Upper GI Problems

Which of the conditions is not a common cause of an upper gastrointestinal (GI) bleed?

Cholecystitis affects the gastrointestinal system but is not associated with an upper GI bleed. Esophageal varices, stomach cancer, and NSAIDS are common causes of an upper GI bleed.

When administering a dose of ondansetron (Zofran), the nurse would teach the patient to report which common adverse effect?

Headache that is severe enough to require an analgesic medication is a common adverse effect of ondansetron. The patient should be taught to report this symptom to the nurse. Double vision and paresthesias are not adverse reactions associated with ondansetron. Nausea would indicate the ondansetron was not effective.

The nurse is preparing to administer a dose of octreotide (Sandostatin) to a patient who is experiencing an acute episode of upper gastrointestinal (GI) bleeding and is waiting for an endoscopy procedure. The nurse knows that the octreotide will have which mechanism of action? Select all that apply.

Octreotide is a somatostatin analog that works by reducing blood flow to the GI tract and reduces hydrochloric acid secretion by reducing the release of gastrin. Octreotide does not increase production of mucus in the stomach. Epinephrine, when injected during an endoscopy procedure, produces hemostasis by causing tissue edema and pressure on the source of bleeding. Vasopressin (Pitressin) works by causing vasoconstriction, reducing pressure in the portal circulation and stopping the bleeding.

The postoperative patient states that he or she has never taken pantoprozole (Protonix) in the past. The patient asks why he or she is getting this medication if the patient has never had heartburn. What is the best response by the nurse?

Pantoprazole is a proton-pump inhibitor which decreases acid production in the stomach. It minimizes damage to the gastric mucosa while the patient is on bed rest and hospitalized after surgery. Pantoprazole will not prevent gas pains and will not prevent stomach bleeding from surgery. Heartburn is not a side effect of diabetes.

The nurse is giving a patient instructions regarding the management of gastroesophageal reflux disease (GERD). Which statement indicates that further teaching is required?

Patients with GERD should be instructed to avoid milk, especially at bedtime, because it increases gastric acid secretion. There is not a specific diet for GERD, but rather the recommendation to avoid particular foods. Small frequent meals are recommended to prevent gastric distention. Chewing gum increases salivation and helps reduce a mild presentation of symptoms.

The nurse is teaching a patient preventive strategies to avoid staphylococcal poisoning. Which action indicates effective learning?

Immediate refrigeration of foods helps prevent staphylococcal poisoning. The nurse should instruct the patient to eat food immediately after cooking it, as it prevents the growth of microorganisms. Boiling canned food for 15 minutes before eating prevents botulism. Cooking meat at a high temperature prevents food poisoning.

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, board-like abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate?

A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Oral bicarbonate would not be given as the client would be nothing by mouth, and gastric pH testing is not a priority . Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term.

The nurse is teaching a patient about measures to prevent Salmonella poisoning. Which action indicates effective learning?

Improperly cooked eggs are a source of Salmonella typhimurium. Avoiding improperly cooked eggs prevents Salmonella poisoning. Contaminated cheese contains Escherichia coli (E. coli) and therefore causes E. coli poisoning. Canned food poses a risk of botulism. Rewarmed meat contains Clostridium perfringens and may cause clostridial poisoning.

During rounds, the nurse notes that a patient who had a total gastrectomy the day before has a very small amount of fluid draining from the nasogastric (NG) tube. What is the nurse's priority action?

After total gastrectomy, the NG tube does not drain a large quantity of secretions because removal of the stomach has eliminated the reservoir capacity. The nurse will only need to continue to monitor the patient and the NG tube drainage. Increasing the level of suction places the patient at higher risk for acid-base balance. Irrigating the NG tube is not necessary. The health care provider does not need to be notified, as this is a normal finding.

After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, the nurse explains that what may be experienced as a common temporary adverse effect of the medication?

Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine.

After administering a dose of promethazine (Phenergan), the nurse explains that which common temporary adverse effect may occur?

Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Urinary retention, tinnitus, and a sensation of falling are not considered common adverse effects of promethazine.

In assessing the vital signs of a patient with an upper gastrointestinal (GI) bleed, it is important to determine whether the patient is in which kind of shock?

Although fluctuations in vital signs occur in neurogenic, cardiogenic, and septic shock states, these fluctuations are not associated with blood loss. However, signs and symptoms of hypovolemic shock caused by GI blood loss, such as elevated heart rate, respiratory rate, and decreased blood pressure, would be evident. Assessment of the patient's vital signs assist the nurse in determining whether patient is in hypovolemic shock.

A patient undergoes gastrectomy. What should the nurse recommend to decrease the symptoms of dumping syndrome?

Avoiding fluids with meals prevents dilution and liquefaction of food and thus slows the movement of food into the jejunum. Postgastrectomy patients are often instructed to eat "dry" meals. Remaining in a high Fowler's position after meals may increase the risk for dumping syndrome. A diet high in carbohydrates, especially simple carbohydrates, increases the risk of dumping syndrome. Taking fluids with meals causes stomach contents to empty more rapidly into the jejunum, resulting in dumping syndrome.

A patient underwent abdominal surgery 4 days ago and has sutures in the upper epigastric region. Which is the most appropriate initial nursing intervention to prevent pulmonary complications?

Splinting the incision site with a pillow reduces the pain during coughing and deep breathing and should be taught first. Steam inhalation and bronchodilator drugs also prevent pulmonary complications but are more useful if the patient is not able to remove pulmonary secretions by himself. Early ambulation is also a measure to prevent pulmonary complications but is not applicable in the early phase of care.

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient?

Because of this patient's history of excessive alcohol intake, smoking, hemoptysis, and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of carcinoma, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. Capsule endoscopy can show alterations in the esophagus, but more often is used for small intestine problems. An endoscopic ultrasonography may be used to stage esophageal cancer. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer when it is suspected.

The nurse is giving care guidelines to the caregiver of a patient with candidiasis. During the follow-up visit, the nurse finds that there the patient's condition has improved. Which actions of the caregiver does the nurse anticipate are responsible for improving the patient's condition? Select all that apply.

Candidiasis is a fungal infection of the mouth. The tongue, cheeks, and mouth are covered by yeast, and the mouth is sore. A patient with candidiasis has difficulty swallowing. Therefore, providing soft and nutritious food is beneficial. Lemons, oranges, and tomatoes contain citric acid, which aggravate the soreness. Therefore, avoiding citrus fruits is helpful. Using antiseptic mouthwash kills the viable candida, and is therefore beneficial to the patient. Spicy food should be avoided in patients with candidiasis, because spices irritate the ulcers and may worsen the patient's condition. Warm compresses are given if the patient has inflammation. Hence, this intervention is not beneficial to the patient.

A patient with gastroesophageal reflux disease (GERD) is on cimetidine therapy. Which parameter does the nurse monitor to provide effective care?

Cimetidine is a histamine-receptor used in the treatment of peptic ulcer and GERD. Cimetidine decreases gastric motility and causes constipation. Therefore, the nurse monitors the patient for any changes in bowel sounds. This may help with early detection of constipation. Cimetidine does not have extrapyramidal side effects and does not cause motor incoordination. Cimetidine does not alter serum calcium or magnesium levels.

A patient complains of nausea. When administering a dose of metoclopramide (Reglan), the nurse should teach the patient to report which potential adverse effect?

Extrapyramidal side effects, including tremors and tardive dyskinesia, may occur as a result of metoclopramide administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide. Anxiety, tremor, and hallucinations are adverse reactions. Uncontrolled movement of the mouth is a sign of tardive dyskinesia, which is a possibly irreversible extrapyramidal adverse effect of metoclopramide. The nurse should withhold the dose and notify the health care provider of this development to maintain patient safety. Altered sense of smell and bradycardia are not known adverse reactions from metoclopramide.

A patient who is admitted with an upper gastrointestinal bleed has a history of two previous heart attacks and is presently being given large doses of intravenous fluids. Which possible complication(s) should the nurse monitor the patient for? Select all that apply.

First, the patient is being given large doses of fluids in a short period of time, which can result in volume overload. This may eventually cause cardiac failure and subsequent pulmonary edema. Also, the patient has had two previous heart attacks, which means heart function is compromised. Intravenous fluids are unlikely to cause conduction abnormalities, infection, or vomiting.

A patient has had esophageal surgery, and a jejunostomy feeding tube is inserted to administer oral fluids. The nurse has been told to check for signs of intolerance and leakage of feeding into the mediastinum. Which signs should the nurse be observant for? Select all that apply.

With tube feedings, the patient should be observed for signs of intolerance of feeding or leakage of the feeding into the mediastinum. Symptoms that indicate leakage are pain, dyspnea, and increased temperature. Feeding is done through the tube in an upright position; therefore, the chance of acid reflux is unlikely. Tachycardia doesn't occur immediately as a sign of leakage into the mediastinum.

The nurse is obtaining a health history from a patient who comes to the office for evaluation of gastric distress. The patient indicates that the symptoms occur two to five hours after meals, and the pain is "burning" and sometimes like a cramp in the midepigastric region, just below the xiphoid process. Based on these descriptions, the nurse suspects that the patient has which disorder?

The symptoms of duodenal ulcers occur when gastric acid comes in contact with the ulcers. With meal ingestion, food is present to help buffer the acid. Symptoms of duodenal ulcers occur generally two to five hours after a meal. The pain is described as "burning" or "cramplike." It most often is located in the midepigastric region beneath the xiphoid process. Duodenal ulcers also can produce back pain. The discomfort generally associated with gastric ulcers is located high in the epigastrium and occurs about one to two hours after meals. The pain is described as "burning" or "gaseous." If the ulcer has eroded through the gastric mucosa, food tends to aggravate rather than alleviate the pain. For some patients, the earliest symptoms are caused by a serious complication, such as perforation. Pain and burning two to five hours after meals are not symptoms of esophagitis or chronic gastritis. A patient with a gastric ulcer will experience pain one to two hours after meals.

A patient has had persistent nausea and vomiting for the last 5 days. Which immediate nursing interventions available are appropriate for this patient? Select all that apply.

The vital signs should be monitored continuously to determine the physiological state of the patient. Patients with persistent vomiting should immediately be put on NPO status (no food or liquid by mouth) and should be given intravenous fluids to prevent dehydration. A nasogastric tube should be placed for aspiration of stomach contents. Opioids induce vomiting and hence should not be administered. Persistent vomiting would induce fatigue, and physical activity would worsen the condition of the patient.

A 72-year-old patient was admitted with epigastric pain caused by a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care?

A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain three to four hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain one to two hours after a meal is from an expected manifestation with a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.

A nurse is teaching an obese patient with gastroesophageal reflux disease (GERD) measures that should be taken to prevent complications. What instructions should the nurse give? Select all that apply.

In an obese person, the intra-abdominal pressure is increased, which can exacerbate GERD. Maintaining a low-fat diet could help in losing weight and therefore relieve the condition. Tea, coffee, and nicotine (a component of cigarettes) are known to decrease the lower esophageal sphincter pressure, aggravating GERD. Patients with GERD are prescribed cholinergic drugs to relieve their condition. Anticholinergic drugs, on the other hand, affect the lower esophageal sphincter pressure and may therefore cause GERD. Lying down immediately after having food may promote the movement of food toward the esophageal sphincter and increase the pressure on it, therefore exacerbating the condition.

The nurse is caring for a patient with chronic gastritis. Which of these symptoms is associated specifically with this condition?

In chronic gastritis the manifestations are similar to those described for acute gastritis. Patients with acute gastritis and chronic gastritis may experience nausea and vomiting or hemorrhage. However, with chronic gastritis, when the parietal cells are lost as a result of atrophy, the source of intrinsic factor is also lost. The loss of intrinsic factor, a substance essential for the absorption of cobalamin in the terminal ileum, ultimately results in cobalamin deficiency. With time, the body's storage of cobalamin in the liver becomes depleted, and a state of deficiency exists. Diarrhea is not associated with gastritis.

The patient has a prescription for rabeprazole (Aciphex). The nurse would assess the effectiveness of the medication by noting whether the patient obtained relief from which symptom?

Rabeprazole is a proton pump inhibitor that provides relief of gastric discomfort and heartburn by neutralizing gastric acid. This medication would not be effective in the treatment of abdominal pain, flatulence, or constipation.

The nurse is involved in a health promotion program for teenagers related to the potential development of oral cancer. The behaviors that can put a person at risk for oral cancer include which of the following? Select all that apply.

Risk factors for oral cancer include use of smokeless tobacco, overexposure to the sun, and excessive intake of alcohol. Chewing gum and drinking carbonated beverages do not cause or place a patient at risk for oral cancer.

A patient is experiencing persistent vomiting with emesis consisting of contents from the small intestine. Which alteration in blood gas will the nurse expect to occur?

Metabolic acidosis occurs when contents of the small intestine are vomited because of the loss of sodium bicarbonate. Metabolic alkalosis occurs when there is a loss of gastric hydrochloric (HCL) acid. Sodium bicarbonate is secreted by the pancreas into the small intestines. The respiratory alkalosis or respiratory acidosis that would occur in the presence of the metabolic states would be a compensatory response.

A nurse is teaching a patient about prevention of peptic ulcers. What instructions should the nurse give the patient? Select all that apply.

Nicotine, a component of cigarettes, causes gastric irritation, and therefore smoking should be avoided by those with peptic ulcers. Washing hands thoroughly with soap after using the restroom and before eating would help prevent the Helicobacter pylori infection that causes peptic ulcers. Any symptom of gastric irritation such as nausea and epigastric pain must be reported to the health care provider to prevent lethal consequences of peptic ulcer disease. Consumption of raw uncooked food increases the chance of H. pylori infection; therefore, it should be avoided. NSAIDs should not be taken for a long period of time, as they are a potent gastric irritant.

The nurse is teaching care management to a patient with gastroesophageal reflux disease (GERD). In the follow-up visit, the patient complains of severe heartburn. Which actions indicate the need for further teaching? Select all that apply.

Oranges are a source of citric acid. Eating acidic foods aggravates the symptoms of gastroesophageal reflux disease (GERD). Ice cream is rich in fatty acids. Fats tend to decrease lower esophageal sphincter (LES) pressure, resulting in regurgitation of stomach acid. Drinking a cup of milk at bedtime increases gastric acid secretion. Therefore, the nurse recommends that the patient avoid oranges, ice cream, and milk. Drinking 2 L of water neutralizes the pH of stomach acid and reduces the symptoms of GERD. Chewing gum increases the production of saliva, thereby helping neutralize the pH of gastric acid. Ginger is known for its antiinflammatory and antacid activities.

Several patients are seen at an urgent care center with symptoms of nausea, vomiting, and diarrhea that began two hours ago while attending an office picnic. The nurse will question the patients about foods they ate that included which of these? Select all that apply.

Staphylococcus aureus toxins provoke onset of symptoms (i.e., vomiting, nausea, abdominal cramping, and diarrhea) within 30 minutes and up to 7 hours. Meat, bakery products, cream fillings, salad dressings, and milk are the usual sources from the skin and respiratory tract of food handlers. Fried chicken and home-preserved vegetables are not correct; other food-borne illnesses become evident after eight hours.

A nurse assesses a patient with suspected peptic ulcer disease. Which symptom will the patient most likely report?

Symptoms of peptic ulcer disease (PUD) are variable and often absent. However, discomfort, if present, may occur before meals or 2 to 3 hours after meals and at bedtime. The discomfort may be relieved by eating because the food will dilute and buffer gastric acid. Although vomiting or abdominal distention after meals may occur, they are less likely to be associated with PUD than is the relief caused by eating.

A patient is admitted to the hospital with a severe duodenal ulcer. The patient suddenly complains of severe pain spreading over the entire abdomen, likely due to a perforation. What should be the most immediate intervention by the nurse, if prescribed?

The immediate focus of management for a patient with a perforation is to stop the spillage of gastric or duodenal contents into the peritoneal cavity and restore blood volume. An NG tube is inserted into the stomach to provide continuous aspiration and gastric decompression to stop spillage through the perforation and thereby prevent peritonitis. Administering nitrates to such a patient will not be helpful in relieving the condition. Administration of pain medications and preparations for laparoscopic surgery are done later.

The nurse is interviewing a patient with a duodenal ulcer. Which characteristic of pain is the nurse likely to find?

The pain related to a duodenal ulcer is cramplike and appears 5 to 6 hours after a meal. The pain is located in the midepigastric region beneath the xiphoid process. The pain is relieved by food intake.

The nurse is conducting patient teaching regarding aspirin. Which medication should the nurse teach to avoid while taking aspirin?

The patient should not take celecoxib while taking ibuprofen because the combination could increase the risk of gastrointestinal bleeding. Aspirin can be administered concurrently with acetaminophen, diltiazem, or digoxin.

The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit?

The patient will have bloody drainage from the NG tube for 8 to 12 hours and it should not be repositioned or reinserted without contacting the health care provider. Turning and deep breathing will be done every two hours and the spirometer will be used more often than every four hours. Coughing would put too much pressure in the area and should not be done. Because the patient will have the NG tube, the patient will not be eating yet. The patient should be kept in a semi-Fowler or Fowler position, not supine, to prevent reflux and aspiration of secretions.

The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. The nurse should know that which drugs probably will be used for this patient?

To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori. An antiulcer would not be effective to eradicate H. pylori .

Following a gastrectomy performed for peptic ulcer disease, the patient has recovered and is ready for discharge. What instructions should the nurse include in discharge teaching to prevent dumping syndrome?

To prevent dumping syndrome after gastrectomy, the patient should avoid large meals, instead dividing meals into six small meals to avoid overloading the intestines at mealtimes. Fluids should not be taken with meals. Fluids can be taken at least 30 to 45 minutes before or after meals. This helps prevent distension or a feeling of fullness. Concentrated sweets should be avoided because they sometimes cause dizziness, diarrhea, and a sense of fullness. Protein and fats should be increased in the diet to help rebuild body tissue and to meet energy needs.

The nurse is teaching care guidelines to the caregiver of a patient with upper gastrointestinal (GI) bleeding. In the follow-up visit, the patient complains of traces of blood in the vomit. Which action of the patient's caregiver is responsible for the patient's condition?

Traces of blood in the vomit indicate gastrointestinal bleeding. When given on an empty stomach, aspirin irritates the gastrointestinal mucosa and causes gastrointestinal (GI) bleeding. Therefore, it should be taken along with meals or snacks. Alcohol consumption aggravates the symptoms of hyperacidity. However, drinking 10 mL of alcohol once a month will not cause GI bleeding. Coadministration of nonsteroidal antiinflammatory drugs (NSAIDs) and proton-pump inhibitors reduces the risk of bleeding. Deep-breathing provides relaxation and does not cause GI bleeding.

The nurse is assisting a patient who has been admitted with severe abdominal pain. Suddenly, the patient vomits a large amount of emesis that looks similar to coffee grounds. Which action by the nurse is a priority?

Vomitus with a "coffee ground" appearance is related to gastric bleeding, where blood changes to dark brown as a result of its interaction with HCl acid. The primary health care provider needs to be notified immediately about this change in the patient's condition. Asking the patient about the timing of the last meal and monitoring the patient are appropriate, but not the priority. The nurse should not offer water just in case the patient may have to have a diagnostic study that requires nothing by mouth (NPO) status.