GI NCLEX
Indications of peptic ulcer disease
- history of tarry black stools - history of alcohol abuse - history of gastric pain 2-4 hrs after meals
Home care instructions for peptic ulcer disease
- learn to use stress reduction techniques - avoid food intake of foods that aggravate pain - quit smoking - avoid NSAIDS
Insertion of Levin tube for GI decompression. Set suction for w/c pressure?
- low and intermittent
Recommended diet for viral hepoatitis
- low fat content - small, frequent meals - eat a healthy breakfast - adequate fluid intake of 2500 - 3000 mL/day
Pernicious anemia prevention after gastrectomy
- regular monthly injections of B12 - symptoms occur 5 yrs or less - not fatal
Treatment for IBS
- stress reduction measures. Biofeedback, progressive relaxation and regular exercise. - increase fluid and fiber - antispasmodic - sedative meds as needed
Hepatic Coma Treatment
1. Lactulose: decreases serum ammonia 2. Cleansing enema: blood in the stool can increase ammonia levels. 3. Decrease protein in diet (Because liver cannot filter) 4. Monitor serum ammonia
Ulcerative Colitis/Crohn's Disease Treatment
1. Low fiber diet to limit GI mobility to help save fluid 2. Avoid cold foods, hot foods, and smoking (Temperature extremes). All of these can increase motility
Drinking liquids with meals
A client is resuming a diet after partial gastrectomy. To minimize complications, the nurse would tell the client to avoid doing which of the following?
Left Sims' position
A nurse is administering a cleansing enema to a client with a fecal impaction. Before administering the enema, the nurse assists the client to which of the following positions?
Personal history of ulcerative colitis or gastrointestinal (GI) polyps
A nurse is participating in a health screening clinic and is preparing teaching materials about colorectal cancer. The nurse would plan to include which risk factor for colorectal cancer in the material?
ERCP endoscopic retrograde cholangiopancreatography
- NPO 12 hrs before procedure - throat is sprayed w/ anesthetic - NPO until gag reflex returns - contrast dye is injected via a catheter into the pancreatic or bile ductal systems - lie still about an hour - IV sedation is given to relax the client
clinical manifestations of peritonitis
- hiccups - tachycardia - hypoactive - abdominal rigidity - mucous membranes will be dry and become pale.
Discharge instruction for Barium enema
- take laxative to enhance passage of remaining barium - stool will return to a normal color
Colonoscopy Pre-Procedure
1. Clear liquid diet for 12-24 hours and then NPO 6-8 hours pre-procedure 2. Avoid NSAIDs (May alter procedure results) 3. Laxative or enemas until clear 4. Polyethylene glycol (Anti-Emetic) pre-procedure 5. Sedate for procedure
Cirrhosis Signs/Symptoms
1. Firm, nodular liver (Should not be able to palpate liver normally) 2. Abdominal pain - Liver capsule has stretched 3. Chronic dyspepsia (GI upset) 4. Change in bowel habits 5. INCREASED ALT & AST 6. DECREASED serum albumin -> Ascites - Liver is sick and cannot synthesize protein to album. If there is no albumin then there is nothing to hold fluid in vascular space. 7. Splenomegaly - If the spleen is enlarged then the immune system is involved. 8. Anemia (No more clotting)
Dumping Syndrome Signs/Symptoms
1. Fullness 2. Weakness 3. Palpitations 4. Cramping 5. Faintness 6. Diarrhea
Hiatal Hernia Signs/Symptoms
1. Heartburn (Dyspepsia) 2. Dysphagia 3. Fullness after eating 4. Regurgitation
Bleeding Esophageal Varices Patho
1. High BP in the liver (PORTAL HYPERTENSION) forces collateral circulation to form
Peptic Ulcer Medications
1. Liquid Antacids 2. Proton Pump Inhibitors 3. H2 Antagonists 4. GI Cocktail 5. Antibiotics for H Pylori 6. Sucralfate
Upper GI Series
1. Look at the esophagus and stomach with dye 2. NPO past midnight 3. No smoking, chewing gum, or mints. Remove nicotine patch as well.
After the procedure, keep client nothing by mouth (NPO) until the gag reflex returns
A client is scheduled for an endoscopic retrograde cholangiopancreatography (ERCP). The nurse includes which intervention in the plan of care for the client?
Offer small, frequent meals
A client with viral hepatitis has no appetite, and food makes the client nauseated. Which nursing intervention would be appropriate
Assist the client in expressing feelings
A client with viral hepatitis states to the nurse, "I am so yellow." The nurse would appropriately:
Tube with a lumen and an air vent
A health care provider asks a nurse to obtain a Salem Sump tube for gastric intubation. The nurse selects which of the following tubes from the unit storage area?
Low and intermittent
A nurse has assisted in the insertion of a Levin tube for gastrointestinal (GI) decompression. The nurse plans to set the suction to which of the following pressures?
A decrease in sour eructation
A nurse has been reinforcing dietary teaching for a client with peptic ulcer disease who has a routine follow-up visit. Which behavior is the best indicator of a successful outcome for this client?
It is all right to drive an hour after the test is finished
A nurse has given postprocedure instructions to a client who has undergone a colonoscopy. The nurse determines that the client did not fully understand the directions if the client states that:
High Fowler's position
A nurse is assisting with the insertion of a nasogastric tube into a client. The nurse places the client in which position for insertion?
Vitamin B12
A nurse is caring for a client with a diagnosis of chronic gastritis. The nurse anticipates that this client is at risk for which vitamin deficiency?
Placement of the NG tube is accurate.
A nurse is caring for a client with a nasogastric (NG) tube and tests the pH of the aspirate to determine correct placement. The nurse notes that the pH is 5 and determines that the:
Presence of bowel sounds in all four quadrants
A nurse is caring for a client with a resolved intestinal obstruction who has a nasogastric tube in place. The health care provider has now prescribed the nasogastric tube to be discontinued. To determine the client's readiness for discontinuation of the nasogastric tube, the nurse should check for:
My pain comes shortly after I eat, maybe a half hour or so later
A nurse is collecting data from a client admitted to the hospital with a diagnosis of suspected gastric ulcer and is asking the client questions about pain. Which statement, if made by the client, would support the diagnosis of gastric ulcer?
Elevate the scrotum
A nurse is instructing a client who had a herniorrhaphy about how to reduce postoperative swelling following the procedure. Which of the following would the nurse suggest to the client to prevent swelling?
Sweating and pallor
A nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which of the following symptoms indicate this occurrence?
Signs of acute viral hepatitis
- weight loss - dark urine - fatigue
Hiatal hernia clinical manifestation
- asymptomatic - difficulty swallowing - heartburn - regurgitation, reflux
Hepatitis clinical manifestations
- drowsiness
Hiatial hernia heartburn relief
- eating small frequent and bland meals - histamine antagonists and antacids - elevation of thorax after meals and during sleep.
Herniorrhapy intervention
- elevate scrotum and apply ice packs while in bed to decrease pain and swelling. - scrotal support when out of bed
What do you use sengstaken-blakemore tube?
- esophageal varices. Cirrhosis w/ ruptured esophageal varices.
Diet pre procedure of oral cholecystography
- fat free diet evening before test - normal intake of fat should be maintained during the days before test.
green tea GI SE
- nausea - heartburn
Indication of liver damage on hepatitis pt.
- pruritis - jaundice - urine dark amber or browm
4 Major Functions of the liver
1. Detoxifying the body 2. Helps body to CLOT 3. Liver helps to metabolize drugs 4. Liver synthesizes Albumin
Ulcerative Colitis and Crohn's DIsease S/S
1. Diarrhea -> Dehydration 2. Blood in stools 3. Rectal bleeding -> Anemia 4. Weight loss 5. Vomiting 6. Cramping 7. Rebound tenderness 8. Fever
Monitoring prothrombin and partial thromboplastin values
A nurse planning care for a client with hepatitis plans to meet the client's safety needs by:
Stoma retraction
Sinking of the stoma
Inability to pass flatus
A nurse is caring for a client with acute pancreatitis and a history of alcoholism and is monitoring the client for complications. Which of the following data would be a sign of paralytic ileus?
Maintaining a patent nasogastric (NG) tube
A nurse is caring for a client within the first 24 hours following a total gastrectomy for gastric cancer. The nurse should focus interventions on which of the following during this time frame?
The transfer of digested food molecules from the GI tract into the bloodstream
A nurse is collecting data about how well a client with a gastrointestinal (GI) disorder is able to absorb food. While carrying out this function, the nurse recalls that absorption is best defined as:
A mechanical and chemical process involving the breakdown of foods
A nurse is collecting data about how well a client with a gastrointestinal (GI) disorder is able to digest food. The nurse recalls that digestion is best defined as:
Reluctant client w/ colostomy and not looked at colostomy. What NI?
- ask a member a the local osteomyelitis club to visit - ask enterostomal nurse specialist to consult - ask client yo begin doing one part of the osteomy care and increase task daily.
prevention of recurrence in symptoms of hiatial hernia
- low fat diet - avoid lying down for an hour after eating - elevate the HOB
Diet instructions for peptic ulcer
- may eat food as long as they do not cause pain - Increase GI motility is avoided - unnecessary to eat small frequent meals
pernicious anemia reinforcement instruction
- meticulous and frequent oral hygiene - lightweight blanket as needed - check blood serum b12 levels every 1-2 yrs.
safety needs for a hepatitis pt.
- monitor coagulation studies like prothrombin and partial thromboplastin.
Senna SE
- nausea - vomiting - diarrhea - anorexia - cramping
End stage liver failure pain management
- notify HCP if pain increases - increase fluids if constipated - breathing exercises to control pain - Check LOC. Change in LOC indicates opioid OD.
anastomotic leak for gastric bypass surgery
- oliguria - restlessness - abdominal pain - unexplained tachycardia
Discharge instruction after gastrectomy to prevent dumping syndrome
- fluid restriction with meals - avoid high carb foods inc. fluids such as fruit nectars - low fowlers during meals - lie down for 30 mins after eating to delay gastric emptying - antispasmodics as prescribed
Barium swallow interventions
- remove all jewelry - fast for 8-12 hrs - oral meds are withheld - monitor for constipation following procedure
Appendicitis
- right lower quadrant pain - NPO, IV fluids for hydration - cold packs may provde comfort - laxatives are not prescribed. - no heat pad
Salem sump tube
- used for gastric intubation - larger suction lumen and air vent
Lie on the right side for 2 hours
A nurse provides instructions to a client after a liver biopsy. The nurse tells the client to:
Assisting the Physician to insert a central line
Have saline available for a flush Do not start fluids until positive confirmation of placement (Chest X-Ray)
what to monitor when sengstaken-blakemore tube is deflated?
Hematemesis. when deflated the esophageal varices might bleed again causing blood in vomit.
Normal Hemoglobin/Hematocrit Lab Values Female
Hemoglobin: 12-16 g/dl Hematocrit: 37-47%
Normal Hemoglobin/Hematocrit Lab Values Male
Hemoglobin: 14-18 g/dl Hematocrit: 42-52%
Liver Biopsy Pre-Procedure
Watch for bleeding -> Clotting studies pre-procedure: PT, INR, and aPTT Vital signs
3
A nurse is preparing to administer a soapsuds enema to a client. Into which position does the nurse place the client to administer the enema? Refer to figure.
Client teaching about peptic ulcers
1. Decrease stress 2. STOP SMOKING 3. Eat what you can tolerate; avoid temperature extremes and extremely spicy foods 4. No caffeine
Check the gag reflex before giving oral foods or fluids.
A client has just undergone gastroscopy. Which of the following is the essential post-procedure nursing intervention
Upright
A client with ascites is scheduled for a paracentesis. The nurse is assisting the health care provider in performing the procedure. Which of the following positions will the nurse assist the client to assume for this procedure?
Difficulty swallowing
A client with possible hiatal hernia complains of frequent heartburn and regurgitation. The nurse should gather further information about the presence of which signs or symptoms
rigid, boardlike abdomen
A nurse is monitoring a client with a diagnosis of peptic ulcer. Which finding would most likely indicate perforation of the ulcer?
Indication of perforation of the ulcer w/ peptic ulcer
- Rigid, board like abdomen - sudden, sharp, intolerable severe pain beginning in mid epigastric area and spreading over abdomen. - nausea and vomiting may occur.
intervenions for acute pancreatitis
- pain is aggravated if the client lies in supine and flat position - NPO - anticholinergic meds as prescribed - insertion of NG tube
Post op for Billroth 2 procedure
- patency of ng tube is critical for prevention of retentionn of gastric secretions - never reposition or irrigate gastric tube after gastric surgery unless ordered. - leg exercise, early ambulation, cough and deep breath. Proper post op.
Readiness of removing NG tube w./ intestinal obstruction
- presence of bowel sounds in all 4 quadrants
Post discharge for hepatitis
- several weeks to resume full activity level - adequate rest so liver may heal - high carb and low fat diet - avoid aspirin and alcohol - take prescribes amounts of vitamin K.
TPN Nursing Considerations
1. Do not mix ahead - the mixture changes daily according to electrolytes 2. Keep refridgerated; warm for administration; let sit out a few minutes prior to hanging 3. Central line with a filter is needed; NOTHING ELSE should go through this line 4. Daily weights 5. May have to start taking insulin (Lots of sugar in TPN) 6. Blood glucose checks every 6 hours 7. Check urine for glucose and ketones 8. Can only be hung 24 hours; Change tubing with each new bag 9. IV bag may be covered with dark bag to prevent chemical breakdown 10. Needs to be on a pump
Treating Pancreatitis
1. Main goal is pain control. 2. Decrease gastric secretions (NPO, NGT to suction, bed rest). We want to stomach empty and dry so there's no digestion occuring. 3. Steroids to decrease inflammation 4. Anticholinergics to dry up secretions (Block parasympathetic transmissions) 5. GI Protectants 6. Maintain fluid and electrolyte balance 7. Maintain nutritional status -> ease into a diet 8. Insulin (B/c blood sugar increases) 9. Daily weights 10. Eliminate alcohol
Hepatic Coma Signs/Symptoms
1. Minor mental changes/motor problems 2. Difficulty awakening 3. Asterixis (tremor of the hand when the wrist is extended) 4. Handwriting changes 5. Decreased reflexes 6. EEG activity decreases 7. Fetor (Breath smelling like ammonia) 8. Patients with liver issues tend to be GI bleeders
Pancreatitis Signs/Symptoms
1. Pain INCREASES while eating. 2. Abdominal distension/ascites (losing protein rich fluid like enzymes and blood into the abdomen) -> ascites 3. Abdominal mass - Swollen pancreas 4. Rigid board-like abdomen (guarding or bleeding): Bleeding that can lead to peritonitis 5. Bruising 6. Fever 7. Nausea/Vomiting 8. Jaundice (Meaning liver is now involved) 9. Hypotension because of bleeding or ascites
Other Appendicitis Signs/Symptoms
1. Rebound tenderness 2. Nausea and vomiting 3. Anorexia
Paracentesis
1. Removal of fluid from the peritoneal cavity (ascites) 2. Have the client void and sit up 3. Take vital signs and monitor for signs of shock. Anytime you are pulling fluids you can throw a patient into shock.
Blood loss
A client who has a history of chronic ulcerative colitis is anemic. The nurse interprets that which factor is likely responsible for this laboratory finding?
Occult blood
A client who has been prescribed indomethacin (Indocin) for gout is asked to provide a stool sample for guaiac testing. The nurse explains that the purpose of the test is to determine:
I should take a laxative and my stool should return to normal color."
A client who has undergone a barium enema is being readied for discharge from the ambulatory care unit. The nurse determines that the client has understood the discharge instructions if the client states:
I should take a laxative, and my stool will then return to a normal color.
A client who has undergone barium enema is being readied for discharge. The nurse determines that the client has understood discharge instructions when the client states:
30 minutes before meals
A client with Crohn's disease has a prescription to begin taking antispasmodic medication. The nurse should time the medication so that each dose is taken:
Reduces the stimulation of acid secretions
A client with a peptic ulcer is scheduled for a vagotomy, and the client asks the nurse about the purpose of this procedure. The nurse tells the client that a vagotomy:
Difficulty swallowing both liquids and solids
A client with a possible hiatal hernia complains of frequent heartburn and regurgitation. Which sign or symptom would support this diagnosis?
Nasogastric (NG) tube
A client with a tentative diagnosis of gastroesophageal reflux is going to undergo ambulatory pH monitoring. The nurse brings which of the following items to the bedside?
Lying flat
A client with acute pancreatitis is experiencing severe pain from the disorder. The nurse tells the client to avoid which position that could aggravate the pain?
"Everyone in my immediate family has died from gastrointestinal cancer."
A generally healthy 63-year-old man is seen in the health care provider's office for a routine examination. Which statement made by the client is important for the nurse to follow up on?
A client has a suspected peptic ulcer in the duodenum. What should the nurse expect the client to report when describing the pain associated with this disease?
A gnawing sensation relieved by food.The act of eating allows the hydrochloric acid in the stomach to work on and be neutralized by food rather than irritate the intestinal mucosa.
Hemoglobin 10.2 g/dL
A nurse analyzes the results of laboratory studies performed on a client with peptic ulcer disease. Which of the following laboratory values would indicate a complication associated with the disease?
Semi-Fowler's
A nurse assigned to care for a client with cirrhosis reviews the medical record and notes that the client has difficulty maintaining an effective breathing pattern due to pressure on the diaphragm. The nurse plans care, knowing that which client position will best assist in facilitating breathing?
Aspiration
A nurse gathers data from a client admitted to the hospital with gastroesophageal reflux disease (GERD) who is scheduled for a Nissen fundoplication. Based on an understanding of this disease, the nurse determines that the client may be at risk for which complication
Resume full activity level within 1 week
A nurse has given the client with hepatitis instructions about postdischarge management during convalescence. The nurse determines that the client needs further teaching if the client states to:
"I'm glad I don't have to lie still for this procedure
A nurse has taught a client about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that the client needs additional information if the client makes which statement?
Give frequent oral and nasal care.
A nurse is assisting in caring for a client with a Sengstaken-Blakemore tube. To prevent ulceration and necrosis of oral and nasal mucosa, the nurse plans to
The pH of the aspirate is 5.
A nurse is caring for a client with a nasogastric tube. Which observation is reliable in determining that the tube is correctly placed?
Protruding and swollen
A nurse is monitoring for stoma prolapse in a client with a colostomy. The nurse would observe which of the following appearances in the stoma if prolapse occurred
Reducing stressors in life
A postgastrectomy client who is being discharged from the hospital tells the nurse, "I hope my stomach problems are over. I need to get back to work right away. I've missed a lot of work and I'm really behind. If I don't get my act together, I may lose my job." Based on the client's statement, the nurse determines that at this time, it is appropriate to discuss:
Where do Peptic Ulcers form?
A sore that develops on the lining of the esophagus, stomach, or small intestine.
A client with an acute episode of ulcerative colitis is admitted to the hospital. Blood studies reveal that the chloride level is low. The nurse expects that the electrolyte deficiency will be corrected by:
Intravenous therapy ensures a well-controlled technique for electrolyte (chloride) replacement.
late symptoms of dumping syndrome
- 2-3 hrs after eating - rise in blood glucose levels - excessive insulin secretion - check blood glucose 2 hrs after meals
pain for gastric ulcer
- occurs in upper epigastrium, left of the midline - exacerbated by food - half an hour to and hour after a meal and rarely at night.
pain for duodenal ulcer
- occurs to the right epigastrium - 90 mins to 3 hrs after eating - awakens client at night
Why would we need insulin for pancreatitis?
1 Pancreas is sick so limited insulin production 2. Steroids make blood sugar HIGH 3. TPN
How long does a client with peptic ulcers need to have checkups?
1 year
Peptic Ulcers Patho
1. Common cause of GI bleeding 2. Mainly in MALES but increasing in females 3. Erosion is present
Hemoglobin
12 - 16 and 14 - 18
How many days does barium stay in stool
12 - 24 hrs
Time an antispasmodic med is given to a Crohn's disease pt.
30 mins before meals to decrease bowel motility
Hematocrit
42-52 and 37-47
Supine with the head raised slightly and the knees slightly flexed
A licensed practical nurse (LPN) is helping a registered nurse (RN) conduct an abdominal assessment. The LPN assists the client into which of the following positions?
Esophageal varices
A nurse is assigned to care for a client with a Sengstaken-Blakemore tube. The nurse should suspect that the client has which diagnosis?
Regular monthly injections of vitamin B12 will prevent this complication
A nurse reinforces instructions to a client following a gastrectomy about the signs and symptoms of pernicious anemia, knowing that:
Learn to use stress reduction techniques
A nurse should include which of the following in a teaching plan for a client who has peptic ulcer disease?
Normal ALT and AST values
ALT = 10-30 U/L AST = 8-40 U/L
Pancreatitis
Auto-digestion of the pancreas Digestive enzymes need to be inactive while inside the pancreas. With inflammation -> occlusion, the normally inactive enzymes activate inside the pancreas causing scar tissue and gallstones.
Evaluate absorption of the last feeding
Before administering an intermittent tube feeding through a nasogastric tube, the nurse checks for gastric residual volume. The nurse understands that the rationale for checking gastric residual volume before administering the tube feeding is to:
A client is a candidate for intubation as a result of bleeding esophageal varices. Which type of tube should the nurse anticipate will most likely be used to meet the needs of this client?
Blakemore-Sengstaken includes an esophageal balloon that exerts pressure on inflation, which retards hemorrhage.
Pancreatitis Anticholinergics
Block paraysympathetic. Fight and flight (No more digestion) Dry up secretions Benztropine Diphenoxylate/Atropine
A nurse assesses a client who had a gastric resection. During the first 24 hours after surgery, the nurse expects to identify:
Bloody nasogastric drainage.
Turner's Sign
Bruising around flank area
Cullen's Sign
Bruising around umbilical area
What can untreated cirrhosis eventually lead to?
Can progress to hepatic encephalopathy/coma (Ammonia builds up in bloodstream resulting in loss of consciousness/brain function)
The nurse observes that a client's nasogastric tube has suddenly stopped draining. The tube is connected to suction, the machine is on and functioning and all connections are snug. The tube is secured properly and does not appear to have been dislodged. After checking placement, the nurse gently flushes the tube with 30 mL of normal saline, but the tube still is not draining. The nurse analyzes this problem as which?
Channels of gastric secretions may be bypassing the holes in the tube; turning the client will promote stomach emptying.
Cirrhosis
Chronic liver damage from a variety of causes leading to scarring and liver failure.
The nurse evaluates that dietary teaching for a client with a colostomy is effective when the client states, "It is important that I eat:
Clients with a colostomy can eat a regular diet; only gas-forming foods that cause distention and discomfort should be avoided.
Vagotomy
Cutting of the vagus nerve - eliminate parasympathetic stimulation of gastric secretion.
Proton Pump Inhibitors
Decrease acid secretions omeprazole lansoprazole pantoprazole esomeprazole
H2 antagonist
Decreases acid secretions famotidine ranitidine
Sucralfate
Forms a barrier over the wound so acid cannot got on the ulcer
Antibiotics for H. Pylori
H. Pylori bacteria can cause stomach ulcers Clarithromycin amoxicillin tetracycline metronidazole
position for NG tube insertion
High fowlers
Most frequent TPN Complcation
Infections
Position for colonoscopy
Left sims position
Normal Lipase and Amylase values
Lipase: 0-110 U/L Amylase: 30-220 U/L
J Pouch
NO EXTERNAL BAG Colon is removed and ileum is attached to the rectum
How long should Balloon Tamponade be used?
No longer than 12 hours
The nurse teaches a client that the client's new sigmoid colostomy should be irrigated when the:
Once stool is formed, peristalsis needs to be stimulated to promote the passage of the stool
A client with Laënnec cirrhosis has ascites and jaundice and is confused. What is the nursing priority when caring for this client?
Physical Safety. Hepatic encephalopathy, related to high ammonia levels, results in central nervous system derangement
Sucralfate (Carafate)
Promotes healing by covering the ulcer, protecting it from erosion caused by gastric acids.
Omeprazole (Prilosec)
Proton pump inhibor
Abnormal finding for an abdominal assessment
Pulsation between the umbilicus and pubis can indicate abdominal aortic aneurysm
Subtotal gastrectomy
Removing the distal portion of the stomach
Ascending and transverse Colostomy
Semi liquid stools
What are the three most common places for collateral hypertension?
Stomach, esophagus, and rectum
Instructions to a pt. After a liver biopsy
To splint the puncture site, client is kept on right side for a minimum of 2 hrs.
pH level for correct inserton of NG tube
acidic. 6 below
celiac disease
gluten free food
position for cleansing enema, fecal impaction
left sims position
A client has an abdominal perineal resection with the formation of a colostomy for cancer of the rectum. The nurse evaluates that teaching about colostomy care is understood when the client states, "I will call the clinic and report:
"If I have difficulty inserting the irrigating tube into the stoma." Difficulty inserting the irrigating tube into the stoma occurs with stenosis of the stoma; forcing insertion of the tube may cause injury.
common risk factors for colorectal cancer
- age over 40 yrs. - 1st degree relative w/ colorectal cancer - history of ulcerative colitis or GI polyps
How do you position a patient for liver biopsy?
1. Position patient supine to stretch the abdomen out. 2. EXHALE AND HOLD BREATH to get diaphragm out of the way.
High-fiber diet
A client has asymptomatic diverticular disease. What type of diet should the nurse anticipate to be prescribed
Remain with the client and be silent.
A client is admitted to the hospital with a bowel obstruction secondary to a recurrent malignancy, and the health care provider plans to insert a Miller-Abbott tube. When the nurse tries to explain the procedure, the client interrupts the nurse and states, "I don't want to hear about that. Just let the doctor do it." Based on the client's statement, the nurse determines that the best action is to:
Alteration in comfort related to abdominal pain
A client is admitted to the hospital with a diagnosis of acute pancreatitis. The nurse plans care, knowing that which problem occurs with this disorder
One day
A licensed practical nurse (LPN) is providing follow-up teaching after a client underwent an upper gastrointestinal (GI) series. The nurse reminds the client that the stools will remain white for approximately:
Pruritus
A nurse is collecting data on a client admitted to the hospital with hepatitis. Which data would indicate that the client may have liver damage?
Vitamin B12 and folic acid studies
A nurse is providing discharge instructions to a client who has had a total gastrectomy. The nurse tells the client about the importance of returning to the health care clinic as scheduled for which priority assessment?
Take actions to prevent dumping syndrome
A nurse is providing home care instructions to a client following a gastric resection. The nurse includes which of the following in the instructions?
1-2 days
A nurse is providing post-procedure teaching after a client underwent an upper gastrointestinal (GI) series. The nurse reminds the client that the stools will remain white for approximately
Eat anything as long as it does not aggravate or cause pain
A nurse is reinforcing dietary instructions to a client with peptic ulcer disease. The nurse encourages the client to:
Be sure to sleep with your head elevated in bed."
A nurse is teaching a client with a newly diagnosed hiatal hernia about measures to prevent recurrence of symptoms. Which statement would be included in the teaching?
Left Sims' position
A nurse is teaching the client about an upcoming colonoscopy procedure. The nurse would include in the instructions that the client will be placed in which of the following positions for the procedure?
Impaired nutritional status
A nurse is working with a client diagnosed with anorexia nervosa. The nurse plans care, focusing on which of the following as the primary problem
Nausea/Vomiting or Abdominal pain first?
Abdominal pain first THEN N/V for appendicitis
Bleeding Esophageal Varices
Abnormal veins in the lower part of the tube running from the throat to the stomach that bleed Esophageal varices can be no problem until rupture occurs -> Dizziness, vomiting bright red blood
Never give ____________ to people with liver problems
Acetaminophen
A client is placed on a heart-healthy diet to control the intake of saturated fats and cholesterol. What information should the nurse include in a teaching plan to explain best the dietary nature of this diet?
Cholesterol is an essential precursor of body substances such as vitamin D and steroid hormones; although the body synthesizes some cholesterol, a small amount is needed in the diet.
When performing the initial history and physical examination of a client with a tentative diagnosis of peptic ulcer, the nurse expects the client to describe the pain as:
Classic symptoms of peptic ulcer include gnawing, boring, or dull pain located in the midepigastrium or back; pain is caused by irritability and erosion of the mucosal lining.
Ischemia of stoma
Dusky or bluish color
More common treatment of esophageal bleeding varices?
EVL and Endoscopic Sclerotherapy
EVL
EVL is a banding procedure
After any major abdominal surgery what is the position of choice?
Elevate HOB to decrease pressure on the abdomen and the suture line.
Pyloroplasty
Incision and resuturing of the pylorus to relax the uncle and enlarge the opening from the stomach to the duodenum
Ambulatory pH monitoring
Inserting of NG tube w/ a probe attached.
A client suspected of carcinoma of the liver is scheduled for a liver biopsy. To determine if there are any procedural contraindications present, the nurse should assess the client for:
International normalized ratio (INR) greater than 4.5. A normal INR range is 0.7 to 1.8. INR values over 4.5 increase the risk of major hemorrhage. This should be corrected before the biopsy to prevent hemorrhage.
Ph of miller abbot tube for colorectal placement
Intestinal fluid 7 or higher
When you see an alcoholic client with GI bleeding...
It is usually esophageal varices
Diet for appendicitis
NPO in anticipation of emergency surgery
Stenosed stoma
Narrow opening, level of skin or fascia
Medication instruction for peptic ulcer disease
Nizatidine (Axid), h2-receptor blocker. Decrease the secretion of gastric acid.
Stool characteristics of Crohns disease
Non-bloody diarrhea, no more than 4 or 5 stools daily.
Sengstaken-Blakemore tube
Nose to the the esophagus and stomach
Which is the priority intervention for the dependant client with peptic ulcer disease (PUD) who is vomiting bright red blood?
Recall the airway, breathing, and circulation (ABCs) of priority care. The client who needs assistance to manage self-care should be placed in the side-lying position, when vomiting, to prevent aspiration.
A primary health care provider prescribes three stool specimens for occult blood for a client who complains of blood-streaked stools and a 10-pound weight loss in one month. To ensure valid test results, the nurse should instruct the client to:
Red meat can react with reagents used in the test to cause false-positive results
Appendicitis Patho
Related to a LOW Fiber diet. Appendix can fill with bowel contents and become inflamed b/c located close to large intestine
Bilroth II procedure
Removal of the ulcer and a large portion of the cells that produce hydrochloric acid
Why no smoking for upper GI series?
Smoking increases stomach motility and increases stomach secretions (Risk for aspiration)
vitamin deficiency r/t chronic gastritis
Vitamin b 12.
Balloon Tamponade
Sengstaken-Blakemore Tube Purpose is to hold pressure on the bleeding varices Infrequently used emergency procedure that may be used to stabilize clients with severe hemorrhage. It is one of the few times that bilateral wrist restraints should be advocated for (So that patient will not pull it out)
Dumping Syndrome
Stomach empties too quickly after eating and client experiences uncomfortable to severe side effects Usually secondary to gastric bypass, gastrectomy, or gall bladder disease
Which information should be included in the teaching plan for the elderly client with peptic ulcer disease who is taking an antacid and sucralfate (Carafate)?
Sucralfate should be taken on an empty stomach one hour before meals. Sucralfate works best in a low pH environment; therefore, it should be given on an empty stomach either one hour before or two hours after meals.
Abdominal assessment position
Supine w/ head raised slightly and knees slightly flexed
Appendicitis Treatment
Surgery Most often laparascopic unless perforated.
Why is an x-ray done post-insertion
TO CHECK FOR PLACEMENT Also to make sure the patient does not have a pneumothorax
When is the best time to take antacids?
Take when the stomach is empty and at bedtime. When the stomach is empty, acid can get on the peptic ulcer and cause pain so we want antacids to coat the ulcer first.
Gastroscopy
Thin, flexible tube called an endoscope is used to look inside the esophagus, stomach and first part of the small intestine (duodenum) 1. NPO pre-procedure 2. Sedated 3. NPO until gag reflex returns. Patient is expected to return from procedure without gag reflex 4. Watch for perforation by watching for pain, bleeding, or if they are having trouble swallowing.
Ulcerative Colitis Surgery
Total colectomy (Ileostomy is formed) Koch's ileostomy or a J pouch
Absorption of food
Transfer of digested food molecules from GI tract into the bloodstream
Irrigating the nasogastric (NG) tube
A nurse is caring for a client after a Billroth II procedure. On review of the postoperative prescriptions, which of the following, if prescribed, would the nurse question and verify?
MOM
A nurse is caring for a client in the emergency department who has right lower quadrant abdominal pain. After noting a white blood cell count of 16,500/mm3, the nurse should question a prescription for which of the following?
No oral intake of liquids or food
A nurse is caring for a client suspected of having appendicitis. Which of the following would the nurse anticipate will be prescribed for this client?
Provide frequent oral and nasal care on a regular basis.
A nurse is caring for a client with a Sengstaken-Blakemore tube. To prevent ulceration and necrosis of oral and nasal mucosa, the nurse should plan to:
Impaired nutritional status
A nurse is caring for a client with anorexia. The nurse plans care for the client, focusing on which of the following as the primary problem?
Constipation
A nurse is caring for a client with pneumonia who has a history of bleeding esophageal varices. Based on this information, the nurse plans care, knowing that it is important to prevent:
4.0
A nurse is checking a client for the correct placement of a nasogastric (NG) tube. The nurse aspirates the client's stomach contents and checks their pH level. Which of the following pH values indicates the correct placement of the tube?
Drowsiness
A nurse is collecting admission data on the client with hepatitis. Which of the following findings would be a direct result of this client's condition
Turkey and lettuce sandwich
A nurse is evaluating the effect of dietary counseling on the client with cholecystitis. The nurse determines that the client understands the instructions given if the client states that which food item is acceptable to include in the diet?
The nizatidine (Axid) will cause me to produce less stomach acid."
A nurse provides medication instructions to a client with peptic ulcer disease. Which statement by the client indicates the best understanding of the medication therapy?
Maintaining a patent nasogastric (NG) tube
A nurse who is assisting in the care of a client within the first 24 hours following a total gastrectomy for gastric cancer should focus interventions on which of the following?
Take action to prevent dumping syndrome.
A nurse who is providing instructions to a client following gastric resection would include which of the following suggestions
Learn to use stress reduction techniques.
A nurse would include which of the following when reinforcing home care instructions for a client who has peptic ulcer disease?
Postprandial blood glucose readings
A post-gastrectomy client is at high risk for hyperglycemia related to uncontrolled gastric emptying of fluid and food into the small intestine (dumping syndrome). Because of this risk, the nurse plans to monitor the
I can never drink alcohol again."
A sexually active 20-year-old client has developed viral hepatitis. Which of the following statements, if made by the client, would indicate a need for teaching
A client with ulcerative colitis has experienced frequent severe exacerbations over the past several years. The client is admitted to the hospital with intense pain, severe diarrhea, and cachexia. Which therapeutic course should the nurse expect the health care provider to explore with this client?
If medical management fails, surgical therapy is the next logical choice because it removes the affected intestine.
Administering an Enema Principles
If patient starts to cramp STOP the fluids and then lower the bag and/or check the temperature of the fluid
Hepatitis A
It has been determined that a client with hepatitis has contracted the infection from contaminated food. What type of hepatitis is this client most likely experiencing?
Lay on _______ side to keep food in stomach
LEFT SIDE leaves it in. Right side will release the food
Liquid antacids
Liquid Antacids coat the stomach Take when stomach is empty and at bedtime: When the stomach is empty acid can get on the ulcer and cause pain.
Diet for acute gastroentritis
Low fiber
Diet for acute diverticulitis, ulcerative colitis, IBS
Low fiber diet
Position to avoid for acute pancreatitis
Lying flat
Koch's Pouch
Ostomy bag that has a nipple valve that opens and closes to empty intestines No external bag
Prolapse of stoma
Protruding and swollen
McBurney's Point?
RLQ
Client w/ GERD is at risk for what?
- Aspirations, if regurgitation happens when client is recumbent.
Gastric surgery supplement needed
- B12 - folic acid - iron - calcium - vitamin D
A nurse begins to teach a client how to perform a colostomy irrigation. The nurse evaluates that the instructions are understood when the client states, "I should:
"Keep the irrigating container 18-24 inches above the stoma." Keeping the irrigating container 18-24 inches above the stoma permits the solution to flow slowly with little force so that excessive peristalsis is not precipitated immediately
Treating Cirrhosis
1. Antacids (For dyspepsia), Vitamins, Diuretics 2. NO MORE ALCOHOL 3. I/O & Daily weights (Any time you have ascites, you have fluid issues) 4. Abdominal Girth Measuring b/c of ascites 5. Rest 6. Bleeding precautions (clotting issues) 7. Monitor jaundice 8. Avoid narcotics b/c liver cannot metabolize drugs well when it is sick 9. Paracentesis
Ulcerative Colitis/Crohn's Disease medications
1. Antidiarrheals (For mild cases) 2. Antibiotics 3. Steroids to decrease inflammation
Peptic Ulcers Signs/Symptoms
1. Burning pain usually in the mid-epigastric area or back 2. Heartburn
Diagnosing Peptic Ulcer
1. Gastroscopy 2. Upper GI Series
Ask a member of the local ostomy club to visit with the client before discharge, Ask the enterostomal nurse specialist to consult with the client before discharge,Ask the client to begin doing one part of the ostomy care and increase tasks daily.
A client who has undergone a colostomy several days ago is reluctant to leave the hospital and has not yet looked at the ostomy site. Which measures are most likely to promote coping?
Smaller and more frequent meals should be eaten.
A client who has undergone a subtotal gastrectomy is being prepared for discharge. Which item concerning ongoing self-management should the nurse reinforce to the client?
History of alcohol use, smoking, and weight loss
A client complains of stomach pain 30 minutes to 1 hour after eating. The pain is not relieved by further intake of food, although it is relieved by vomiting, and a gastric ulcer is suspected. The nurse should gather which of the following additional supportive data for this diagnosis from the client?
History of alcohol use, smoking, and weight loss
A client complains of stomach pain 30 minutes to 1 hour after eating. The pain is not relieved by further intake of food, although it is relieved by vomiting. A gastric ulcer is suspected. Which of the following data would further support this diagnosis?
Hemigastrectomy
A client diagnosed with pernicious anemia asks the nurse what caused the deficiency. The nurse replies that it is likely a result of which of the following conditions that is part of the client's health history?
Smaller, more frequent meals should be eaten
A client has undergone subtotal gastrectomy and the nurse is preparing the client for discharge. Which item should be included when teaching the client about ongoing self-management?
Milk of magnesia
A client in the emergency department reports right lower quadrant abdominal pain. After noting a white blood cell count of 16,500/mm3, the nurse would question a prescription for which of the following
What is your understanding of celiac disease?"
A client is admitted to an acute care facility with complications of celiac disease. Which question would be helpful initially in obtaining information for the nursing care plan?
fat free
A client is scheduled for an oral cholecystography. The nurse would plan to obtain what type of diet for the evening meal before the test?
I just lost a family to gastrointestinal cancer."
A client is seen in the ambulatory care office for a routine examination. Which statement by the client would be important for the nurse to follow up?
Occult blood
A client who has been taking indomethacin (Indocin) for gout has a prescription for guaiac testing of the stool. The nurse explains to the client that this test is necessary because it detects which of the following that may be caused or affected by this medication?
Avoid eating or drinking after midnight before the test.
A client will undergo a barium swallow to confirm a diagnosis of a hiatal hernia. In preparation for the test, the nurse instructs the client to:
Avoid eating or drinking after midnight before the test
A client will undergo a barium swallow to determine whether the client has a hiatal hernia. The nurse provides pre-procedure instructions and tells the client to:
Cut the tube and pull it out
A client with a Sengstaken-Blakemore tube in place to treat esophageal varices suddenly becomes restless. The client's heart rate and blood pressure increase and the client has difficulty breathing. The important initial nursing action is to:
low-fiber diet
A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. To aid the client in symptom management, the nurse suggests foods that are on which of the following diets
Client previously oriented to person only; can now state name, year, and present location
A client with hepatic encephalopathy is receiving lactulose (Cephulac). The nurse determines that the medication is effective if which of the following is observed?
Lying recumbent after meals
A client with hiatal hernia chronically experiences heartburn after meals. The nurse would teach the client to avoid which of the following, which is contraindicated with hiatal hernia?
Hematemesis
A nurse has been caring for a client with a Sengstaken-Blakemore tube. The health care provider arrives on the nursing unit and deflates the esophageal balloon. Following deflation of the balloon, the nurse should monitor the client most closely for which of the following
Protect the gastric mucosa
A client with peptic ulcer disease has been prescribed misoprostol (Cytotec) and sucralfate (Carafate). The nurse teaches the client that these two medications will work primarily to:
Protect the gastric mucosa
A client with peptic ulcer disease has been prescribed to take misoprostol (Cytotec) and sucralfate (Carafate). The nurse teaches the client that these two medications will work primarily to:
A tube with a larger lumen and an air vent
A health care provider asks the nurse to obtain a Salem Sump tube for gastric intubation. The nurse would correctly select which of the following tubes from the unit storage area?
Document the finding in the client's record.
A health care provider places a Miller-Abbott tube in a client who has a bowel obstruction. Six hours later, the nurse measures the length of the tube outside of the nares and notes that the tube has advanced 6 cm since it was first placed. Based on this finding, which action should the nurse take next?
From the tip of the client's nose to the earlobe and then down to the xiphoid process
A licensed practical nurse (LPN) is assisting in insertion of a nasogastric (NG) tube for an adult client. The LPN helps determine the correct length to insert the tube by measuring
Take and hold a deep breath.
A licensed practical nurse (LPN) is preparing to assist a registered nurse (RN) with removing a nasogastric (NG) tube from the client. The LPN would instruct the client to do which of the following?
Right side-lying with a small pillow or towel under the puncture site
A nurse has assisted the health care provider with a liver biopsy, which was done at the bedside. Upon completion of the procedure, the nurse assists the client into which of the following positions?
Low and intermittent
A nurse has assisted with the insertion of a Levin tube for gastrointestinal (GI) decompression. The nurse expects that the health care provider will prescribe the suction setting at:
Diet of asymptomatic diverticula disease
High fiber diet.
Crohn's Disease
Also known as Regional Enteritis; inflammation and erosion of the ileus primarily but can affect anywhere in small or large intestine.
An emergency department nurse assesses an older client who reports cramping pain in the left lower quadrant, weakness, bloating, and malaise. The client also has a low-grade fever. Which condition does the nurse suspect as the most likely cause of the client's clinical findings?
Although diverticula can occur at any point within the gastrointestinal tract, they are most common in the sigmoid colon; therefore, pain associated with diverticulitis occurs in the left lower quadrant.
70 mcg/dL
An adult client with hepatic encephalopathy has a serum ammonia level of 120 mcg/dL and receives treatment with lactulose (Chronulac) syrup. The nurse determines that the client has the best and most optimal response if the level changes to which of the following after medication administration?
Requires the client to lie still for short intervals
An ultrasound of the gallbladder is scheduled for the client with a suspected diagnosis of cholecystitis. The nurse explains to the client that this test:
This opioid will cause very deep sleep, which is what my husband needs."
Which statement by the spouse of a client with end-stage liver failure indicates the need for additional teaching by the multidisciplinary team regarding the management of pain?
A client has an excision of a thrombosed external hemorrhoid. What should the nurse teach the client to use when cleaning the anus after a bowel movement?
Witch hazel-moistened pads (Tucks) are not irritating and are soothing to the anal mucosa.
Liver Biopsy Post-Procedure
Worry about hemorrhage so Lie on RIGHT SIDE to hold pressure on the liver Repeat vital signs
contraindication for antihypocalcemic drugs
avoid use of mineral oil. it decreases vitamin D absorption.
Remove jewelry before the test
A client being seen in a health care provider's office has just been scheduled for a barium swallow the next day. The nurse writes down which of the following instructions for the client to follow before the test
No special preparation is necessary.
A client with Crohn's disease is seen by the health care provider, and a complete blood count (CBC) has been prescribed. The nurse provides instructions to the client who will be reporting to the laboratory in the morning to have the blood test drawn. The nurse gives the client which of the following information about this test
Administer antacids, as prescribed,Encourage coughing and deep breathing,Administer anticholinergics, as prescribed
A nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Choose the interventions that the nurse would expect to be prescribed for the client.
Be sure to sleep with your head elevated in bed."
A nurse is teaching a client who is newly diagnosed with a hiatal hernia about measures to prevent recurrence of symptoms. The nurse makes which statement to the client?
Channels of gastric secretions may be bypassing the holes in the tube; turning the client will promote stomach emptying
A nurse observes that a client's nasogastric tube has suddenly stopped draining. The tube is connected to suction, the machine is on and functioning and all connections are snug. The tube is secured properly and does not appear to have been dislodged. After checking placement, the nurse gently flushes the tube with 30 mL of normal saline, but the tube still is not draining. The nurse analyzes this problem as:
Regular monthly injections of vitamin B12 are used to treat this disorder
A nurse provides information to a client following a gastrectomy about the signs and symptoms of pernicious anemia. The nurse understands that:
Two types of pancreatitis
Acute and Chronic Acute - #1 cause is alcohol then gallbladder disease Chronic - #1 cause is alcohol
Miller abbot tube
- decompress the intestine - to correct a bowel obstriction
Diet for cholecystitis
- decrease overall intake of dietary fat -no red Meat cuz contain fat - no mashed potatoes cuz of milk and butter - turkey and lettuce sandwich is good.
preparation for barium swallow
- NPO after midnight before the test. - no smoking - no medication before test
Appendicitis
Appendix becomes inflamed and filled with pus, causing pain.
A client is experiencing an exacerbation of ulcerative colitis. A low-residue, bland, high-protein diet and parental vitamins B, C, and K have been prescribed. The nurse explains that this dietary regimen is designed to reduce:
Colonic irritation
Appendicitis Contraindication
Do NOT give enemas or laxatives because you are worried about perforation
A client with the diagnosis of ulcerative colitis has surgery for the creation of an ileostomy. Postoperatively, for which potential life-threatening complication should the nurse assess the client?
E-lyte imbalances. An ileostomy directs liquid feces out of the body, bypassing the large intestine where fluid and electrolytes normally are reabsorbed. The continuous excretion of liquid feces may deplete the body of fluid and electrolytes, resulting in a life-threatening fluid deficit and electrolyte imbalance.
The pancreas has two separate functions
Endocrine - Insulin Exocrine - Digestive Enzymes
After a gastrojejunostomy (Billroth II) for cancer of the stomach, a client progresses to a regular diet. After eating lunch, the client becomes diaphoretic and has palpitations. What does the nurse conclude is the probable cause of these clinical manifestations?
Extracellular fluid shift into the bowel. Hypertonic food increases osmotic pressure and pulls fluid from the intravascular compartment into the intestine (dumping syndrome).
Famotidine (Pepcid) is prescribed for a client with peptic ulcer disease. The client asks the nurse what this medication does. The nurse responds, "It:
Famotidine decreases gastric secretion by inhibiting histamine at H2 receptors. Increases gastric motility, neutralizes gastric acidity, and facilitates histamine release are not actions of famotidine.
NG tube residual is 200 mL for intermittent feeding
Feeding is held and HCP is called. Indication feeding is not bein absorbed. Residual is less than 100 mL, feeding is administered.
Classifying Gastric vs Duodenal Ulcers
Gastric: Malnourished, pain is usually half hour to 1 hour after meals; food does not help but vomiting does. Blood is found in vomit "Every time the patient eats they feel like throwing up" Duodenal: Well-nourished; night time pain is common and 2-3 hours after meals; Food helps; blood is in stool "Every time the stomach is empty patient is in pain"
McBurney's Point
Generalized pain initially felt that eventually localizes in the right lower quadrant Often a sign/symptom of Appendicitis
After a client has a total gastrectomy, the nurse plans to include in the discharge teaching the need for:
Intrinsic factor is lost with removal of the stomach, and vitamin B12 is needed to maintain the hemoglobin level once the client is stabilized; injections are given monthly for life.
Asterixis
Irregular flapping movements of the fingers and wrists when the hands and arms are outstretched, palms down, wrist bent up, fingers spread. - most common reliable sign of hepatic encepalophaty is developing
A client has a new colostomy. The nurse has provided teaching related to when the client should irrigate the colostomy. Which client statement indicates correct understanding of the teaching?
Irrigation should be performed at the time the client routinely defecated before the colostomy, to maintain continuity in lifestyle.
A nurse is caring for a client with a nasointestinal tube. Which solution should the nurse use when instilling the tube to ensure its patency?
Isotonic saline most closely resembles body fluids; it will not cause an imbalance by pulling fluids and electrolytes out of the intravascular compartment.
If air gets in the central line, what position do you put the client in?
Left sided trendelenburg
A client who recently experienced a brain attack (cerebrovascular accident, CVA) and who has limited mobility complains of constipation. What is most important for the nurse to determine when collecting information about the constipation?
Length of time it's existed
The nurse is reviewing a list of current medications with a 75-year-old client who has developed gastrointestinal bleeding. Which medication prescription should the nurse discuss with the prescriber because it is contraindicated for a person who is experiencing gastrointestinal bleeding?
Lisinopril is a calcium channel blocker that is used to reduce high blood pressure and for treatment of heart failure; it can contribute to GI bleeding.
What kind of diet for cirrhosis patients?
Low protein (Liver cannot break down the ammonia) Low salt (Don't want more fluid)
Digestion
Mechanical and chemical process involving breakdown of foods
A client who had a choledochostomy to explore the common bile duct is returned to the surgical unit with a T-tube in place. What is the priority intervention when caring for this client?
Protect the abdominal skin from bile drainage. The enzymatic activity of bile can cause excoriation and skin breakdown; the skin should be protected.
Regular Protein Breakdown
Protein -> Breaks down to ammonia -> Liver converts ammonia to urea - > Kidneys excrete urea If liver is damaged, liver cannot convert ammonia to urea and hepatic ecepalopathy/coma may occur (Toxicity)
Prevent ulceration and necrosis of oral and nasal mucosa for a sengstaken-blakemore tube
Provide frequent oral and nasal care on a regular basis
Rebound Tenderness
Push in -> let go -> it hurts Indicator for Peritonitis (Covers stomach and abdominal organs)
#1 thing to worry about with appendicitis is _______
RUPTURE
A client with a diagnosis of gastric cancer has a gastric resection with a vagotomy. Which clinical response should alert the nurse that the client is experiencing dumping syndrome?
Reactive hypoglycemia. Rapid gastric emptying that occurs after a gastric resection causes rapid elevation of blood glucose followed by increased insulin secretion, resulting in reactive hypoglycemia.
Descending or sigmoid colostomy
Semi formed or formed stools. Requires irrigation because water is almost gone. Best time to irrigate is the same time everyday and after meals. Use same principles for giving an enema
A nurse identifies a moderate amount of bright red blood in a client's gastric drainage four hours after a subtotal gastrectomy. What should the nurse do first?
Some bright blood at this point is an expected finding that should be monitored
Crohn's Disease Surgery
TRY NOT TO DO SURGERY May remove only the affected area Client may end up with ileostomy or colostomy
Nurse is providing instructions to a clien following gastric resection would inc. w/c of the following suggestions?
Take action to prevent dumping syndrome
Brush the client's teeth frequently. Use diluted mouthwash and water to rinse the mouth
The nurse observes that a client with a nasogastric tube connected to continuous gastric suction is mouth breathing, has dry mucous membranes, and has a foul breath odor. In planning care, which nursing intervention would be best to maintain the integrity of this client's oral mucosa?
Position the patient how for central line placement?
Trendelenburg in order to distend the veins.
position for abdominal assessmen
dorsal recumbent
Early signs and symptoms of dumping syndrome
- 5-30 mins after eating. - vertigo - tachycardia - syncope - sweating - pallor - palpitations - desire to lie down
Platelet
150,000-400,000
Increase intake of fluids.
A client is admitted to the hospital with viral hepatitis and is complaining of a loss of appetite. In order to provide adequate nutrition, the nurse encourages the client to:
Pancreatitis GI protectants
Pantoprazole Ranitidine Famotidine Antacids
Colonoscopy intervention
- dont drive for several hrs. Client is given a sedative. - resume intake slowly and progress as tolerated - gas or abdominal tenderness for a short while
Diagnosing Cirrhosis
1. Ultrasound 2. CT, MRI 3. Liver biopsy
Discharge, self management for gastrectomy
- eat smaller, more frequent smalls. - resume activity gradually - minimize stressors. - ongoing medical supervision and evaluation
Eating low-fat or nonfat foods
A nurse documents that a client with a hiatal hernia is implementing effective health maintenance measures after the client reports doing which of the following
Learn measures such as biofeedback or progressive relaxation.
A nurse is assisting in planning stress management strategies for the client with irritable bowel syndrome. Which suggestion would the nurse give to the client?
involve in complete digestive process
- chemical - absorption - Mechanical - active transport
A client w/ sengstaken-blakemore tube suddenly becomes restless. HR and BP increase. Difficulty breathing. Initial nursing action
- cut the tube and pull it out. - rupture of balloon can cause airway obstruction, aspiration and asphyxiation
liver disease medication to avoid
Acetaminophen (tylenol), can cause hepatoxicity.
Antidote for acetaminophen overdose
Acetylcysteine
What is often the first sign of hepatic coma?
Handwriting changes
Bilroth II resection
proximal remnant of stomach is anastomosed to the proximal jejunum
poor absorption of fat indication w/ chronic pancreatitis
steatorrhea
Ileostomy Care
1. It is going to drain LIQUID all the time. Primary concern is losing fluid/electrolytes. 2. Ileostomies do not require irrigation. 3. Avoid foods hard to digest and rough foods; Increase motility. 4. Gatorade in the summer! 5. At risk for kidney stones because patient is always a little dehydrated.
After a live biopsy, the nurse places the client in the w/c position?
right-side lying position w/ a small pillow of foldes towel under the puncture site for at least 3 hrs.
Client instruction for removal of NG tube
take and hold a deep breath
Steatorrhea
A nurse is reviewing the health care record of a client with a diagnosis of chronic pancreatitis. Which data noted in the record indicate poor absorption of dietary fats?
A client has a permanent sigmoid colostomy, and colostomy irrigations are prescribed. The client asks the nurse why they are needed. How should the nurse respond?
"They help establish an elimination schedule." Irrigations regulate the bowel to function at a specific time for the convenience of the client.
A client who has inoperable cancer of the head of the pancreas involving the common bile duct has a T-tube inserted. During the first 48 hours after insertion of the tube, the nurse should:
A T-tube drains by gravity into a small collection bag; the right side lying or the semi-Fowler position enhances gravity drainage.
Administration of an analgesic
A client arrives at the emergency department and complains of severe abdominal pain. The initial diagnosis is acute abdomen, and an x-ray and an abdominal ultrasonogram are prescribed to be obtained immediately. The nurse prepares the client for these diagnostic tests and reviews the health care provider's prescriptions. Which of the following prescriptions would the nurse question if written on the health care provider's prescription form?
Nasogastric
A client arrives in the emergency department with bleeding esophageal varices, and the health care provider states that a Sengstaken-Blakemore tube will need to be used to try to control the gastrointestinal hemorrhage. The nurse prepares for insertion of the tube via which of the following routes?
Colostomy Care
As waste moves through colon water and nutrients are being absorbed and a stool is forming The further down the colon a stoma is, the more formed the stool will be because water is being drawn out.
A client is diagnosed as having the hepatitis B virus (HBV). The nurse reviews the client's health history for possible situations in which exposure may have occurred. Which event does the nurse determine is the most likely source of this infection?
Had a small tattoo on the arm three months ago
After deflation of the balloon of sengstaken-Blakemore tube. What esophageal complication does the nurse monitor?
Hemorrhage
Priority intervention for prevention of Hepa B
Hepatitis B vaccine
An older client's colonoscopy reveals the presence of extensive diverticulosis. What type of diet should the nurse encourage the client to follow?
High-fiber
Hiatal Hernia
Hole in the diaphragm is too large so the stomach moves up into the thoracic cavity Main cause is a LARGE ABDOMEN Other causes: Congenital abnormalities, trauma, and surgery
Differences between Ulcerative Colitis and Crohn's
In Crohn's disease, there are healthy parts of the intestine mixed in between inflamed areas. Ulcerative colitis, on the other hand, is continuous inflammation of the colon. Ulcerative colitis only affects the inner most lining of the colon while Crohn's disease can occur in all the layers of the bowel walls.
Client w/ hepatic encephalopathy serum ammonia level of 120 mcg/dL. Receives treatment w/ lactose (chronulac) syrup (removes ammonia from colon). Optimum response if it changes to...
Normal serum ammonia level is 10-80 mcg/dL. Hepatic encephalopathy is not likely to drop below normal.
A client had surgery for a perforated appendix with localized peritonitis. In which position should the nurse place this client?
Semi-Fowler. The semi-Fowler position aids in localizing drainage to the lower abdominal cavity and prevents the spread of infection throughout the abdominal cavity.
Endoscopic Sclerotherapy
The physician injects a sclerosing agent into the varices via an endoscope. Sclerosing agent causes the target vein to immediately shrink, and then dissolve over a period of weeks as the body naturally absorbs the treated vein.
A nurse is caring for a postoperative client who had a gastrectomy. What early client response indicates that peristalsis has returned?
The presence of borborygmi indicates the return of peristalsis.
Which is the priority assessment for the client with active gastrointestinal bleeding?
The priority assessment of the client with active gastrointestinal bleeding is focused on evaluating for evidence of impending shock.
A client with a ruptured appendix is scheduled for an appendectomy. Preoperatively, the nurse should place the client in which position?
The semi-Fowler position localizes the spilled contents of the ruptured appendix in the lower part of the abdominal cavity.
Ulcerative Colitis
Ulcerative Inflammatory Bowel disease only found in large intestine
Antacids
Used as adjunct therapy and neutralize acid in the stomach
Intervention on oral mucosa for NG tube w/ gastric suction client
- frequent oral hygiene - small sips of water are contraindicated - lemon glycerin swabs have a drying or irritating effect on mucous membrane.
Ulcerative Colitis/Crohn's Disease Diagnosis
1. CT 2. Colonoscopy 3. Barium Enema: Done if colonoscopy is incomplete
When you are changing the tubing how can you avoid getting air in the line?
1. Clamp it off 2. Valsalva (Contraindicated with cardiac patients!) 3. Take a deep breath and HUMMMM (Increased intrathoracic pressure)
Checking for return of a gag reflex
A client has undergone esophagogastroduodenoscopy (EGD). The nurse places highest priority on which of the following items as part of the client's care plan?
Fatigue
A client is admitted to the hospital with acute viral hepatitis. Which signs or symptoms would the nurse expect to note, based upon this diagnosis?
Consuming low-fat or nonfat foods
A nurse documents that a client with a hiatal hernia is complying with the prescribed treatment if the client reports doing which of the following
acute pancreatitis
- abdominal pain, predominant symptom - shock and hypovolemia may occur from hemorrhage - toxemia - loss of fluid into the peritoneal space - potassium and sodium loss to gastric suction and vomiting - hyperglycemia, impaired carb matabolism
Highest priority after EGD
- airway, return of gag reflex - VS is monitored, sudden sharp increase in temp. could indicate GI tract perforation - monitor for sore throat and heartburn is important but airway is priority.
Hemigastrectomy/partial gastrectomy post op intervention
- avoid drinking liquids with meals - at risk for dumping syndrome - high in protein - moderate in fat - high in calories - frequent small meals - avoid concentrated sweets
Successful outcome for peptic ulcer disease
- decrease in sour eructation (burping)
Priority assessment for discharge with a total gastrectomy
- Vitamin b12 and folic acid studies - common nutritional problem following stomach removal include b12 and folic acid deficiency.
Cirrhosis Patho
1.Liver cells are destroyed and are replaced with connective/scar tissue. 2. This alters circulation within the liver 3. BP in the liver goes UP -> This is called PORTAL HYPERTENSION
A nurse evaluates that a client understands appropriately how to take the antacids prescribed by the primary health care provider when the client states, "I will take my antacids:
30 mins after meals. Antacids are most effective when taken after digestion has started but before the stomach begins to empty. Antacids should be taken before the onset of pain; pain indicates that gastric irritation has begun, and the aim of treatment is to protect the gastrointestinal mucosa.
The aspirate from the tube has a pH of 7.45.
A client had a Miller-Abbott tube inserted 24 hours ago. The nurse is asked to check the client to determine whether the tube is in the appropriate location at this time. Which of the following findings would indicate adequate location of the tube?
Low fiber
A client has been diagnosed with acute gastroenteritis. Which of the following diets should the nurse anticipate would be prescribed for the client
Vitamin B12 injections
A client has been diagnosed with chronic gastritis and has been told that there is too little intrinsic factor being produced. The nurse tells the client about the need for:
vit B12 injections
A client has been diagnosed with chronic gastritis and has been told that there is too little intrinsic factor being produced. The nurse tells the client that which of the following will be prescribed to treat the problem?
"That is because the empty stomach sends signals to the brain to stimulate hunger."
A client has had extensive surgery on the gastrointestinal tract and has been started on parenteral nutrition (PN). The client tells the nurse, "I think I'm going crazy...I feel like I'm starving and yet that bag is supposed to be feeding me." The best response of the nurse would be:
laxative
A client has just returned from the radiology department following an upper gastrointestinal (GI) series. The nurse reviews the health care provider's prescriptions, expecting to note which of the following needed for routine post-procedure care?
Monitoring for the gag reflex
A client has just undergone a gastroscopy. Which action should be taken by the nurse as the essential post-procedure nursing intervention?
post procedure for gastroscopy
monitor for gag reflex to prevent aspiration
Kaolin SE
nausea - anorexia - constipation
Indomethacin (indocin)
nonsteroidal anti inflammatory medication that can cause GI irritation
History of the use of acetaminophen (Tylenol) for pain and discomfort
nurse is collecting data on a client with a diagnosis of peptic ulcer disease. Which of the following is least likely associated with this disease?
Position the client supine and flat
nurse is reviewing the health care provider's prescriptions written for a client admitted with acute pancreatitis. Which health care provider prescription would the nurse verify if noted on the client's chart?
Diarrhea
nurse is reviewing the record of a client with Crohn's disease. Which of the following stool characteristics would the nurse expect to see documented in the record
A client reports frequently taking calcium carbonate (Tums). What effect should the nurse advise the client that this can have?
The antacid action of calcium carbonate adds alkalinity, neutralizing gastric pH; this in turn stimulates renewed secretion of acid by the gastric mucosa
Limit the fluids taken with meals.
The nurse is providing discharge instructions to a client after gastrectomy. Which measure will the nurse instruct the client to follow to help prevent dumping syndrome?
A client had a laminectomy and is receiving a skeletal muscle relaxant that will be continued after discharge. The nurse provides education about the medication and concludes that the teaching was effective when the client says:
These drugs tend to irritate the gastric mucosa and should be taken with milk or food to limit gastrointestinal irritation.
A client w/ hepatic encephalopathy is receiving lactulose (Cephulac). Indication that meds is effective
- Improvement in LOC - Hepatic encapalophaty produces alteration in LOC because of the livers inability to metabolize and cleanse the blood of ammonia and mercaptans. - Lactulose is given to decrease ammonia levels.
Hiatial hernia, experience heartburn after meals. Avoid. What is the pain caused by?
- Lying recumbent after meals. - ingestion of irritating foods - consuming large or fatty meals.
NI 1st 24 hrs of a total gastrectomy for gastric cancer
- Maintain a patent NG tube. - NG tube is inserted and left for 24 - 48 hrs to decompress GI tract
Interventions for acute pancreatitis
- NPO status - pain meds as prescribed - side lying position, head 45 degrees - turn, cough, deep breath - Antacids, anticholinergics to suppress GI secretions
Medication to avoid for acute gastritis or any GI disorder
- NSAIDS, Ubuprofen (MOtrin), aspirin, Celebrex
Misoprostol (cytotec) and sucralfate (Carafate)
- Protect the gastric mucosa. - Cytotec increase mucous production and bicarbonate levels - carafate coats the ulcer surface
Risk factor for gastric ulcer
- alcohol use - smoking - weight loss - history of chronic obstructive pulmonary disease w/ weight loss - stomach pain 30 mins to 1 hr after eating - pain is not relieved by intake of food, but by vomiting.
Umbilical hernia repair home teaching
- avoid coughing - encourage breathing exercises - take analgesics as prescribed
Interventions for enema
- disposable gloves - left sims position - lubricate and insert 3-4 inches - cramping or discomfort, clamp the tube. - hung container 12 - 18 inches above anus - temp. 100 - 105
a client w/ hepatitis has contracted the infection from contaminated food. w/c hepatitis?
- hepatitis A is through food - hepa b,c,d via infected blood or body fluids
Treating Bleeding Esophageal Varices
1. Replace blood 2. Vital Signs 3. CVP 4. Oxygen (Any time someone is anemic, they need O2) 5. Octreotide to lower BP in the liver. 6. Balloon Tamponade 7. Cleansing enema to get rid of blood 8. Lactulose to decrease ammonia 9. Saline lavage to get blood out of the stomach
Dumping Syndrome Treatment
1. Semi-recumbent with meals 2. Lie down after meals 3. NO FLUIDS with meals 4. Meals should be small and frequent rather than large 5. Avoid foods high in carbs and electrolytes
Pancreatitis Labs
1. Serum lipase and amylase INCREASE (Digestive enzymes that are NOT supposed to be in the blood) 2. WBCs INCREASE (Inflammation) 3. Blood sugar INCREASE (No more insulin) 4. ALT, AST - Liver enzymes INCREASE 5. Serum Bilirubin level INCREASES 6. Hemoglobin and Hematocrit INCREASE with dehydration, DECREASE with bleeding.
Treating Hiatal Hernia
1. Small frequent meals 2. Sit up 1 hour after eating 3. Elevate HOB 4. Surgery 5. Teaching life style changes and healthy diet (Reduce abdomen size)
Appendicitis Diagnosis
1. WBC INCREASE 2. Ultrasound finds a larger appendix 3. CT
Feeling self-conscious about appearance
A client is admitted to the hospital with severe jaundice and is having diagnostic testing. Because the client has no complaints of fatigue, the client is encouraged to ambulate in the hall to maintain muscle strength. The client paces around the room but will not enter the hall. Which of the following problems most likely is the reason for the client's reluctance to walk in the hall?
A pyloroplasty involves an incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum
A client with peptic ulcer disease is scheduled for a pyloroplasty and the client asks the nurse about the procedure. The nurse bases the response on which of the following?
Pulsation between the umbilicus and pubis
A nurse is performing an abdominal assessment on a client. The nurse interprets that which finding is abnormal and should be reported to the registered nurse (RN) or health care provider?
Stop the irrigation temporarily
A nurse is performing colostomy irrigation on a client. During the irrigation, the client begins to complain of abdominal cramps. Which of the following is the appropriate nursing action?
Apply disposable gloves,Lubricate the enema tube and insert it approximately 4 inches,Clamp the tubing if the client expresses discomfort during the procedure,Ensure that the temperature of the solution is between 100° F (37.8° C) and 105° F (40.5° C).
A nurse is preparing to administer an enema to an adult client. Choose the interventions that the nurse would perform for this procedure
Fowler's
A nurse is preparing to administer an enteral feeding through a nasogastric tube. The nurse would place the client in which position during and after the feedings
Hold the feeding
A nurse is preparing to administer an intermittent tube feeding to a client with a nasogastric tube. The nurse checks the residual and obtains an amount of 200 mL. The nurse would:
2
A nurse is preparing to perform an abdominal assessment on a client. The nurse places the client in which best position to perform the assessment? Refer to figure.
Eat anything that does not aggravate or cause pain.
A nurse is providing dietary instructions to a client with peptic ulcer disease. The nurse tells the client to:
Ibuprofen (Motrin)
A nurse is reviewing the medication record of a client with acute gastritis. Which of the following medications, if noted on the client's record, would the nurse question
A right side-lying position with a small pillow or folded towel under the puncture site
After a liver biopsy, the nurse places the client in which of the following positions?
Hemorrhage
After the deflation of the balloon of a client's Sengstaken-Blakemore tube, the nurse monitors the client closely for which esophageal complication
A nurse is caring for a client with a hiatal hernia. Which risk factor is associated most commonly with this diagnosis?
Obesity. Obesity causes stress on the diaphragmatic musculature, which weakens and allows the stomach to protrude into the thoracic cavity.
Hepatitis B vaccine
Of the following infection control methods, which would be the priority to include in the plan of care to specifically prevent hepatitis B in a client considered to be at high risk for exposure?
A client is admitted for repair of bilateral inguinal hernias. Before surgery the nurse assesses the client for signs that strangulation of the intestine may have occurred. What is an early sign of strangulation?
Pain is wavelike, colicky, and sharp because of obstruction and localized bowel ischemia
Nasogastric
Treatment measures have been implemented for a client with bleeding esophageal varices and have been unsuccessful. The health care provider states that a Sengstaken-Blakemore tube will be used to control the resulting hemorrhage. The nurse prepares for insertion via which of the following routes?
Client w/ ascites. W/c position for paracentesis
Upright position. Allows intestine to float posteriorly to help prevent intestinal laceration
A client has been diagnosed w. Chronic gastritis, too little intrinsic factors being produced. Client need?
Vitamin B12 injections. - insufficient intrinsic factors result in inability to absorb b12.
Colonoscopy Post-Procedure
Watch for perforation. Signs of perforation are pain or unusual discomfort.
Hepatic Coma Patho
When you eat protein, it transforms into AMMONIA and the liver converts it to UREA. Urea can be excreted through the kidneys without difficulty When the liver becomes impaired it can no longer make this conversion so AMMONIA builds up in the blood Ammonia acts as a sedative and lowers LOC
miller-Abbott tube w/ bowel obstruction advances 6 cm after 6 hrs of placement. what should the nurse do 1st?
document finding in clients record.