Chapter 40: Management of Patients with Gastric and Duodenal Disorders

A client comes to the clinic reporting pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if the client has a peptic ulcer? "Does your pain get worse if you get up and do some exercise?" "Do you find that your pain is worse when you need to have a bowel movement?" "Do over-the-counter pain medications help your pain?" "Does your pain resolve when you have something to eat?"

"Does your pain resolve when you have something to eat?" Pain relief after eating is associated with peptic ulcers. The pain of peptic ulcers is generally unrelated to activity or bowel function and may or may not respond to analgesics.

A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching? "I'm going to visit my pastor weekly for a while." "I will have to take vitamin B12 shots up to 1 year after surgery." "I will weight myself each day and record the weight." "I will call my physician if I begin to have abdominal pain."

"I will have to take vitamin B12 shots up to 1 year after surgery." After a total gastrectomy, a client will need to take vitamin B12 shots for life. Dietary B12 is absorbed in the stomach, and the inability to absorb it could lead to pernicious anemia. Visiting clergy for emotional support is normal after receiving a cancer diagnosis. This action should be encouraged by the nurse. It's appropriate for the client to call the physician if he experiences signs and symptoms of intestinal blockage or obstruction, such as abdominal pain. Because a client with a total gastrectomy will receive enteral feedings or parenteral feedings, he should weigh himself each day and keep a record of the weights.

A client with an H. pylori infection asks why bismuth subsalicylate is prescribed. Which response will the nurse make? "It enhances the function of the pyloric sphincter." "It helps propel food from the stomach into the duodenum." "It aids in the healing of the stomach lining." "It improves digestion in the stomach."

"It aids in the healing of the stomach lining." Bismuth subsalicylate suppresses H. pylori bacteria in the gastric mucosa and assists with healing of mucosal ulcers. It does not affect digestion, enhance the function of the pyloric sphincter, or propel food from the stomach into the duodenum.

A client with peptic ulcer disease asks for pain medication. Which response will the nurse make? "I will ask the health care provider to prescribe pain medication." "The medications for the ulcer will reduce the pain." "Eating more food will help reduce the pain." "Using pain medication is what caused the ulcer to develop."

"The medications for the ulcer will reduce the pain." The relief of pain from a peptic ulcer can be achieved by taking the medications as prescribed. Medications prescribed to treat the peptic ulcer should provide relief of ulcer-associated pain. Meals should be eaten at regular intervals; however, more food will not reduce the pain. The nurse has no way of knowing the true cause of the client's peptic ulcer. There is no reason to ask the health care provider to prescribe pain medication.

A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen? "These medications will coat the ulcer and decrease the acid production in my stomach." "I should take these medications only when I have pain from my ulcer." "My ulcer will heal because these medications will kill the bacteria." "The medications will kill the bacteria and stop the acid production."

"The medications will kill the bacteria and stop the acid production." Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton-pump inhibitors, and bismuth salts that suppress or eradicate H. pylori. Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton-pump inhibitor and bismuth salts (Pepto-Bismol). Research is being conducted to develop a vaccine against H. pylori.

A client being treated for a peptic ulcer seeks medical attention for vomiting blood. Which statement indicates to the nurse the reason for the client developing hematemesis? "I only ate dinner yesterday and it gave me an upset stomach." "I felt better but then just got really nauseated and threw up." "The pain stopped so I stopped taking the medications." "I think the soda that I drank irritated my stomach."

"The pain stopped so I stopped taking the medications." The client should be instructed to adhere to and complete the medication regimen to ensure complete healing of the peptic ulcer. Because most clients become symptom free within a week, it should be stressed to the client the importance of following the prescribed regimen so that the healing process can continue uninterrupted and the return of symptoms can be prevented. Since the client stopped taking the medication, the ulcer was not healed and became worse. The statements about soda, being nauseated, and eating only one meal would not explain the reason for the client's new onset of hematemesis during treatment for a peptic ulcer.

A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? 4 to 6 days 7 to 9 days 15 to 20 days 10 to 14 days

10 to 14 days Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton pump inhibitor and bismuth salts (Pepto-Bismol).

A client weighing 165 lb. (75 kg) is being treated for acute gastritis. Which amount of urine output for 4 hours would indicate an adequate fluid balance if the output should be 1 mL/kg/hour?

300 To determine the client's weight in kg, divide the weight in lb. by 2.2 or 165 / 2.2 = 75 kg. Fluid balance for this client would be 75 mL/hr. For four hours, the client's output would need to be 300 mL as an indication of fluid balance.

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? A sectioned portion of the stomach is joined to the jejunum. The antral portion of the stomach is removed and a vagotomy is performed. The vagus nerve is cut and gastric drainage is established. A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.

A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. A Billroth I procedure involves removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum. A vagotomy severs the vagus nerve; a Billroth I procedure may be performed in conjunction with a vagotomy. If the remaining part of the stomach is anastomosed to the jejunum, the procedure is a Billroth II.

The nurse is caring for a client with hypovolemia related to prolonged vomiting and decreased intake of oral fluids. What activity(ies) should the nurse include in the client's plan of care? Select all that apply. Advise the client to avoid alcohol. Encourage the client to drink a 16 oz (480 ml) glass of water over the course of 15 minutes. Offer the client a low-fat and high-protein meal. Inform the primary health care provider if urine output is 3.5 oz (103 ml) per day or lower. Administer intravenous fluids as ordered.

Advise the client to avoid alcohol. Administer intravenous fluids as ordered. The nurse should advise the client to avoid food and alcohol until symptoms subside. The nurse should be prepared to administer intravenous fluids. The slow introduction of fluids enables the client to develop tolerance and determine if they can advance the diet. The nurse should recommend the use of commercial, over-the-counter beverages that contain electrolytes. If the client's urine output drops below 17 oz (502 mL) per day, the nurse should notify the health care provider because this indicates severe hydration and the need for IV replacement fluids.

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse? Irrigate the client's NG tube. Assess the client's abdomen and vital signs. Notify the health care provider. Place the client in the high-Fowler's position.

Assess the client's abdomen and vital signs. Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.

A young adult client is prescribed misoprostol to prevent gastric ulcers caused by frequent use of nonsteroidal anti-inflammatory agents for an autoimmune disorder. For which reason will the nurse question giving the client a dose of this medication? Awaiting the results of a pregnancy test May cause diarrhea and cramping Needs to be taken without food Can cause constipation

Awaiting the results of a pregnancy test Misoprostol is a synthetic prostaglandin that protects the gastric mucosa from agents that cause ulcers, and also increases mucus production and bicarbonate levels. It is a pregnancy category X medication and should not be taken by a pregnant client as it can soften the cervix and result in miscarriage or premature labor. This medication does not cause constipation. Sucralfate needs to be taken without food. Misoprostol can cause diarrhea and cramping; however, this is not the reason to question giving the client a dose of the medication.

The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer? Vomiting Hemorrhage Constipation Awakening in pain

Awakening in pain The client with a duodenal ulcer is more likely to awaken with pain during the night than is the client with a gastric ulcer. Vomiting, constipation, diarrhea, and bleeding are symptoms common to both gastric and duodenal ulcers.

Which of the following clients is at highest risk for peptic ulcer disease? Client with blood type AB Client with blood type O Client with blood type B Client with blood type A

Client with blood type O Clients with blood type O are more susceptible to peptic ulcers than those with blood types A, B, and AB.

Which ulcer is associated with extensive burn injury? Duodenal ulcer Curling ulcer Peptic ulcer Cushing ulcer

Curling ulcer Curling ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.

Clients with Type O blood are at higher risk for which of the following GI disorders? Diverticulitis Esophageal varices Gastric cancer Duodenal ulcers

Duodenal ulcers Familial tendency also may be a significant predisposing factor. People with blood type O are more susceptible to peptic ulcers than are those with blood type A, B, or AB. Blood type is not a predisposing factor for gastric cancer, esophageal varices, and diverticulitis.

The nurse is caring for a client who has developed dumping syndrome while recovering from a gastrectomy. What recommendation should the nurse make to the client? Eat several small meals daily spaced at equal intervals. Drink a minimum of 12 ounces of fluid with each meal. Choose foods that are high in simple carbohydrates. Sit upright when eating and for 30 minutes afterward.

Eat several small meals daily spaced at equal intervals. The client with dumping syndrome should consume small meals at intervals to reduce symptoms. The client should not consume fluids with meals. Carbohydrates should be limited and sitting upright does not relieve the symptoms.

A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? Stool antigen test Gastric secretion study Barium study of the upper gastrointestinal tract Endoscopy

Endoscopy Barium study of the upper GI tract may show an ulcer; however, endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions. Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained. Endoscopy may reveal lesions that, because of their size or location, are not evident on x-ray studies. Less invasive diagnostic measures for detecting H. pylori include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test.

Which medication is classified as a histamine-2 receptor antagonist? Metronidazole Famotidine Lansoprazole Esomeprazole

Famotidine Famotidine is a histamine-2 receptor antagonist. Lansoprazole and esomeprazole are proton pump inhibitors (PPIs). Metronidazole is an antibiotic.

The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage? Hematemesis Hypertension Polyuria Bradycardia

Hematemesis The nurse interprets hematemesis as a sign/symptom of possible hemorrhage from the ulcer. Other signs that can indicate hemorrhage include tachycardia, hypotension, and oliguria/anuria.

A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, labored breathing, and appears to be confused. Which complication has the client most likely developed? Pyloric obstruction Hemorrhage Penetration Perforation

Hemorrhage Signs of hemorrhage following surgery include cool skin, confusion, increased heart rate, labored breathing, and blood in the stool. Signs of penetration and perforation are severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature, and increased heart rate. Indicators of pyloric obstruction are nausea, vomiting, distended abdomen, and abdominal pain.

A client diagnosed with a peptic ulcer says, "Now I have something else I have to worry about." Which actions will the nurse take to help reduce the client's anxiety? Select all that apply. Interact with the client in a relaxed manner. Help identify the client's current stressors. Discuss potential coping techniques with the client. Inform the client the medication will solve the problem. Offer information about relaxation methods.

Interact with the client in a relaxed manner. Help identify the client's current stressors. Discuss potential coping techniques with the client. Offer information about relaxation methods. A client with a peptic ulcer may have a problem with anxiety. To help reduce the client's anxiety, the nurse should interact with the client in a relaxed manner and help the client identify stressors. The nurse can also discuss potential coping techniques and offer information about relaxation methods. Stating that medication will solve the problem may not be sufficient if stress and anxiety are contributors to the development of the ulcer.

Which is a true statement regarding gastric cancer? Women have a higher incidence of gastric cancer. Most clients are asymptomatic during the early stage of the disease. Most cases are discovered before metastasis. The prognosis for gastric cancer is good.

Most clients are asymptomatic during the early stage of the disease. Most clients are asymptomatic during the early stage of the disease. Men have a higher incidence of gastric cancer. The prognosis is poor because the diagnosis is usually made late because most clients are asymptomatic during the early stage. Most cases of gastric cancer are discovered only after local invasion has advanced or metastases are present.

The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? Nasogastric tube insertion Oral contrast Stool specimen Pelvic x-ray

Nasogastric tube insertion The nurse anticipates an order for nasogastric tube insertion to decompress the stomach. Pelvic x-ray, oral contrast, and stool specimens are not indicated at this time.

A client is prescribed a histamine (H2)-receptor antagonist. The nurse understands that this might include which medication(s)? Select all that apply. Nizatidine Esomeprazole Cimetidine Lansoprazole Famotidine

Nizatidine Cimetidine Famotidine H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton-pump inhibitors.

During a home visit the nurse notes that a client recovering from peptic ulcer disease is experiencing cool clammy skin and has a heart rate of 96 beats a minute. Which action will the nurse take? Encourage the client to drink a warm beverage. Provide a dose of a proton pump inhibitor. Notify the primary health care provider. Discuss the types of foods the client has been eating.

Notify the primary health care provider. The client with peptic ulcer disease is demonstrating signs of hemorrhage which include cool skin and tachycardia. The health care provider should be immediately notified. The client should not be given any additional medication. A warm beverage could enhance bleeding. It is inappropriate to provide any teaching while the client is experiencing an acute condition.

Peptic ulcer disease occurs more frequently in people with which blood type? B AB O A

O People with blood type O are more susceptible to peptic ulcers than those with blood type A, B, or AB.

A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer. Cimetidine Omeprazole Famotidine Nizatidine

Omeprazole Omeprazole (Prilosec) is a proton pump inhibitor that, if used according to the health care provider's directions, will result in healing in 90% of patients. The other drugs are H2 receptor antagonists that need to be used for 6 weeks.

A 66-year-old African-American client has recently visited a physician to confirm a diagnosis of gastric cancer. The client has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of cancer because he was asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On the basis of knowledge of disease progression, the nurse assumes that organs adjacent to the stomach are also affected. Which of the following organs may be affected? Choose all that apply. Lungs Pancreas Duodenum Bladder Liver

Pancreas Duodenum Liver Most gastric cancers are adenocarcinomas; they can occur anywhere in the stomach. The tumor infiltrates the surrounding mucosa, penetrating the wall of the stomach and adjacent organs and structures. The liver, pancreas, esophagus, and duodenum are often already affected at the time of diagnosis. Metastasis through lymph to the peritoneal cavity occurs later in the disease.

The nurse is teaching a client with peptic ulcer disease who has been prescribed misoprostol. What information from the nurse would be most accurate about misoprostol? Increases the speed of gastric emptying Decreases mucus production Works best when taken on an empty stomach Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs)

Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Misoprostol (Cytotec) is a synthetic prostaglandin that protects the gastric mucosa against ulceration and is used in clients who take NSAIDs. Misoprostol should be taken with food. It does not improve emptying of the stomach, and it increases (not decreases) mucus production.

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? Six small meals and 120 mL fluid daily Three meals and 120 ml fluid daily Three meals and three snacks and 120 mL fluid daily Six small meals daily with 120 mL fluid between meals

Six small meals daily with 120 mL fluid between meals After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals.

A client is preparing for discharge to home following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal? Allows for better absorption of vitamin B12 Provides much needed rest Removes tension on internal suture line Slows gastric emptying

Slows gastric emptying Dumping syndrome is a common complication following subtotal gastrectomy. To avoid the rapid emptying of stomach contents, resting after meals can be helpful. Promoting rest after a major surgery is helpful in recovery but not the reason for resting after meals. Following this type of surgery, clients will have a need for vitamin B12 supplementation due to absence of production of intrinsic factor in the stomach. Resting does not increase absorption of B12 or remove tension on suture line.

A client with peptic ulcer disease has been prescribed sucralfate. What health education should the nurse provide to this client? Take the medication at bedtime to accommodate sedative effects Take the medication 2 hours before or after other medications Ensure adequate potassium intake during therapy Blood levels will be evaluated after 1 week

Take the medication 2 hours before or after other medications Sucralfate should be taken at least 2 hours before or after other medications. It does not decrease potassium levels and laboratory follow up is unnecessary. Sucralfate does not cause sedation

A healthcare provider prescribes a combination of drugs to treat reoccurring peptic ulcer disease, and the client asks the nurse the reason for all the medications. What teaching should the nurse review with the client? The prostaglandin E1 analogs, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. The proton pump inhibitors, prostaglandin E1 analogs, and bismuth salts will suppress or eradicate H. pylori. The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. The antibiotics, prostaglandin E1 analogs, and bismuth salts will work together to suppress or eradicate H. pylori.

The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. The recommended combination of bismuth salts, antibiotics, and proton pump inhibitors will suppress or eradicate H. pylori. Prostaglandin E1 analogs enhance mucosal resistance to injury; they do not suppress or eradicate H. pylori.

The nurse is preparing a teaching tool about delayed release proton pump inhibitors used to treat duodenal ulcer disease caused by H. pylori. Which statement will the nurse include that would apply to most types of proton pump inhibitor prescribed to treat this condition? Interferes with the metabolism of digoxin, iron, and warfarin The medication is to be swallowed whole and taken before meals May cause diarrhea and hyperglycemia Abdominal pain and abnormal liver function tests are expected effects

The medication is to be swallowed whole and taken before meals There are several proton pump inhibitors used to treat duodenal ulcers caused by H. pylori. For most of these medications, they are a delayed-release capsule that is to be swallowed whole and taken before meals. Pantoprazole may cause diarrhea and hyperglycemia. Rabeprazole is the only proton pump inhibitor that interferes with the metabolism of digoxin, iron, and warfarin. Rabeprazole may cause abdominal pain. Pantoprazole may cause abnormal liver function tests.

A client is demonstrating symptoms of a tumor in the small bowel. About which diagnostic test will the nurse anticipate teaching the client? Abdominal flat plate x-ray Ultrasound of the abdomen Barium enema Upper GI series with small bowel follow-through

Upper GI series with small bowel follow-through An upper GI x-ray series with small bowel follow-through using oral water-insoluble contrast with frequent and detailed x-rays to follow the contrast through the small bowel is the traditional approach to diagnose tumors in the small bowel. A barium enema, ultrasound of the abdomen, or abdominal flat plate x-ray are not used to diagnose tumors of the small bowel.

A nurse is providing care for a client recovering from gastric bypass surgery. During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. What will the nurse suspect? Dehiscence of the surgical wound A normal reaction to surgery Peritonitis Vasomotor symptoms associated with dumping syndrome

Vasomotor symptoms associated with dumping syndrome Early manifestations of dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down. Dehiscence of the surgical wound is characterized by pain and a pulling or popping feeling at the surgical site. Peritonitis presents with a rigid, board-like abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.

The nurse is caring for a client with chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? Vitamin A Vitamin C Vitamin E Vitamin B12

Vitamin B12 Clients with chronic gastritis from vitamin deficiency usually have evidence of malabsorption of vitamin B12 caused by the production of antibodies that interfere with the binding of vitamin B12 to intrinsic factor. However, some clients with chronic gastritis have no symptoms. Vitamins A, C, and E are not affected by gastritis.

After a client received a diagnosis of gastric cancer, the surgical team decides that a Billroth II would be the best approach to treatment. How would the nurse explain this procedure to the family? Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach Proximal subtotal gastrectomy Limited resection in the distal portion of the stomach and removal of about 25% of the stomach Total gastrectomy and esophagogastrectomy

Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach The Billroth I involves a limited resection and offers a lower cure rate than the Billroth II. The Billroth II procedure is a wider resection that involves removing approximately 75% of the stomach and decreases the possibility of lymph node spread or metastatic recurrence. A proximal subtotal gastrectomy may be performed for a resectable tumor located in the proximal portion of the stomach or cardia. A total gastrectomy or an esophagogastrectomy is usually performed in place of this procedure to achieve a more extensive resection.

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: a history of hemorrhoids and smoking. alcohol abuse and smoking. a sedentary lifestyle and smoking. alcohol abuse and a history of acute renal failure.

alcohol abuse and smoking. The nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: don't drink liquids 2 hours before meals. restrict fluid intake to 1 qt (1,000 ml)/day. drink liquids only with meals. drink liquids only between meals.

drink liquids only between meals. A client who experiences dumping syndrome after a subtotal gastrectomy should be advised to ingest liquids between meals rather than with meals. Taking fluids between meals allows for adequate hydration, reduces the amount of bulk ingested with meals, and aids in the prevention of rapid gastric emptying. There is no need to restrict the amount of fluids, just the time when the client drinks fluids. Drinking liquids with meals increases the risk of dumping syndrome by increasing the amount of bulk and stimulating rapid gastric emptying. Small amounts of water are allowable before meals.

The nurse is cautiously assessing a client admitted with peptic ulcer disease. The nurse is aware that which complications occur in 20% to 30% of clients with this diagnosis? intractable ulcer or pyrosis pyloric obstruction or melena perforation or mechanical obstruction hemorrhage or perforation

hemorrhage or perforation Hemorrhage and peformation are the most common complications, occuring in 20% to 30% of clients with peptic ulcers. Bleeding may be manifested by hematemesis or melena. Perforation is erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. An intractable ulcer refers to one that is hard to treat, relieve, or cure. Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred (mechanical obstruction) and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down. Pyrosis refers to heartburn, a common symptom associated with peptic ulcers.

The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience pain 2 to 3 hours after a meal. vomiting. weight loss. hemorrhage.

pain 2 to 3 hours after a meal. The client with a duodenal ulcer often awakens between 1 and 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the client with duodenal ulcer. Hemorrhage is less likely in the client with duodenal ulcer than in the client with gastric ulcer. The client with a duodenal ulcer may experience weight gain.