Upper Gastrointestinal Problems

A large number of children at a public school have developed profuse diarrhea and bloody stools. The school nurse suspects food poisoning related to food from the school cafeteria and requests analysis and culture of which food?

Ground beef.

Which lab findings should the nurse expect in the patient with persistent vomiting?

High pH, low potassium, high hematocrit.

A patient who has been vomiting for several days from an unknown cause is admitted to the hospital. What should the nurse anticipate will be included in collaborative care?

IV replacement of fluid and electrolytes.

What physiologically occurs with vomiting?

Immediately before the act of vomiting, activation of the parasympathetic nervous system cases increased salivation, increased gastric motility, and relaxation of the lower esophageal sphincter.

Ondansetron (Zofran) is prescribed for a patient with cancer chemotherapy- induced vomiting. What should the nurse understand about this drug?

It relieves vomiting centrally by action in the vomiting center and peripherally by promoting gastric emptying.

A patient with cancer of the stomach at the lesser curvature undergoes a total gastrectomy with an esophagojejunostomy. Postoperatively, what should the nurse teach the patient to expect?

Lifelong administration of cobalamin

Nursing management of the patient with chronic gastritis includes teaching the patient to

Maintain a nonirritating diet with six small meals a day

Following a patient's esophagogastrostomy for cancer of the esophagus, what is most important for the nurse to do?

Maintain the patient is a semi- Fowler's or Fowler's position

The nurse determines that teaching for the patient with peptic ulcer disease has been effective when the patient makes which statement?

"I have learned some relaxation strategies that decrease my stress."

Which statement by a patient with dumping syndrome should lead the nurse to determine that further dietary teaching is needed?

"I should eat bread and jam with every meal"

What type of bleeding will a patient with peptic ulcer disease with a slow upper GI source of bleeding have?

Melena

Following a Billroth II procedure, a patient develops dumping syndrome. The nurse should explain that the symptoms associated with the problem are caused by

Movement of fluid into the small bowel because concentrated food and fluids move rapidly into the intestine.

While caring for a patient following a subtotal gastrectomy with a gastroduodenostomy anastomosis, the nurse determines that the NG tube is obstructed. What action should the nurse take first?

Notify the surgeon to reposition or replace the tube

A patient with upper GI bleeding is treated with several drugs. Which drug should the nurse recognize as an agent that is used to decrease bleeding and decrease gastric acid secretions?

Octreotide (Sandostain)

Pyloroplasty

Ofter performed with a vagotomy to increase gastric emptying

Duodenal and gastric ulcers have similar as well as differentiating features. What are characteristics unique to duodenal ulcers?

Pain is relieved by eating food Increased gastric secretion occurs There is burning and cramping in the midepigastric area

What should the nurse emphasize when teaching patients at risk for upper GI bleeding to prevent bleeding episodes?

The use of over the counter medications of any kind should be avoided

A patient is scheduled for biopsy of a painful tongue ulcer. Based on knowledge of the risk factors for oral cancer, what should the nurse specifically ask the patient about during a history?

Use of any type of tobacco products

A patient treated for vomiting is to begin oral intake when the symptoms have subsided. To promote rehydration, the nurse plans to administer which fluid first?

Water

Which patient is at highest risk for having a gastric ulcer?

55- year- old female, smoker, with nausea and vomiting

Regardless of the precipitating factor, what causes the injury to mucosal cells in peptic ulcers?

Acid back diffusion into the mucosa

Which type of gastritis is most likely to occur in a college student who has an isolated drinking binge?

Acute gastritis

The nurse is planning to teach the patient with gastroesophageal reflux disease (GURD) about foods or beverages that decrease lower esophageal sphincter (LES) pressure. What should be included in this list?

Alcohol Chocolate Fatty foods Cola sodas

When caring for a patient with an acute exacerbation of a peptic ulcer, the nurse finds the patient doubled up in bed with shallow, grunting respirations. Which action should the nurse take first?

Assess the patient's abdomen and vital signs

What type of pain does the nurse expect a patient with an ulcer of the posterior portion of the duodenum to experience?

Back pain that occurs 2 to 4 hours following meals

Which esophageal disorder is described as a precancerous lesion associated with GERD?

Barrett's esophagus

The nurse evaluates that management of the patient with upper GI bleeding is effective when assessment and lab finding reveal which result?

Decreasing blood urea nitrogen (BUN)

Corticosteroid medications are associated with the development of peptic ulcers because of which probable pathophysiologic mechanism?

The rate of mucous cell renewal is decreased.

A patient with a gastric obstruction has been treated with NG decompression. After the first 24 hours, the patient develops nausea and increased upper abdominal bowel sounds. What is the best action by the nurse?

Check the patency of the NG tube.

Older patients may have cardiac or renal insufficiency and may be more susceptible to problems from vomiting and antiemetic drug side effects. What nursing intervention is most important to implement with these patients?

Do hourly visual checks or use a sitter to keep patient safe.

A patient with oral cancer has a history of heavy smoking, excessive alcohol intake, and personal neglect. During the patient's early postoperative course, what does the nurse anticipate that the patient may need?

Drug therapy to prevent substance withdrawal symptoms

What does the nurse include when teaching a patient with newly diagnosed peptic ulcer disease?

Eat as normally as possible, eliminating foods that cause pain or discomfort.

A patient with esophageal cancer is scheduled for a partial esophagectomy. Which nursing intervention is likely to be of highest priority preoperatively?

Encourage a high calorie, high protein diet.

Which medication are used to decrease gastric or hydrochloric acid secretion

Famotidine (Pepcid) Omeprazole (Prilosec) Misoprostol (Cytotec) Amoxicillin/ clarithromycin/ omeprazole

What are characteristics of gingivitis?

Formation of abscesses with loosening of teeth

When caring for a patient following a glossectomy with dissection of the floor of the mouth and a radical neck dissection for cancer of the tongue, what is the nurse's primary concern?

Patent airway

Which statements are characteristic of the uses of antacids for peptic ulcer disease

Patients frequently noncompliant with use Prevent conversion of pepsinogen to pepsin High dose and frequency stimulate release of gastrin

A patient is admitted to the emergency department with profuse bright- red hematemesis. During the initial care of the patient, what is the nurse's first priority?

Perform a focused assessment of the patient's status.

Billroth I

Removal of distal two thirds of stomach with anastomosis to duodenum

Billroth II

Removal of distal two thirds of stomach with anastomosis to jejunum

What is the rationale for treating acute exacerbation of peptic ulcer disease with NG intubation?

Remove stimulation for hydrochloric acid and pepsin secretion by keeping the stomach empty

Vagotomy

Severing of parasympathetic nerve to decrease gastric secretion

How should the nurse teach the patient with a hiatal hernia or GERD to control symptoms?

Sleep with the head of the bed elevated on 4 to 6 inch blocks.

Which infection or inflammation is found related to systemic disease and cancer chemotherapy?

Stomatitis (inflammation of mouth)

A patient with a history of peptic ulcer disease is hospitalized with symptoms of a perforation. During the initial assessment, what should the nurse expect the patient to report?

Sudden, severe upper abdominal pain and back pain

What is an accurate description of eosinophilic esophagitis?

Swelling of the esophagus caused by an allergic response to food or environmental triggers