Module 4: Nursing Care of Patients with Disorders of the Gastrointestinal System

Bariatric surgery typically results in a weight loss of ___% to ___% of total body weight within 2 to 3 years postoperatively.

10% to 35%

In the sleeve gastrectomy, how much of the stomach is removed? About 10% About 60% About 90% About 75%

About 75% In the sleeve gastrectomy (gastric sleeve), about 75% of the stomach is removed, leaving a sleeve-shaped stomach.

Obesity is an excessively high amount of which of the following? Muscle Body Fat Hair Skin

Body fat Obesity is an excessively high amount of body fat or adipose tissue. Obesity is a major health problem because it increases the risk of many other diseases such as diabetes and cancer.

Which of the following is the definitive test for diagnosing Ulcerative Colitis? Colonscopy Barium Swallow Exploratory Laparoscopy MRI

Colonoscopy

Patients receiving gastric or enteric tube feedings do not experience diarrhea or constipation. False True

False Patients receiving gastric or enteric tube feedings can experience diarrhea or constipation

Patients can be educated to sit on the toilet with legs supported and to utilize which reflex by attempting to defecate following a meal and a warm drink? Gastrobiliary reflex Gastroduodenal reflex Gastroileac reflex Gastrocolic reflex

Gastrocolic reflex

The symptoms of Gastroesophageal Reflux Disease (GERD) may mimic which of the following? Gallbladder Disease Heart attack Pancreatitis Stroke

Heart attack

Which type of procedure is used to create an opening into the jejunum for the purpose of administering nutrition, fluids, and medications? Jejostomy Urostomy Nasogastric Gastrostomy

Jejostomy *supposed to be jejunostomy

__________________ taking herbal supplements to treat gastrointestinal esophageal reflux disease (GERD), may delay drug treatment and/or have harmful consequences.

Patients OR clients (one or the other, not both)

Which of the following about patterns of bowel elimination should the nurse ask the patient about during an assessment? Select all that apply. Pus oral ulcers frequency blood

The nurse asks about patterns of bowel elimination, including character, frequency, and presence of blood, pus, fat, or mucus.

Which of the following are symptoms are associated with Ulcerative Colitis? Select all that apply. Crampy pain left lower quadrant abdominal pain intermittent tenesmu passage of mucus, pus, or blood

The predominant symptoms of ulcerative colitis include diarrhea, with passage of mucus, pus, or blood; left lower quadrant abdominal pain; and intermittent tenesmus. The bleeding may be mild or severe, and pallor, anemia, and fatigue result.

A gastrostomy is a procedure in which an opening is created into the stomach either for the purpose of administering nutrition, fluids, and medications via a feeding tube, or for gastric decompression in patients with gastroparesis, gastroesophageal reflux disease, or intestinal obstruction. False True

True

A jejunostomy is a surgically placed opening into the jejunum for the purpose of administering nutrition, fluids, and medications. True False

True

Antiobesity medications work by either inhibiting gastrointestinal absorption of fats False True

True

Antiobesity medications work by either inhibiting gastrointestinal absorption of fats, or by altering central brain receptors to enhance satiety or reduce cravings. False True

True

In constipation straining at stool can have a striking effect on arterial blood pressure. This reflex is known as which of the following? Valsalva maneuver Valvega maneuver Volume maneuver Vessel maneuver

Valsalva maneuver Straining at stool, which results in the Valsalva maneuver (i.e., forcibly exhaling with the glottis closed), has a striking effect on arterial blood pressure.

It is important to discuss dietary patterns, including the amounts of ______________ , caffeine, and nicotine-containing products patients used daily and weekly.

alcohol

Voluminous, greasy stools suggest intestinal malabsorption (impaired transport across the mucosa), and the presence of ___________, mucus, and pus in the stools suggests inflammatory enteritis or colitis.

blood

Inflammatory bowel disease is a group of the chronic disorders, Crohn's disease and ulcerative colitis that result in inflammation or ulceration (or both) of the ______________.

bowel

These initial lesions then deepen into longitudinal and transverse ulcers, separated by edematous patches, creating which characteristic appearance? brownstone frothy cobblestone redstone

cobblestone

An ileostomy is commonly performed after a total colectomy (i.e., excision of the entire __________ ) and is either temporary or, less commonly, permanent.

colon

Gastric tubes used for which of the following are connected to a wall mounted suction regulator and canister or to a suction machine? compression and drainage compression and feeding decompression and feeding decompression and drainage

decompression and drainage

Clostridium difficile is the most commonly identified agent in antibiotic-associated ____________ in the hospital.

diarrhea

Gastric tubes used for decompression __________ are connected to a wall mounted suction regulator and canister or to a suction machine.

drainage

Following the intraoperative placement of a gastrostomy or jejunostomy tube for feeding the most common complications are wound _________ or cellulitis at the exit site, bleeding, leakage, excessive tightness of external retention bolster, and dislodgement.

infection

Barrett esophagus (BE) is a condition in which the lining of the esophageal mucosa is altered. It affects 5.6% of the population in the United States, occurs predominantly in white _____________ aged 50 or older, and occurs in association with GERD.

men

Medical treatment for both Crohn's disease and ulcerative colitis is aimed at which of the following? Select all that apply. Suppressing inappropriate immune responses Reducing inflammation Increasing bowel motility to clear enhance bowel movements preventing or minimizing complications

reducing inflammation Suppressing inappropriate immune responses Providing rest for a diseased bowel so that healing may take place Improving quality of life Preventing or minimizing complications

Voluminous, greasy stools suggest intestinal malabsorption (impaired transport across the mucosa), and the presence of blood, mucus, and pus in the _________ suggests inflammatory enteritis or colitis.

stools

Patients receiving gastric or enteric _____ feedings can experience diarrhea or constipation.

tube

How much daily dietary fiber is recommended for the treat of constipation in older adults? 10-15 g/day 25 - 30 g/day 70-75 g/day 45 - 50 g/day

25 - 30 g/day

The __________ Sump tube is a radiopaque (easily seen on x-ray), clear plastic, double-lumen gastric tube.

Salem

Colonoscopy is the definitive screening test that can distinguish ulcerative colitis from other diseases of the colon with similar symptoms. False True

True

Corticosteroids are administered to control symptoms but do not cure underlying disease processes False True

True

During the postoperative course, the most common complications are wound infection or cellulitis at the exit site, bleeding, leakage, excessive tightness of external retention bolster, and dislodgement. True False

True

Fissures are normal or abnormal folds, grooves, or cracks in body tissue. False True

True

For patients receiving nutritional formulas, the nurse observes for weight gain and increased serum albumin. False True

True

Gastric tubes used for decompression and drainage are connected to a wall mounted suction regulator and canister or to a suction machine. True False

True

Parenteral nutrition is indicated in patients who have Crohn's disease with severe malnutrition and intolerance to enteral nutrition and who are expected to likely remain intolerant to enteral nutrition for more than 1 to 2 ______________________ .

Weeks

A _____________ is a procedure in which an opening is created into the stomach either for the purpose of administering nutrition, fluids, and medications via a feeding tube, or for gastric decompression in patients with gastroparesis, gastroesophageal reflux disease, or intestinal obstruction.

gastrostomy

____________________________ are dilated portions of anal veins.

hemorrhoids

Decompression of the bowel through a nasogastric ___________ is necessary for all patients with small bowel obstruction; this may be tried for up to 3 days for patients with partial obstructions; resting the bowel in this manner can result in resolution of the obstruction.

tube Decompression of the bowel through an NG tube is necessary for all patients with small bowel obstruction; this may be tried for up to 3 days for patients with partial obstructions; resting the bowel in this manner can result in resolution of the obstruction

Which of the following would the nurse want to immediately report to the physician regarding a patient with an NG tube for a small bowel obstruction? Select all that apply. Discrepancies in I&O Tolerating ice chips Increased NG output Worsening of pain or abdominal distension

Discrepancies in I&O Increased NG output Worsening of pain or abdominal distension The nurse reports discrepancies in I&O, worsening of pain or abdominal distention, and increased NG output. If the patient's condition does not improve, the nurse prepares him or her for surgery.

The patient complains of symptoms of GERD, notably frequent? dysphagia regurgitation Frequent heartburn hypersalivation

Frequent heartburn

Which type of procedure is used to create an opening in the stomach for the purpose of administering nutrition? Jejostomy Nasogastric Urostomy Gastrostomy

Gastrostomy

When taking a history the nurse must also include questions about past or present causative factors, such as which of the following? Select all that apply. Alcohol use infections Tobacco use Dairy intake

Alcohol use infections Tobacco use This history also includes questions about past or present causative factors, such as infections and chemical, mechanical, or physical irritants; alcohol and tobacco use; and the amount of daily food intake. The nurse determines whether the patient appears emaciated and auscultates the patient's chest to assess for pulmonary complications.

Which of the following are health risk factors associated with obesity? Select all that apply. Diabetes Mellitus Respiratory and Sleep Problems Gastrointestinal Problems Neurological Problems

Cardiovascular Problems Gastrointestinal Problems Reproductive Cancer Respiratory and Sleep Problems Diabetes Mellitus

Treatment for Barrett Esophagus includes the use of proton pump inhibitors (PPI). Which of the following are proton pump inhibitors? Select all that apply. Dexlansoprazole (Dexilant). Pantoprazole (Protonix) Rabeprazole (Aciphex) Calcium Carbonate (Tums) Lansoprazole (prevacid)

Dexlansoprazole (Dexilant). Pantoprazole (Protonix) Rabeprazole (Aciphex) Lansoprazole (prevacid) Proton pump inhibitors include, Pantoprazole (Protonix), Omeprazole (Prilosec), Esomeprazole (Nexium), Lansoprazole (prevacid), Rabeprazole (Aciphex) and Dexlansoprazole (Dexilant). Note PPI suffix is "prazole".

Patients who are prescribed antiobesity medications should be counseled that these prescriptions are meant to supplement, not supplant diet modification and ______________ .

Exercise

The first fluid nourishment is given soon after tube insertion and can consist of a sterile water or normal saline flush of at least 100 mL. True False

False 30 mL

Daily dietary intake of 5 to 15 g/day of fiber (soluble and bulk forming) is recommended, especially for the treatment of constipation in the older adult. True False

False Daily dietary intake of 25 to 30 g/day of fiber (soluble and bulk forming) is recommended, especially for the treatment of constipation in the older adult.

When the dosage of immunomodulators is reduced or stopped, the symptoms of disease may return. False True

False When the dosage of corticosteroids is reduced or stopped, the symptoms of disease may return.

Intragastric balloon therapy involves endoscopic placement of a saline-filled balloon (ORBERA™) or a saline-filled dual balloon (ReShape™) into the stomach. True False

True

Large bowel obstruction differs clinically from small bowel obstruction in that the symptoms develop and progress relatively slowly. True False

True

Obesity is an excessively high amount of body fat or adipose tissue. Obesity is a major health problem because it increases the risk of many other diseases such as diabetes and cancer. True False

True

Patients identified as overweight or pre-obese have a BMI of 25 to 29.9 kg/m2. True False

True

Patients with ulcerative colitis also have a significantly increased risk of osteoporotic fractures due to decreased bone mineral density. False True

True

Sterile saline or water, or tap water can be used as irrigants, depending on the patient's electrolyte levels and ability to fight infection. True False

True

The Roux-en-Y gastric bypass (RYGB) procedure is a combination of restrictive and malabsorptive surgery. False True

True

A __________ is a surgically placed opening into the jejunum for the purpose of administering nutrition, fluids, and medications.

jejunostomy

Tube feeding formula is delivered to patients by either an ________ or closed system.

open

Clinical manifestations of constipation include which of the following? Select all that apply. straining at stool fewer than three bowel movements per week sensation of incomplete evacuation smooth, soft, moist stools

straining at stool fewer than three bowel movements per week sensation of incomplete evacuation Clinical manifestations of constipation include fewer than three bowel movements per week; abdominal distention; pain and bloating; a sensation of incomplete evacuation; straining at stool; and the elimination of small-volume, lumpy, hard, dry stools.

Following the intraoperative placement of a gastrostomy or jejunostomy tube for feeding the most common complications are which of the following? Select all that apply. wound infection dislodgement cellulitis at the exit site Decreased urine output bleeding and leakage

wound infection dislodgement cellulitis at the exit site bleeding and leakage During the postoperative course, the most common complications are wound infection or cellulitis at the exit site, bleeding, leakage, excessive tightness of external retention bolster, and dislodgement.

The patient diagnosed with gastrointestinal esophageal reflux disease (GERD) is instructed to eat a low-fat diet; avoid caffeine, tobacco, beer, milk, foods containing peppermint or spearmint, and carbonated beverages; avoid eating or drinking _________ hours before bedtime; maintain normal body weight; avoid tight-fitting clothes; and elevate the head of the bed by at least 30 degrees.

2

The first fluid nourishment is given soon after tube insertion and can consist of a sterile water or normal saline flush of at least how many ml? 20 30 100 45

30 mL

The onset of symptoms is usually acute in Crohn's disease, with prominent left lower quadrant abdominal pain and diarrhea unrelieved by defecation. True False

False The onset of symptoms is usually insidious in Crohn's disease, with prominent right lower quadrant abdominal pain and diarrhea unrelieved by defecation.

Diphenoxylate with atropine is well absorbed by the oral route with an onset of action of 45 to ____ minutes. The duration of action is 3 to 4 hours. The drug is metabolized in the liver to active metabolites and is excreted in bile and feces.

60

Complications of ulcerative colitis include right lower quadrant abdominal pain and diarrhea unrelieved by defecation. True False

False Complications of ulcerative colitis include toxic megacolon, perforation, and bleeding as a result of ulceration, vascular engorgement, and highly vascular granulation tissue.

Experts believe that orlistat inhibits the reuptake of both serotonin and norepinephrine. The drug causes appetite suppression, which is thought to result from direct stimulation of the satiety center in the hypothalamic and limbic region. True False

False Experts believe that phentermine inhibits the reuptake of both serotonin and norepinephrine. The drug causes appetite suppression, which is thought to result from direct stimulation of the satiety center in the hypothalamic and limbic region.

For patients receiving nutritional formulas, the nurse observes for weight gain and increased serum glucose. True False

False For patients receiving nutritional formulas, the nurse observes for weight gain and increased serum albumin.

Case Study Melissa Drake is a 22-year-old college student who suffered a fractured femur, pelvis, and tibia in a motor vehicle accident. She recently has been discharged after recovering from her injuries and is taking opioid analgesics several times daily for pain. On a routine follow-up visit to the medical clinic, she tells the nurse that she has been constipated; her last bowel movement was 1 week ago and was small, hard, and difficult to pass. She is instructed on risk factors for constipation and advised on lifestyle modifications that may ease the constipation and to take psyllium daily. 1. Melissa states "I have never been constipated in the past. Why is this happening now?" How should the nurse respond? 2. Melissa states "Wait a minute. Isn't psyllium for older people?" How should the nurse respond?

Answer 1. Constipation involves infrequent defecation that often is due to variations in diet and other factors such as low-fiber diet, decreased fluid intake, limited mobility, certain drugs, certain diseases, elderly, and overuse of laxatives. The nurse explains to Melissa that since her accident, risk factors such as opiate use, limited activity, and possible changes to her diet and fluid intake may contribute to constipation. 2. The nurse should explain that psyllium is the laxative with the most physiologic effect. The effect of this drug is similar to that of increasing dietary intake of fiber. Thus, it can be beneficial for all ages, not only in the older population.

Case Study Tom Fields is a 34-year-old client who works as a pastor of a mid-sized church. He is 5 feet 11 inches tall and weighs 320 lb, BMI 44.7. He was diagnosed with type 2 diabetes mellitus and sleep apnea during the preceding year. Mr. Fields is being seen at the medical clinic today for a consultation regarding his weight. He has requested bariatric surgery. He states that his mother and father were overweight and that he knows his genetic makeup is the reason for his weight problem. He states that, because of his genetic history, "just plain old diet and exercise will not work for me." 1. Is Mr. Fields a candidate for drugs or surgery to aid him in his weight management? Why or why not? 2. Mr. Fields is prescribed phentermine. Discuss the nursing considerations related to the administration of this drug, including client teaching that should occur.

Answer 1. Drug therapy is indicated when the client's BMI is 30 kg/m2 or higher and accompanied by health problems (hypertension, dyslipidemia, coronary artery disease, type 2 diabetes, sleep apnea) that are likely to improve with weight loss. Mr. Fields' BMI is 44.7. His type 2 diabetes mellitus and sleep apnea are caused or aggravated by obesity. Therefore, he is a candidate for drug therapy. 2. The nurse should explain that phentermine is approved for short-term therapy, generally 3 months or less. Thus, he should not depend on drug therapy alone to resolve his weight issue. The nurse should assist Mr. Fields in selecting a program to modify his dietary intake, referring him to a nutritionist if possible. An increase in physical activity and behavioral modification should also be included in his therapeutic regimen. Mr. Fields should be taught that phentermine is a CNS and cardiovascular stimulant, which increases blood pressure, so his blood pressure should be monitored regularly. He should be taught other potential adverse effects of the drug, including nervousness, dry mouth, and constipation. Fast or irregular heartbeat, dizziness, insomnia (if taken late in the day), and mental confusion may also occur. He should be taught the signs and symptoms of heart attack and stroke because these are potential serious adverse effects of the drug. He should take phentermine on an empty stomach in the morning for the best effect of appetite suppression and to reduce insomnia. If taking a multiple dose preparation, Mr. Fields should take the medication 30 minutes before meals, with the last dose about 6 hours before going to bed. Over-the-counter decongestants, allergy, asthma, and cold remedies, and weight loss herbal or dietary supplements should be avoided because the combination of these drugs with phentermine can cause serious effects from excessive heart and brain stimulation. Psychological support will be important for Mr. Fields and may aid in his chances for successful weight management; the nurse should provide him with resources for support groups in his area.

Case Study A nursing student is preparing a presentation for an in-service to the staff nurses on the unit where the clinical rotation is done. The in-service is being presented on medications for gastrointestinal orders, which are among the most common complaints seen in clinical practice. What are the therapeutic actions for drugs used to decrease acid content (H2 receptor antagonists, antacids, proton pump inhibitors, and prostaglandins)? How does acid rebound occur? What are the therapeutic actions of sucralfate and misoprostol? What are the considerations for older adults when using drugs that affect GI secretions? What are the important teaching points to include for a patient receiving ranitidine?

Answer 1. What are the therapeutic actions for drugs used to decrease acid content (H2 receptor antagonists, antacids, proton pump inhibitors, and prostaglandins)? H2 antagonists block the release of acid in response to gastrin or parasympathetic release Antacids are used to chemically react with and neutralize acid in the stomach. They can provide rapid relief from increased acid levels. The gastric acid pump or proton pump inhibitors suppress gastric acid secretion by specifically inhibiting the hydrogen-potassium adenosine triphosphatase (H+, K+-ATPase) enzyme system on the secretory surface of the gastric parietal cells. This action blocks the final step of acid production, lowering the acid levels in the stomach. Prostaglandin inhibits gastric acid secretion and increases bicarbonate and mucus production in the stomach; thus, protecting the lining of the stomach. 2. How does acid rebound occur? Acid rebound occurs when the stomach produces more gastrin and more acid in response to lowered acid levels in the stomach, which commonly occurs with the use of antacids. Balancing the reduction of the stomach acid without increasing acid production is a clinical challenge. 3. What are the therapeutic actions of sucralfate and misoprostol? The GI protectant sucralfate forms a protective coating over the eroded stomach lining to protect it from acid and digestive enzymes to aid healing. The prostaglandin misoprostol blocks gastric acid secretion while increasing the production of bicarbonate and mucous lining in the stomach. 4. What are the considerations for older adults when using drugs that affect GI secretions? Older adults frequently are prescribed one or more of these drugs. Older adults are more likely to develop adverse effects associated with the use of these drugs, including sedation, confusion, dizziness, urinary retention, and cardiovascular effects. Safety measures may be needed if these effects occur and interfere with the patient's mobility and balance. Because of changes that occur within the GI tract with age, absorption of nutrients can be affected when any of these drugs is used. The use of proton pump inhibitors and H2 blockers in older adults has been associated with decreased absorption of vitamin B12 and the development of pernicious anemia. Older adults also are more likely to have renal and/or hepatic impairment related to underlying medical conditions, which could interfere with the metabolism and excretion of these drugs. The dosage for older adults should be started at a lower level than recommended for younger adults. Patients should be monitored very closely, and dosage adjustment should be made based on patient response. These patients also need to be alerted to the potential for toxic effects when using over-the-counter (OTC) preparations that may contain the same ingredients as many of these agents. They should be advised to check with their health care provider before beginning any OTC drug regimen. Proton pump inhibitors may be the best choice for treating gastroesophageal reflux disease in older patients because of fewer adverse effects and better therapeutic response with these drugs. 5. What are the important teaching points to include for a patient receiving ranitidine? Ranitidine is called a histamine-2 receptor antagonist. A histamine-2 receptor antagonist decreases the amount of acid that is produced in the stomach. It is used to treat conditions that are aggravated by excess acid. Some of the following adverse effects may occur with this drug: Diarrhea: Have ready access to bathroom facilities. This usually becomes less severe over time. Dizziness, headache: These usually lessen as your body adjusts to the drug. Change positions slowly. If you feel drowsy, avoid driving or dangerous activities. Report any of the following to your health care provider: sore throat, unusual bleeding or bruising, confusion, muscle or joint pain, and/or tarry stools. Avoid taking any over-the-counter medication without first checking with your health care provider. Several of these medications can interfere with the effectiveness of this drug. If an antacid has been ordered for you, take it exactly as prescribed, spaced apart from your ranitidine. Tell any physician, nurse, or other health care provider involved in your care that you are taking this drug.

For patients receiving nutritional formulas, the nurse observes for weight gain and increased serum potassium. False True

False For patients receiving nutritional formulas, the nurse observes for weight gain and increased serum albumin.

Calcium Carbonate (Tums) is a PPI that is used to treat Barrett Esophagus. True False

False Proton pump inhibitors include, Pantoprazole (Protonix), Omeprazole (Prilosec), Esomeprazole (Nexium), Lansoprazole (prevacid), Rabeprazole (Aciphex) and Dexlansoprazole (Dexilant). Note PPI suffix is "prazole".

Which of the following is the more sensitive test for diagnosing Crohn's Disease? CT Scan Barium Swallow Exploratory Laparoscopy MRI

CT scan CT scan can highlight bowel wall thickening and mesenteric edema, as well as obstructions, abscesses, and fistulae. Therefore, CT scan is considered more sensitive in diagnosing Crohn's disease than barium studies, and may help specify abscess formation and location, guiding percutaneous access and drainage.

A small bowel obstruction can lead to severe distention and perforation unless some gas and fluid can flow back through the ileocecal valve. True False

False A large bowel obstruction can lead to severe distention and perforation unless some gas and fluid can flow back through the ileocecal valve

Aminosalicylates such as sulfasalazine (Azulfidine) are often effective for mild or moderate pain and are used to prevent or reduce recurrences in long-term maintenance regimens. True False

False Aminosalicylates such as sulfasalazine (Azulfidine) are often effective for mild or moderate inflammation and are used to prevent or reduce recurrences in long-term maintenance regimens

Which of the following are patient teaching guidelines for nutritional products? Select all that apply. For tube feedings, use or give with the patient in a sitting position, if possible, to decrease risks of aspirating formula into the lungs. With continuous feedings, change containers and tubing daily. For tube feedings, do not take or give more than 1500 mL per feeding, including 60 to 90 mL of water for flushing the tube. This helps to avoid overfilling the stomach and possible vomiting. For giving medications by tube, give medications all at once.

For tube feedings, use or give with the patient in a sitting position, if possible, to decrease risks of aspirating formula into the lungs. With continuous feedings, change containers and tubing daily.

Which type of constipation involves normal transit mechanisms of mucosal transport? Functional constipation Dysfunctional constipation Slow-transit constipation Defecatory disorders

Functional constipation Functional constipation, which involves normal transit mechanisms of mucosal transport. This type of constipation is most common and can be successfully treated by increasing intake of fiber and fluids.

The ___________ tube has a single lumen (channel within a tube or catheter) and is made of plastic or rubber.

Levin

Commonly used gastric tubes include which of the following? Levin Tube and Salem Sump Levin Sump and Salem Tube Lewis Sump and Salve Tube Lewis Tube and Salve Sump

Levin Tube and Salem Sump The Levin tube has a single lumen (channel within a tube or catheter) and is made of plastic or rubber. The Salem Sump tube is a radiopaque (easily seen on x-ray), clear plastic, double-lumen gastric tube.

Which of the following are manifestations are associated with Crohn's Disease? Select all that apply. joint disorders (e.g., arthritis) Hypoalbuminemia disorders (e.g., uveitis) oral ulcers

Manifestations may extend beyond the GI tract and can include joint disorders (e.g., arthritis), skin lesions (e.g., erythema nodosum), ocular disorders (e.g., uveitis), and oral ulcers. Hypobilirubemia is associated with Ulcerative Colitis.

Patients receiving gastric or enteric tube feedings can experience diarrhea or constipation. Possible causes of diarrhea include which of the following? Select all that apply. Medication therapy Dumping syndrome Clostridium difficile Malnutrition Zirconium deficiency

Medication therapy Dumping syndrome Clostridium difficile Malnutrition Patients receiving gastric or enteric tube feedings can experience diarrhea or constipation. Possible causes of diarrhea include medication therapy, C-Diff, malnutrition, dumping syndrome.

Which of the following are symptoms associated with Gastroesophageal Reflux Disease (GERD)? Select all that apply. dysphagia Ulceration in the Small and large colon hypersalivation regurgitation dyspepsia

Symptoms may include pyrosis (heartburn, specifically more commonly described as a burning sensation in the esophagus), dyspepsia (indigestion), regurgitation, dysphagia or odynophagia, hypersalivation, and esophagitis. The symptoms may mimic those of a heart attack. GERD can result in dental erosion, ulcerations in the pharynx and esophagus, laryngeal damage, esophageal strictures, adenocarcinoma, and pulmonary complications

Small, frequent feedings (6 to 8 per day) are recommended because large quantities of food overload the stomach and promote gastric reflux. False True

True

Tube feeding formula is delivered to patients by either an open or a closed system False True

True

Vagal blocking therapy involves placement of a pacemaker-like device (vBloc™). False True

True

The U.S. Preventive Services Task Force (USPSTF) recommends that all adults with BMIs in excess of 30 kg/m2 be advised to engage in multicomponent behavioral interventions. False True

True The U.S. Preventive Services Task Force (USPSTF) recommends that all adults with BMIs in excess of 30 kg/m2 be advised to engage in multicomponent behavioral interventions

Diarrhea is an increased frequency of bowel movements (more than 3 per day) with altered consistency (i.e., increased liquidity) of stool. It can be associated with which of the following? Select all that apply. Headache Nausea Incontinence Urgency Perianal discomfort

Urgency Perianal discomfort Incontinence Nausea Diarrhea is an increased frequency of bowel movements (more than 3 per day) with altered consistency (i.e., increased liquidity) of stool. It can be associated with urgency, perianal discomfort, incontinence, nausea, or a combination of these factors (NIDDK, 2014d). Any condition that causes increased intestinal secretions, decreased mucosal absorption, or altered motility can produce diarrhea.

Which of the following are clinical manifestations in a small bowel obstruction? Select all that apply. Vomiting Low back pain Distended abdomen Signs of dehydration

Vomiting Signs of dehydration Distended abdomen The initial symptom is usually crampy pain that is wavelike and colicky due to persistent peristalsis both above and below the blockage. The patient may pass blood and mucus but no fecal matter and no flatus. Vomiting occurs. If the obstruction is complete, the peristaltic waves initially become extremely vigorous and eventually assume a reverse direction, with the intestinal contents propelled toward the mouth instead of toward the rectum. The signs of dehydration become evident: intense thirst, drowsiness, generalized malaise, aching, and a parched tongue and mucous membranes. The patient may continue to have flatus and stool early in the process due to distal peristalsis. The abdomen becomes distended. The lower the obstruction in the GI tract, the more marked the abdominal distention; this may cause reflux vomiting. Vomiting results in loss of hydrogen ions and potassium from the stomach, leading to reduction of chloride and potassium in the blood and to metabolic alkalosis. Dehydration and acidosis develop from loss of water and sodium. With acute fluid losses, hypovolemic shock may occur; septic shock may also occur (Ansari, 2014; Nobie, 2015; Saccomano & Ferrara, 2013).

Signs and symptoms of pulmonary complications include which of the following? Select all that apply. fever coughing during the administration of foods or medications difficulty clearing the airways bradypnea

fever coughing during the administration of foods or medications difficulty clearing the airway Signs and symptoms of pulmonary complications include coughing during the administration of foods or medications, difficulty clearing the airway, tachypnea, and fever. Assessment includes regular auscultation of lung sounds and monitoring of vital signs and laboratory values. The nurse also carefully confirms the proper placement of the tube with a variety of methods before instilling any fluids or medications. If tube position is ever in question, radiographic confirmation is essential (Metheny, 2016).

Tube feeding formula is delivered to patients by which of the following systems? open or closed open or remote slow or closed rapid or slow

open or closed