Ch 21: GI Disorders and Therapeutic Management jk
A patient is admitted with the diagnosis of acute pancreatitis. The nurse expects which laboratory values to be elevated? (Select all that apply.) a.Calcium b.Serum amylase c.Serum glucose d.Potassium e.WBC f.Serum lipase
b.Serum amylase c.Serum glucose e.WBC f.Serum lipase Serum amylase, serum glucose, serum lipase, and WBCs are all elevated in acute pancreatitis while calcium and potassium decrease with acute pancreatitis.
A patient with a history of chronic alcoholism was admitted with acute pancreatitis. The nurse is developing a patient education plan. Which topic would the nurse include in the plan? a.Diabetes management b.Alcohol cessation c.Occult blood testing d.Anticoagulation management
b.Alcohol cessation As the patient moves toward discharge, teaching should focus on the interventions necessary for preventing the recurrence of the precipitating disorder. If an alcohol abuser, the patient should be encouraged to stop drinking and be referred to an alcohol cessation program.
Which nursing intervention is a priority for a patient with gastrointestinal hemorrhage? a.Positioning the patient in a high-Fowler position b.Ensuring the patient has a patent airway c.Irrigating the nasogastric tube with iced saline d.Maintaining venous access so that fluids and blood can be administered
b.Ensuring the patient has a patent airway Priorities in the medical management of a patient with gastrointestinal hemorrhage include airway protection, fluid resuscitation to achieve hemodynamic stability, correction of co-morbid conditions (e.g., coagulopathy), therapeutic procedures to control or stop bleeding, and diagnostic procedures to determine the exact cause of the bleeding.
A patient has been admitted with pancreatitis. Which clinical manifestations would the nurse expect to observe in support of this diagnosis? (Select all that apply.) a.Epigastric and abdominal pain b.Nausea and vomiting c.Diaphoresis d.Jaundice e.Hyperactive bowel sounds f.Fever
a.Epigastric and abdominal pain b.Nausea and vomiting c. Diaphoresis d.Jaundice f.Fever Clinical manifestations of acute pancreatitis include pain, vomiting, nausea, fever, abdominal distention, abdominal guarding, abdominal tympany, hypoactive or absent bowel sounds, severe disease, peritoneal signs, ascites, jaundice, palpable abdominal mass, Grey Turner sign, Cullen sign, and signs of hypovolemic shock. There may be peritonitis involved with pancreatitis and percussion will reveal a tympanic abdomen; bowel sounds will be decreased or absent.
A patient with a history of chronic alcoholism was admitted with acute pancreatitis. What intervention would the nurse include in the patient's plan of care? a.Monitor the patient for hypovolemic shock from plasma volume depletion. b.Observe the patient for hypoglycemia and hypercalcemia. c.Initiate enteral feedings after the nasogastric tube is placed. d.Place the patient on a fluid restriction to avoid the fluid sequestration.
a.Monitor the patient for hypovolemic shock from plasma volume depletion. Because pancreatitis is often associated with massive fluid shifts, intravenous crystalloids and colloids are administered immediately to prevent hypovolemic shock and maintain hemodynamic stability. Electrolytes are monitored closely, and abnormalities such as hypocalcemia, hypokalemia, and hypomagnesemia are corrected. If hyperglycemia develops, exogenous insulin may be required.
A patient is admitted with a gastrointestinal hemorrhage due to esophagogastric varices. The nurse knows that varices are caused by which pathophysiologic mechanism? a.Portal hypertension b.Superficial mucosal erosions c.Breakdown the mucosal resistance d.Inflammation and ulceration
a.Portal hypertension Esophagogastric varices are engorged and distended blood vessels of the esophagus and proximal stomach that develop as a result of portal hypertension secondary to hepatic cirrhosis, a chronic disease of the liver that results in damage to the liver sinusoids. Without adequate sinusoid function, resistance to portal blood flow is increased, and pressures within the liver are elevated. This leads to a rise in portal venous pressure (portal hypertension), causing collateral circulation to divert portal blood from areas of high pressure within the liver to adjacent areas of low pressure outside the liver, such as into the veins of the esophagus, spleen, intestines, and stomach.
The nurse is caring for a patient after an esophagectomy. In the immediate postoperative period, which nursing intervention would have the highest priority? a.Preventing atelectasis b.Managing pain c.Promoting ambulation d.Preventing infection
a.Preventing atelectasis It is imperative to appropriately manage the patient's pain after GI surgery. Adequate analgesia is necessary to promote the mobility of the patient and decrease pulmonary complications. Initial pain management may be accomplished by intravenous opioid (morphine, hydromorphone) administration by means of a patient-controlled analgesia (PCA) pump, or through continuous epidural infusion of an opioid and local anesthetic (bupivacaine).
A patient is admitted with an upper gastrointestinal bleed. Which disorder is the leading cause of upper gastrointestinal (GI) hemorrhage? a. Stress ulcers b. Peptic ulcers c. Nonspecific erosive gastritis d. Esophageal varices
b. Peptic ulcers Peptic ulcer disease (gastric and duodenal ulcers), resulting from the breakdown of the gastromucosal lining, is the leading cause of upper GI hemorrhage, accounting for approximately 21% of cases.
A patient was admitted with severe epigastric pain and has been diagnosed with cancer. The patient is scheduled for an esophagectomy. The patient asks about the procedure. What would be an appropriate response from the nurse? a."This procedure is usually performed for cancer of the proximal esophagus and gastroesophageal junction." b."This procedure is usually performed for cancer of the distal esophagus and gastroesophageal junction." c."This procedure is usually performed for cancer of the pancreatic head." d."The procedure is usually performed for varices of the distal esophagus and gastroesophageal junction."
b."This procedure is usually performed for cancer of the distal esophagus and gastroesophageal junction." Esophagectomy is usually performed for cancer of the distal esophagus and gastroesophageal junction.
A patient with acute pancreatitis is complaining of a pain in the left upper quadrant. Using a 1- to 10-point pain scale, the patient states the current level is at an 8. What intervention would the nurse include in the patient's plan of care to facilitate pain control? a.Administer analgesics only as needed. b.Administer analgesics around the clock. c.Educate the patient and family on lifestyle changes. d.Teach relaxation and distraction techniques.
b.Administer analgesics around the clock. Pain management is a major priority in acute pancreatitis. Administration of around-the-clock analgesics to achieve pain relief is essential. Morphine, fentanyl, and hydromorphone are the commonly used narcotics for pain control. Relaxation techniques and the knee-chest position can also assist in pain control. However, the patient's pain needs to be addressed first.
A patient has been admitted with acute liver failure. Which interventions would the nurse expect as part of the interprofessional collaborative management plan? (Select all that apply.) a.Administer benzodiazepines for agitation. b.Monitor oxygen saturation. c.Initiate an insulin drip for hyperglycemia. d.Monitor serum electrolyte levels. e.Assess for signs of cerebral edema.
b.Monitor oxygen saturation. d.Monitor serum electrolyte levels. e.Assess for signs of cerebral edema. The patient may experience a variety of other complications, including cerebral edema, cardiac dysrhythmias, acute respiratory failure, sepsis, and acute kidney injury. Cerebral edema and increased intracranial pressure develop as a result of breakdown of the blood-brain barrier and astrocyte swelling. Circulatory failure that mimics sepsis is common in acute liver failure and may exacerbate low cerebral perfusion pressure. Hypoxemia, acidosis, electrolyte imbalances, and cerebral edema can precipitate the development of cardiac dysrhythmias. Acute respiratory failure, progressing to acute respiratory distress syndrome, intrapulmonary shunting, ventilation-perfusion mismatch, sepsis, and aspiration may be attributed to the universal arterial hypoxemia.
The nurse is caring for a patient after an esophagectomy. The nurse knows the patient is at risk for an anastomotic leak. Which finding would indicate this occurrence? a.Crackles in the lung bases b.Subcutaneous emphysema c.Incisional bleeding d.Absent of bowel sounds
b.Subcutaneous emphysema The clinical signs and symptoms include tachycardia, tachypnea, fever, abdominal pain, anxiety, and restlessness. In a patient who had an esophagectomy, a leak of the esophageal anastomosis may manifest as subcutaneous emphysema in the chest and neck.
A patient is admitted with a gastrointestinal hemorrhage due to esophagogastric varices. What medication would the nurse expect the practitioner to order for this patient? Select all that apply a.Histamine2 (H2) antagonists b.Vasopressin c.Heparin d.Antacids e. Somatostatin f. Octerotide
b.Vasopressin e. Somatostatin f. Octerotide In acute variceal hemorrhage, control of bleeding can be accomplished through the use of pharmacologic agents. Intravenous vasopressin, somatostatin, and octreotide have been shown to reduce portal venous pressure and slow variceal hemorrhaging by constricting the splanchnic arteriolar bed.
A patient was admitted after a Roux-en-Y gastric bypass (RYGBP). A nursing student asks the nurse what type of surgery is a RYGBP. What would be an appropriate response from the nurse? a."It is an esophagectomy performed using the transthoracic approach." b."It is an esophagectomy performed using a transhiatal approach." c."It is a combination of restrictive and malabsorption types of bariatric surgery. d."It is a standard operation for pancreatic cancer."
c."It is a combination of restrictive and malabsorption types of bariatric surgery. Bariatric procedures are divided into three broad types: (1) restrictive, (2) malabsorptive, and (3) combined restrictive and malabsorptive. The Roux-en-Y gastric bypass combines both strategies by creating a small gastric pouch and anastomosing the jejunum to the pouch. Food then bypasses the lower stomach and duodenum, resulting in decreased absorption of digestive materials. The standard operation for pancreatic cancer is a pancreaticoduodenectomy, also called the Whipple procedure.
The nurse is caring for a patient with acute liver failure. The practitioner asks the nurse to assess the patient for asterixis. How should the nurse assess for this symptom? a.Inflate a blood pressure cuff on the patient's arm. b.Have the patient bring the knees to the chest. c.Have the patient extend the arms and dorsiflex the wrists. d.Dorsiflex the patient's foot.
c.Have the patient extend the arms and dorsiflex the wrists. The patient should be evaluated for the presence of asterixis, or "liver flap," best described as the inability to voluntarily sustain a fixed position of the extremities. Asterixis is best recognized by downward flapping of the hands when the patient extends the arms and dorsiflexes the wrists.
The nurse is caring for a patient with acute liver failure. The patient has elevated ammonia levels. Which medication would the nurse expect the practitioner to order for this patient? a.Insulin b.Vitamin K c.Lactulose d.Lorazepam
c.Lactulose Lactulose, a synthetic Ketoanalogue of lactose split into lactic acid and acetic acid in the intestine, is given orally through a nasogastric tube or as a retention enema. The result is the creation of an acidic environment that results in ammonia being drawn out of the portal circulation. Lactulose has a laxative effect that promotes expulsion. Vitamin K is used to help control bleeding. Insulin would be given to control hyperglycemia. Use of benzodiazepines and other sedatives is discouraged in a patient with ALF because pertinent neurologic changes may be masked, and hepatic encephalopathy may be exacerbated.
A patient was admitted with acute pancreatitis. The nurse understands that pancreatitis occurs as a result of what pathophysiologic mechanism? a.Uncontrolled hypoglycemia caused by an increased release of insulin b.Loss of storage capacity for senescent red blood cells c.Premature activation of inactive digestive enzymes, resulting in autodigestion d.Release of glycogen into the serum, resulting in hyperglycemia
c.Premature activation of inactive digestive enzymes, resulting in autodigestion In acute pancreatitis, the normally inactive digestive enzymes become prematurely activated within the pancreas itself, creating the central pathophysiologic mechanism of acute pancreatitis, namely autodigestion.
A Salem sump nasogastric tube has two lumens. The first lumen is for suction and drainage. What is the purpose of the second lumen? a.Allows for administration of tube feeding. b.Allows for testing of gastric secretions. c.Prevents tube from adhering to the gastric wall. d.Prevents the tube from advancing.
c.Prevents tube from adhering to the gastric wall. The Salem sump has one lumen that is used for suction and drainage and another that allows air to enter the patient's stomach and prevents the tube from adhering to the gastric wall and damaging the mucosa.
A patient is admitted with a severe head injury. The nurse knows that critically ill patients are at risk for gastrointestinal hemorrhage due to stress-related mucosal disease. The nurse would monitor the patient for which signs and symptoms? a.Metabolic acidosis and hypovolemia b.Decreasing hemoglobin and hematocrit c.Hyperkalemia and hypernatremia d.Hematemesis and melena
d.Hematemesis and melena The initial clinical presentation of the patient with acute gastrointestinal (GI) hemorrhage is that of a patient in hypovolemic shock; the clinical presentation depends on the amount of blood lost. Hematemesis (bright red or brown, coffee grounds emesis), hematochezia (bright red stools), and melena (black, tarry, or dark red stools) are the hallmarks of GI hemorrhage.
