GI quiz 470
The nurse is preparing to insert a nasogastric tube into a 68-year-old patient with an abdominal mass and suspected bowel obstruction. The patient asks the nurse why this procedure is necessary. Which of the following responses is most appropriate? "The tube will help to drain the stomach contents and prevent further vomiting." "The tube will push past the area that is blocked, and thus help to stop the vomiting." "The tube is just a standard procedure before many types of surgery to the abdomen." "The tube will let us measure your stomach contents, so that we can plan what type of IV fluid replacement would be best."
"The tube will help to drain the stomach contents and prevent further vomiting."
what does pretreatment of lactase prep do?
(e.g. lactacid drops) before ingestion can reduce symptoms. Ingestion of lactase enzyme tablets with the first bite of food can reduce symptoms.
What are clinical manifestations for appendicitis?
1. generalized abdominal pain, w/i 2-12 hrs pain localizes in right lower quadrant 2. Anorexia, moderate malaise, mild fever, nausea and vomiting. 3. Usually constipation occurs ; occasionally diarrhea. 4. Rebound tenderness, involuntary guarding, generalized abdominal rigidity.
what is total gastrectomy
100% of stomach removed - esophagus attached to jejunum
what is Billroth II surgical procedure
50% of stomach removed - remaining stomach attached to jejunum
what is billroth I surgical procedure for stomach cancer
50-75% of stomach removed - remaining stomach attached to duodenum
The client developed a paralytic ileus after abdominal surgery. 1. Administer a laxative of choice 2. Encourage client to increase oral fluids 3. Encourage client to take deep breaths 4. Maintain a patient nasogastric tube
: 4. A paralytic ileus is the absence of peristalsis; therefore, the bowel will be unable to process any oral intake. A nasogastric tube is inserted to decompress the bowel until surgical intervention or until bowel sounds return spontaneously.
what is dumping syndrome?
: rapid evacuation of bowel 15 to 30 minutes after eating: patient experiences cramping, borborygmi (audible bowel sounds), and urge to defecate
what is stomach cancer?
Adenocarinoma of the stomach wall More prevalent in men of poverty - those living in urban areas
A colectomy is scheduled for a 68-year-old woman with an abdominal mass, possible bowel obstruction, and a history of rectal polyps. The nurse should plan to include which of the following prescribed measures in the preoperative preparation of this patient? Instruction on irrigating a colostomy Administration of a cleansing enema A high-fiber diet the day before surgery Administration of IV antibiotics for bowel preparation
Administration of a cleansing enema
when can pt with appendicitis surgery ambulate
Ambulation day of surgery or POD #1
what is bowel obstruction?
Blockage of inside of intestine Interrupts normal flow of contents
what is splenic trauma and when do s/s occur
Blunt force trauma is typical MOI. Signs and symptoms may not developed until 24 hours later.
how can you diagnose peritonitis?
CBC, CT scan, US, xray, peritoneoscopy
what are s/s of bowel obstruction
Cramping abdominal pain, nausea, vomiting (often of fecal matter), abdominal distension
what is esophageal varices?
Dilated veins in lower part of esophagus Common in ETOH abusers, patients with liver disease May produce massive upper GI bleeds
how can you diagnose stomach cancer
Endoscopy and biopsy, Complete blood count Elevated liver enzymes and serum amylase may indicate liver and pancreatic metastasis
what is peptic ulcer disease?
Erosion of the lining of the stomach, duodenum, or esophagus -MAY CAUSE SIGNIFICANT GI BLEED
what is ectopic pregnancy
Fertilized egg is implanted outside the uterus. Growth causes rupture and can lead to massive bleeding. Patient c/o of severe RLQ or LLQ pain with radiation.
what is treatment for e coli
Fluid and Electrolyte replacement
where do you find e coli?
Found in undercooked meats (hamburger, ham & turkey) Also raw milk & unpasteurized juice/contaminated juice or sewage contaminated water
what is acute abdomen mean?
General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining)
The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which of the following types of bowel sounds that is consistent with the patient's clinical picture? Low pitched and rumbling above the area of obstruction High pitched and hypoactive below the area of obstruction Low pitched and hyperactive below the area of obstruction High pitched and hyperactive above the area of obstruction
High pitched and hyperactive above the area of obstruction
what are complications with peritonitis
Hypovolemic shock Sepsis Paralytic ileus Acute respiratory distress syndrome ***can be fatal if no treatment
Two days following a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms occur as a result of which of the following? Impaired peristalsis Irritation of the bowel Nasogastric suctioning Anastomosis site inflammation
Impaired peristalsis
what is peptic ulcer disease increased by? decreased by?
Increased by coffee, stress, spicy food, smoking Decreased by alkaline food, antacids
what is cholecystitis?
Inflammation of gall bladder Commonly associated with gall stones More common in 30 to 50 year old females
what is pancreatitis
Inflammation of pancreas Triggered by ingestion of EtOH; large amounts of fatty foods
what is gastroenteritis?
Inflammation of stomach or small intestine mucosa
what is PID? pelvic inflam disease
Inflammation of the fallopian tubes and tissues of the pelvis Typically lower abdominal or pelvic pain, nausea, vomiting
where is pain for splenic trauma
LUQ but may present atypical to other quadrants.
what about mets and stomach cancer
Large percentage have metastasis at time of diagnosis
what is peritonitis?
Localized or generalized inflammation of peritoneum
what is AAA?
Localized weakness of blood vessel wall with dilation Pulsating mass in abdomen Can cause lower back pain
The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which of the following instructions would be most helpful to prevent further episodes of constipation? Maintain a high intake of fluid and fiber in the diet. Reduce intake of medications causing constipation. Eat several small meals per day to maintain bowel motility. Sit upright during meals to increase bowel motility by gravity.
Maintain a high intake of fluid and fiber in the diet.
what is a kidney stone?
Mineral deposits form in kidney, move to ureter Often associated with history of recent UTI
what is treatment for gastroenteritis
Most cases are self-limiting and do not require hospitalization -NPO status until vomiting stops Fluids with glucose & electrolytes to replace fluids and energy demands
what is important for treatment of appendicitis??
NO HEAT - CAN CAUSE RUPTURE
what are s/s of cholecystitis
Nausea, vomiting; RUQ pain, tenderness; fever
what is s/s pancreatitis
Nausea, vomiting; abdominal tenderness; pain radiating from upper abdomen straight through to back Signs, symptoms of hypovolemic shock
what are s/s of diverticulitis
Pain Perforation Risk for severe peritonitis
what are recommendations for stomach cancer
Patient encouraged to eat small frequent meals Fluids not taken with meals: 30-45 mins before or after meal Increase intake of protein and fats: rebuild body tissues/meet energy needs
how can we diagnose appendicitis?
Physical exam WBC (shows inc with inc neutrophils) urinalysis to rule out urinary abdominal xray ultrasound or CT scan
what are s/s of shock
Poor skin signs (pale, diaphoresis) Sustained tachycardia Hypotension
what is diverticulitis
Pouches become blocked and infected with fecal matter causing inflammation
what is inguinal hernia?
Protrusion of the intestine through a tear in the inguinal canal. Usually identified by abnormal mass in lower quadrant, with or without pain. Strangulation can lead to necrosis.
Following bowel resection, a patient has a nasogastric tube to suction, but complains of nausea and abdominal distention. The nurse irrigates the tube prn as ordered, but the irrigating fluid does not return. Which of the following should be the priority action by the nurse? Notify the physician. Auscultate for bowel sounds. Reposition the tube and check for placement. Remove the tube and replace it with a new one.
Reposition the tube and check for placement.
The nurse is caring for a patient in the emergency department with complaints of acute abdominal pain, nausea, and vomiting. When the nurse palpates the patient's left lower abdominal quadrant, the patient complains of pain in the right lower quadrant. The nurse will document this as which of the following diagnostic signs of appendicitis? Rovsing sign Referred pain Chvostek's sign Rebound tenderness
Rovsing sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant.
what are s/s of kidney stones?
Severe flank pain radiates to groin, scrotum Nausea, vomiting, hematuria
what are s/s of stomach cancer?
Signs/symptoms of anemia (caused by erosion of tissue and blood loss) Peptic Ulcer Disease Indigestion (early fullness after meals, weight loss, dysphagia, and constipation) Mass is usually palpated and/or seen upon inspiration in abdominal area
what does steady pain vs cramps pain mean?
Steady pain - inflammatory process Crampy pain - obstructive process
what are s/s of peptic ulcer disease
Steady, well-localized epigastric or LUQ pain Described as a "burning", "gnawing", "aching"
what is botulism
Toxin from clostridium botulinum Sources: improperly canned or preserved foods
what are indicators of concern?
Unstable or significant change from baseline in vital signs Positive postural changes Evidence of on-going bleeding Severe, unremitting pain
what is an imp question to ask when getting history?
Was onset of pain gradual or sudden? (this helps diagnose!!!)
what are s/s of peritonitis?
abdominal pain - tenderness over area of involvement Rebound tenderness, muscular rigidity, and spasms will makes patients lie still and breathe shallowly due to pain with movement Fever, abdominal distention, tachycardia, tachypnea, nausea/vomiting and altered bowel habits may also be present
what is food poisoning?
acute GI episode/disorder (not a disease)
what are main causes of bowel obstruction?
adhesions, hernias, fecal impactions, tumors
what else should you look at for diagnosing patient with abdomen problem
age, history, ranking of frequency
what should you avoid with e coli?
anti-diarrheal agents (want to poop e coli all out)
what is most common treatment for appendicitis?
appendectomy
what is primary peritonitis
bacteria from blood borne pathogens, genital tract organisms or cirrhosis with ascites *** worry about these pts more!!-they are a lot sicker -comes from line contamination
what is secondary peritonitis
bile, enzymes or bacteria from ruptured appendix, trauma, Ischemic bowel disorders, GI obstruction, pancreatitis, and peritoneal dialysis
what are s/s of e coli in adult
bloody diarrhea and abdominal cramps
what can e.coli cause?
can cause hemorrhagic colitis Can be life threatening for very young & elderly
what is major emergency situation with AAA (abdominal aortic aneurysm)
can rupture, emergency situation that causes abdominal pain -main concern with aneurysm; dissection!!!! (very short time to live)30 mins from door to OR...need to meet this!
what is special consideration for adults over 30 and abdominal pain
consider possibility of referred cardiac pain
what about consideration with females and abdominal pain
consider possible gyn problem, especially tubal ectopic pregnancy
what can reduce risk of stomach cancer
consuming whole grains, fresh fruits and vegetables
what will blood in esophageal varices be?
dark red blood
how can you diagnose e coli
detecting bacterium in stool **antibiotic treatment remains controversial
what are risk factors for stomach cancer
diet high in smoked foods, salted fish/meats & pickled vegetables Infection with H. Pylori at an early age Pernicious anemia, atrophic gastritis, peptic ulcer disease Smoking & obesity
where does pain radiating to Right shoulder, angle of right scapula mean
gall bladder, liver, spleen
what are s/s of e coli in young children
hemolytic uremic syndrome causing destruction of RBCs and kidney failure
when should you really notify physician with appendicitis?
if pain suddenly ceases, this indicates perforation, which is a medical emergency.
what are signs to look for peritonitis?
increasing severity of pain, tenderness, rigidity, distention, absent bowel sounds, fever, malaise, and tachycardia
what are attacks of cholecystitis triggered by
ingestion of fatty foods
where does pain radiating to flank or groin mean?
kidney, ureter
what is complaint of peptic ulcer disease
lies very still with complaint of intense, steady pain, rigid abdomen with exam, suspect perforation
what are complications of appendicitis?
major complication of appendicitis is perforation of the appendix, which can lead to peritonitis, abscess formation (collection of purulent material), or portal pylephlebitis, which is septic thrombosis of the portal vein caused by vegetative emboli that arise from septic intestines.
The nurse would question the use of which of the following cathartic agents in a patient with renal insufficiency? Bisacodyl Lubiprostone Cascara sagrada Milk of magnesia
milk of magnesia
what is pancreatitis stereotype
most pts have some ETOH abuse (NOT ALL) -there is stereotype they have drinking problem
what are s/s of gastroenteritis/
nausea/vomiting, diarrhea, abdominal cramps, abdominal distention, fever, ↑ WBCs, blood or mucous in stool
what are s/s of botulism
nausea/vomiting; abdominal pain CNS: H/A, dizziness, muscular in coordination/weakness, breathing difficulty, paralysis, coma
When do colorectal cancer symptoms present?
not until disease is advanced
what about age and diverticulitis
older you are, more at risk.. u can live with diverticulosis, need to do something about diverticulitis -not always have abdominal pain
what do pts with kidney stones need?
ou usually need IV narcotics... -very bad pain -need to understand pain management
how is e. coli spread
person to person contact
what do you always worry about with peptic ulcer disease?
rupture!!!
what is position comfortable for appendicitis
semi fowlers with knees flexed
what about abdominal distention?
skin is shiny...when you get super distended and taught (really bad cases)
what is treatment for stomach cancer
surgical removal of tumor -Correction of anemia (blood transfusions) and malnutrition before surgery is important to decrease complications Chemotherapy & Radiation therapy may be used if surgical cure is not available (gastrectomy
what are postop complications to report for appendicitis?
temperature, nausea and vomiting, or abdominal distention; these may indicate infection.
what happens if peritonitis occurs with appendicitis
treatment involves.. • GI Intubation • Parenteral replacement of IV fluids and electrolytes • Administration of Antibiotics
what is treatment for botulism
ventilation maintenance, antitoxin therapy
what are causes of gastroenteritis (3 types)
viral (rotavirus), bacterial (e. coli, salmonella, c. diff) or parasitic (giardia)
what is GERD?
will have diffuse pain, or get tired Signs & symptoms can mimic cardiac pain. Usually onset after eating Typically resolved with medication
what are medications used for appendicitis?
• Intravenous fluids replacements • Analgesics
what are 2 types of food poisoning?
• acute bacterial diseases; issues in GI • botulism: (neurologic symptoms)
what are s/s of food poisoning?
• think of nausea , vomiting and abdominal pain