passpoint nclex prep: GI disorders

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction?

"Avoid coffee and alcoholic beverages." To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.

steroid therapy in ulcerative colitis

"Steroids are used in severe flare-ups because they can decrease the incidence of bleeding." Steroids are effective in management of the acute symptoms of ulcerative colitis. Long-term use is not effective in prolonging the remission and is not advocated. Clients should be assessed carefully for side effects related to steroid therapy, but the benefits of short-term steroid therapy usually outweigh the potential adverse effects.

antacids

Antacids decrease gastric acidity and should be continued even if the client's symptoms subside. Because other medications may interfere with antacid action, the client should avoid taking antacids concomitantly with other drugs. If cardiac problems arise, the client should avoid antacids containing sodium. For optimal results, the client should take an antacid 1 hour before or 2 hours after meals.

atropine

Anticholinergic - decreases salivation and gastric secretions Heart: also increases HR, contractility Lungs: bronchial dilation, decreases bronchial secretions

lower GI series test

Before a lower GI series, the client should eat a low-residue or clear liquid diet for 2 days and take a potent laxative and an oral liquid preparation.

early signs of shock

In early shock, the body attempts to meet its perfusion needs through tachycardia, vasoconstriction, and fluid conservation. The skin becomes cool and clammy. Urine output in early shock may be normal or slightly decreased. The client may experience increased restlessness and anxiety from hypoxia, but loss of consciousness is a late sign of shock.

Meperidine for pain interacts with

MAOIs

A client with a history of peptic ulcer disease is admitted to the hospital. Initial assessment reveals that the blood pressure is 96/60 mm Hg, with a heart rate of 120 bpm. The client just vomited coffee-ground-like material. Based on these data what should the nurse do first?

Prepare to insert a nasogastric (NG) tube. Pt is experiencing an upper gastrointestinal bleed secondary to a peptic ulcer. The client will be placed on nothing-by-mouth status, and an NG tube will be inserted to provide gastric decompression and alleviate vomiting.

acute pancreatitis care

The client with acute pancreatitis usually experiences severe abdominal pain. The client will likely receive an opioid such as morphine to treat the pain. Placing the client in a side-lying position relieves the tension on the abdominal area and promotes comfort. A semi-Fowler's position is also appropriate. The nurse should also monitor the client's respiratory status because clients with pancreatitis are prone to develop respiratory complications. Daily weights are obtained to monitor the client's nutritional and fluid volume status. During the acute phase of the illness while the client is experiencing pain, the pancreas is rested by withholding food and drink. When the diet is reintroduced, it is a high-carbohydrate, low-fat, bland diet.

cholecystography

X-ray examination of the gallbladder, especially used to detect the presence of gallstones. uses iodine for testing (10-12 hrs before the test) so ask about iodine or shellfish allergies

Metoclopramide

antiemetic and bowel movement stimulator

NG tube

assess lungs sounds q4h d/t risk of aspiration irrigate q4h and PRN

gastric bypass sx complication, what to do?

bilious emesis (bright yellow-green liquid emesis that resembles bile), which is a warning sign of gastrointestinal obstruction. Obstruction is a rare but serious complication of gastric bypass procedures. The nurse should request the prescription for an x-ray to investigate this possibility.

asprin

can cause GI distress - avoid alcohol

simvastatin

can cause liver damage, notify PCP if sxs such as jaundice and concentrated urine is present

hiatal hernia control

do not lie down right after meals A client with a hiatal hernia should avoid the recumbent position immediately after meals to minimize gastric reflux. Bedtime snacks, as well as high-fat foods and carbonated beverages, should be avoided. Excessive vigorous exercise also should be avoided, especially after meals. Wearing tight, constrictive clothing such as a girdle can increase intra-abdominal pressure and thus lead to reflux of gastric juices.

GERD pts should limit foods containing what?

fats

steroids SEs

hyperglycemia, gastric irritation, peptic ulcers

S/S of hypokalemia

irregular pulse (arrhythmia), fatigue, muscle weakness, flabby muscles, decreased reflexes, nausea, vomiting, and ileus.

cholecystectomy diet

limited fats Bile flows almost continuously into the intestine for the first few weeks after gallbladder removal. Limiting the amount of fat in the intestine at any one time ensures that adequate bile will be available to facilitate digestion.

pancreatitis diet

low fat, bland, 5-6 small meals daily so as not to irritate the pancreas

Which symptom would the nurse most likely observe in a client with cholecystitis (inflammation of the gallbladder. It happens when a digestive juice called bile gets trapped in your gallbladder) from cholelithiasis (gallbladder stones)?

nausea after ingestion of high-fat foods A client with cholecystitis from cholelithiasis may experience nausea, vomiting, abdominal discomfort, and other gastrointestinal symptoms after eating high-fat foods. This is due to decreased fat absorption related to lack of normal bile flow from the gallbladder.

barium study

no eating or drinking for 6 to 8 hours before the test.

A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent colostomy. This tube will most likely be removed when the client demonstrates:

passage of gas and fecal material from the colostomy. A sign indicating that a client's colostomy is open and ready to function is passage of feces and flatus. When this occurs, gastric suction is ordinarily discontinued, and the client is allowed to start taking fluids and food orally.

severe RLQ pain that suddenly resolves

prepare for sx b/c this could be a sign of ruptured appendix

cholecystectomy

removal of gallbladder complication: Resp complications d/t location of sx so use IS q2h

common causes of metabolic alkalosis

vomiting or gastric suction

gastrectomy, when can pt begin liquid diet?

when bowel sounds are heard