nausea and vomiting - fever - anorexia - intractable pain in the epigastric area (may radiate to the back or upper left side)

Who does Cholecystitis affect?

1st generation American Hispanics, pregnant woman more susceptible, obese woman > 45 yrs

A client with cirrhosis is about to have a paracentesis for relief of ascites. Which activity is essential prior to the procedure?

Ask the client to empty his bladder

The nurse is assisting a client who may have a hiatal hernia. What symptom is the client most likely to report?

Burning substernal pain

Cause of cirrhosis

Chronic long-term alcohol abuse is the most common cause, drugs, toxins and certain general anesthetics

An adult is being treated for peptic ulcer. The physician has prescribed cimetidine (Tagamet) for which reason?

It blocks the secretion of gastric hydrochloric acid

How is Diagnosis of Hepatitis made?

LFT: specific antibody testing for viruses, blood tests can distinguish among of the viruses of that cause

Dx for Hepatitis C

LFTS and specific antibody testing

What is Hepatitis B?

Liver inflammation that is deadly!

An adult has a nasogastric tube in place. Which nursing action will relieve discomfort in the nostril of the NG tube?

Loop the NG tube to avoid pressure on the nares

Who gets Pancreatic cancer?

More common in African Americans than caucasians, more common in males between ages 60 - 80 yrs old

What are the three transmissions that cause Hepatitis B?

Percutaneous, Sexual and Perinatal

Dx of Hemorrhoids

Proctoscope, which allows the provider to inspect inside rectum, to visualize hemorrhoids and take biopsy sample

If patient that has peritonitis develops paralytic ileus and does not respond to treatment, what are the S/S?

Pulse thread, breathing shallow, grows weaker, temperature falls and death follows!

A distal pancreatectomy and splenectomy is performed on a client with cancer of the pancreas. He is returned to his room postoperatively. The client is sleepy but can answer simple questions appropriately. His dressing is dry and intact. Vital signs are within normal limits. Which of the following nursing measures must be done before the nurse leaves the room?

Put all four side rails in high position

Who is recommended to get HBV vaccinations?

Recommended for infants, children, adolescents, adults and health care workers

Tx of Peritonitis

Surgery (irrigated with normal saline,sometimes necessary to close perforation or to repair rupture) and antibiotics

What is Hemorrhoids?

Swollen varicose veins of anus or rectum, alternately appear and disappear and painful (especially if constipated and strains to have bowel movement)

The client had had a severe liver disease. What observation is an indicative of serious problems?

The client is "confused" and can no longer write his name legibly

Following a hemorrhoidectomy the nurse is instructing the client in self-care. Which statement is espcially important to include in these instructions?

Wash the anal area after the defecation and pat it dry

Hepatitis C

- 4 subtypes - no vaccine for HCV - can turn into a chronic disease, some will be lifetime carriers - can develop liver cancer or liver cirrhosis

What are S/S of internal hemorrhoids?

Develops inside anal sphincter, may bleed, unlikely to be painful (if they do not protrude); almost always protrudes on defecation (but Pt can push them back with finger)

What is Hepatitis A (HAV) ?

Most common form of viral hepatitis, self-reserving

As cirrhosis advances the client has what kinds of symptoms?

abdominal pain, rapid pulse, and breathing becomes difficult b/c of enlarged abdomen

Name examples of causes of Hepatitis B

blood semen, body fluids from contaminated person. and contaminated needles

Who usually gets Hepatitis A?

children (day care center) and young adults

What is Cholecystitis?

inflammation of gallbladder (often occurs with cholelithiasis and aggravate the other)

Cause of Hepatitis A

spread by oral-fecal route

What is the cause of Cholecystitis?

unknown of how gallstones are formed, changes in form of diet (i.e. processed cheese to natural cheese)

Percutaneous transmission (Hepatitis B)

blood products, infected blood, needles,blood transfusion (rare) and other invasive instruments

Localized Peritonitis

infection kept in one area

Tx of Hemorrhoids

* sometimes disappear without treatment - warm sitz baths, witch hazel compresses (tucks) are prophylactic - keep stools soft ( proper diet and stool softners), correcting constipation, anesthetic ointments - hemorrhoidectomy surgery (if necessary veins are tied off and excised)

Nursing Interventions for Peritonitis

- Closely observe abdominal wound, pulse, temperature - Document gas, bowel sounds and feces (these indicate return of normal GI function) - Monitor vomiting, incisional or drainage tube output, watch for excessive distention - NPO (give special attention to oral care & fever) - use rectal or NG tube (G tube makes mouth dry & parched) - Put client in semi-fowlers position - Encourage early activity (to promote peristalsis & GI function) - Administer antibiotics and analgesics

Causes of Peritonitis

- Pelvic Peritonitis( ruptured tubal pregnancy, ruptured uterus, infected uterine tube) - Perforation: appendicitis, ulcer, cancer, IBD, abscessed diverticula, appendix, intestinal tract normally filled with bacteria (can cause inflammation & peritoneal infection)

S/S of cirrhosis

- bleed easily (nose bleed, veins dilated b/c of portal hypertension, appears in vomitus) - jaundiced skin is dry - pt feels weak and confused - indigestion , anorexia, hemorrgaging and infection may develop - client may be unaware of low grade fever or of weight loss - Ascites causes an abdominal girth that offsets the weight loss

Nursing Interventions of Hemorrhoids

- daily sitz bath may be ordered; assist client getting in/out of tub - Enemas are received at home night before surgery, given "until returns clear" in the morning of operation; cleanse rectal area and shave it (Pre- operational) - Position client on their side or abdomen to release pressure (use appropriate comfort aids), use appropriate comfort aids ,give analgesics as ordered - liquid diet is permitted 1st day then full diet okay! - allow client to sit up and ambulate client ASAP on operative day or next day

Tx of cirrhosis

- drug choice: Lactulose (cephulac), promotes ammonia retention and excretion through GI tract - alcohol avoidance is a must (client teaching and referrals to proper agencies) - may require restiction of dietary protein - prevent activity intolerance - providing a safe and controlled enviornment - maintaining electrolyte imbalance to lower ammonia levels

S/S of Cholecystitis

- indigestion and complaints of feeling full (after eating fatty foods make conditions worse) - eructation (belching), jaundice, fever, malaise,nausea and vomiting - Pruritis - Dark urine - Steatorrhea (clay colored stool), fatty, foul smelling stools that float and excessive flatus - gallstone colic (sudden onset of acute pain in RUQ)

S/S of Hepatitis

- liver enlargement - dark urine, loss of apetite, abdominal pain - joint and muscle aches - fatigue and lethargy - nausea (sometimes vomitting & diarrhea) - mild fever, jaundice, and malaise

Common complications of Cirrhosis

- more susceptible to infection if pt survives hemorrhage - look for signs of blood in the stool and urine or toothbrush - hematomegaly (liver may become enlarged) - esophageal varices often rupture (causes bloody emesis and may cause hypovolemic shock) - deranged liver metabolism - portal hypertension (blood vessels may become obstructed)

S/S of Peritonitis

- weak and rapid pulse , low BP, gradual temp increase and shallow respirations (breathing hurts abdomen) - nausea and vomiting - severe abdominal pain (abdomen board like, becomes very distended) - Pt tries to avoid moving abdomen and draws knees up to prevent pressure from bed clothes (to relieve pain) - flatus and intestinal contents are stationary in intestinal tract

Dx of Peritonitis

CT scans, Lab studies, abdominal x-ray elimination, ultrasounds, evaluation of symptoms, and WBC count

Generalized Peritonitis

Caused by a ruptured appendix, a perforated ulcer or penetrating wound, may lead to growth of so many disease organisms (release of a lot of bacterial toxin can be fatal)

Cause of Pancreatitis

Gallstones that travel backwards in the duct, drugs, alcohol, and infectious or traumatic damage

What is Pancreatic cancer

a disease in which malignant (cancerous) cells form in the tissues of the pancreas

A client had a barium enema. Following the barium enema, the nurse should anticipate an order for which if the following?

a laxative

Perinatal transmission (Hepatitis B)

an infected mother to her child at birth

Cause of Hepatitis

autoimmune conditions, some drugs, viruses, and alcohol

Sexual transmission (Hepatitis B)

by semen or saliva

What is cirrhosis?

chronic degenerative disease of the parenchymal cells of the liver, the liver can no longer do its work b/c the hepatocytes become infiltrated with fatty and fibrous tissue that cannot detoxify body waste, intrahepatic obstructive jaundice results adn all body functions eventually detorirate

When an elderly client is receiving cimetidine (Tagamet) it is important that the nurse monitor fo which side effect?

confusion

S/S of Pancreatic cancer

early signs: anorexia and weight loss Has vague symptoms usually diagnosed in late stages: -pruritis, jaundice, fatigue and ascites - dark urine, clay colored stool, flatulence - pain that radiates to the back is unrelieved by change in position (more severe at night) - palpable abdominal mass - hepatomegaly

Who usually gets Hepatitis B?

infants of woman who are HBV carriers, people in mental institutions, IV drug users who share needles, clients receiving hemodialysis and sexually active homosexuals

What is Pancreatitis?

inflammation of the pancreas

What is Peritonitis?

inflammation of the peritoneum, serious complication that may be follow infection of an organ covered by the peritoneum (i.e. appendix), can be generalized or localized , develops suddenly!

Can you donate blood if you have Hepatitis B or C?

no (because people can pass the hepatitis to others through blood, some may even carry it without knowing)

How is Hepatitis A spread?

poor sanitation, crowded conditions , it is difficult recognizing the disease carriers

What are S/S of external hemorrhoids?

protrude as lumps around anus, no bleeding, but may become large , painful itchy; painful (especially if Pt constipated & strains to have BM)

Tx for Hepatitis C

ribavarin (copegus) an antiviral, protease inhibitors and interferons (interferon alfa- 2b) to boost immune system