Ch 46

A patient who experienced an upper GI bleed due to gastritis has had the bleeding controlled and the patients condition is now stable. For the next several hours, the nurse caring for this patient should assess for what signs and symptoms of recurrence?

Tachycardia, hypotension, and tachypnea

_____,_____, and ____ are signs of recurrent bleeding

Tachycardia, hypotension, and tachypnea

A patient with a history of peptic ulcer disease has presented to the emergency department (ED) in distress. What assessment finding would lead the ED nurse to suspect that the patient has a perforated ulcer?

The patient has a rigid, boardlike abdomen that is tender.

A nurse is preparing to discharge a patient after recovery from gastric surgery. What is an appropriate discharge outcome for this patient?

The patient maintains or gains weight.

For many years, it had been theorized that the hypertonic gastric food boluses that quickly transit into the intestines drew extracellular fluid from the circulating blood volume into the small intestines to dilute the high concentration of electrolytes and sugars, resulting in symptoms. Now, it is thought that this rapid transit of the food bolus from the stomach into the small intestines instead causes a rapid and exuberant release of metabolic peptides that are responsible for the symptoms of ______.

dumping syndrome

Pain relief after eating is associated with ______ ulcers

duodenal

An extremely tender and rigid (boardlike) abdomen is suggestive of a _______.

perforated ulcer

A patient has experienced symptoms of dumping syndrome following bariatric surgery. To what physiologic phenomenon does the nurse attribute this syndrome?

A sudden release of peptides

A patient comes to the bariatric clinic to obtain information about bariatric surgery. The nurse assesses the obese patient knowing that in addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate what?

Adequate understanding of required lifestyle changes

A patient has been diagnosed with peptic ulcer disease and the nurse is reviewing his prescribed medication regimen with him. What is currently the most commonly used drug regimen for peptic ulcers?

Antibiotics, proton pump inhibitors, and bismuth salts

A patient with a peptic ulcer disease has had metronidazole (Flagyl) added to his current medication regimen. What health education related to this medication should the nurse provide?

Avoid drinking alcohol while taking the drug.

A nurse is providing care for a patient who is postoperative day 2 following gastric surgery. The nurses assessment should be planned in light of the possibility of what potential complications? Select all that apply. A) Malignant hyperthermia B) Atelectasis C) Pneumonia D) Metabolic imbalances E) Chronic gastritis

B, C, D

A patient is receiving education about his upcoming Billroth I procedure (gastroduodenostomy). This patient should be informed that he may experience which of the following adverse effects associated with this procedure?

Diarrhea and feelings of fullness

A nurse is caring for a patient who just has been diagnosed with a peptic ulcer. When teaching the patient about his new diagnosis, how should the nurse best describe a peptic ulcer?

Erosion of the lining of the stomach or intestine.

A nurse is providing anticipator guidance to a patient who is preparing for bariatric surgery. The nurse learns that the patient is anxious about numerous aspects of the surgery. What intervention is most appropriate to alleviate the patients anxiety?

Facilitate the patients contact with a support group

A patient has been prescribed orlistat (Xenical) for the treatment of obesity. When providing relevant health education for this patient, the nurse should ensure the patient is aware of what potential adverse effect of treatment?

Flatus with oily discharge

A nurse in the postanesthesia care unit admits a patient following resection of a gastric tumor. Following immediate recovery, the patient should be placed in which position to facilitate patient comfort and gastric emptying?

Fowlers

Positioning the patient in a ______ position postoperatively promotes comfort and facilitates emptying of the stomach following gastric surgery

Fowlers

Most peptic ulcers result from infection with the gram-negative bacteria _____ which may be acquired through ingestion of food and water.

H. pylori

_____ infection may be determined by endoscopy and histologic examination of a tissue specimen obtained by biopsy, or a rapid urease test of the biopsy specimen.

H. pylori

A nurse is assessing a patient who has peptic ulcer disease. The patient requests more information about the typical causes of Helicobacter pylori infection. What would it be appropriate for the nurse to instruct the patient?

Infection typically occurs due to ingestion of contaminated food and water.

A patient has been admitted to the hospital after diagnostic imaging revealed the presence of a gastric outlet obstruction (GOO). What is the nurses priority intervention?

Insertion of an NG tube for decompression

A nurse is providing patient education for a patient with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The patient has recently been prescribed misoprostol (Cytotec). What would the nurse be most accurate in informing the patient about the drug?

It protects the stomachs lining

A patient is recovering in the hospital following gastrectomy. The nurse notes that the patient has become increasingly difficult to engage and has had several angry outbursts at various staff members in recent days. The nurses attempts at therapeutic dialogue have been rebuffed. What is the nurses most appropriate action?

Make appropriate referrals to services that provide psychosocial support.

______ is a synthetic prostaglandin that, like prostaglandin, protects the gastric mucosa.

Misoprostol (Cytotec)

A patient who underwent gastric banding 3 days ago is having her diet progressed on a daily basis. Following her latest meal, the patient complains of dizziness and palpitations. Inspection reveals that the patient is diaphoretic. What is the nurses best action?

Monitor the patient closely for further signs of dumping syndrome.

Erosion of the lining of the stomach or intestine:

Peptic ulcer

_______ is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Chemical peritonitis develops within a few hours of perforation and is followed by bacterial peritonitis.

Perforation

Diagnostic imaging and physical assessment have revealed that a patient with peptic ulcer disease has suffered a perforated ulcer. The nurse recognizes that emergency interventions must be performed as soon as possible in order to prevent the development of what complication?

Peritonitis (Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Chemical peritonitis develops within a few hours of perforation and is followed by bacterial peritonitis.)

A patient has just been diagnosed with acute gastritis after presenting in distress to the emergency department with abdominal symptoms. What would be the nursing care most needed by the patient at this time? A) Teaching the patient about necessary nutritional modification B) Helping the patient weigh treatment options C) Teaching the patient about the etiology of gastritis D) Providing the patient with physical and emotional support

Providing the patient with physical and emotional support (For acute gastritis, the nurse provides physical and emotional support and helps the patient manage the symptoms, which may include nausea, vomiting, heartburn, and fatigue. The scenario describes a newly diagnosed patient; teaching about the etiology of the disease, lifestyle modifications, or various treatment options would be best provided at a later time.)

Expected outcomes for the patient following gastric surgery include:

1. Ensuring that the patient is maintaining or gaining weight (patient should be weighed daily) 2. Experiencing no excessive diarrhea 3. Tolerating six small meals a day. 4. Vitamin B12 supplementation IM

Measures to help relieve pain from chronic gastritis include:

1. instructing the patient to avoid foods and beverages that may be irritating to the gastric mucosa 2. instructing the patient about the correct use of medications to relieve chronic gastritis.

A patient with gastritis required hospital treatment for an exacerbation of symptoms and receives a subsequent diagnosis of pernicious anemia due to malabsorption. When planning the patients continuing care in the home setting, what assessment question is most relevant? A) Does anyone in your family have experience at giving injections? B) Are you going to be anywhere with strong sunlight in the next few months? C) Are you aware of your blood type? D) Do any of your family members have training in first aid?

Does anyone in your family have experience at giving injections? (Patients with malabsorption of vitamin B12 need information about lifelong vitamin B12injections; the nurse may instruct a family member or caregiver how to administer the injections or make arrangements for the patient to receive the injections from a health care provider)

A patient comes to the clinic complaining of pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if the patient has a peptic ulcer?

Does your pain resolve when you have something to eat?

A patient has received a diagnosis of gastric cancer and is awaiting a surgical date. During the preoperative period, the patient should adopt what dietary guidelines?

Eat small, frequent meals with high calorie and vitamin content.

A patient is one month postoperative following restrictive bariatric surgery. The patient tells the clinic nurse that he has been having trouble swallowing for the past few days. What recommendation should the nurse make?

Eating more slowly and chewing food more thoroughly

Dysphagia may be prevented by educating patients to:

Eating more slowly and chewing food more thoroughly

A patient was treated in the emergency department and critical care unit after ingesting bleach. What possible complication of the resulting gastritis should the nurse recognize?

Esophageal or pyloric obstruction related to scarring

A patient presents to the walk-in clinic complaining of vomiting and burning in her mid-epigastria. The nurse knows that in the process of confirming peptic ulcer disease, the physician is likely to order a diagnostic test to detect the presence of what?

Infection with Helicobacter pylori

A community health nurse is preparing for an initial home visit to a patient discharged following a total gastrectomy for treatment of gastric cancer. What would the nurse anticipate that the plan of care is most likely to include?

Monthly administration of injections of vitamin B12

A nurse is caring for a patient who has a diagnosis of GI bleed. During shift assessment, the nurse finds the patient to betachycardic and hypotensive, and the patient has an episode of hematemesis while the nurse is in the room. In addition to monitoring the patients vital signs and level of conscious, what would be a priority nursing action for this patient? A) Place the patient in a prone position. B) Provide the patient with ice water to slow any GI bleeding. C) Prepare for the insertion of an NG tube. D) Notify the physician.

Notify the physician.

A nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data should the nurse consider most significantly related to the etiology of the patients health problem? A) Consumes one or more protein drinks daily. B) Takes over-the-counter antacids frequently throughout the day. C) Smokes one pack of cigarettes daily. D) Reports a history of social drinking on a weekly basis.

Smokes one pack of cigarettes daily

A nurse is caring for a patient hospitalized with an exacerbation of chronic gastritis. What health promotion topic should the nurse emphasize? A) Strategies for maintaining an alkaline gastric environment B) Safe technique for self-suctioning C) Techniques for positioning correctly to promote gastric healing D) Strategies for avoiding irritating foods and beverages

Strategies for avoiding irritating foods and beverages

A patient with a diagnosis of peptic ulcer disease has just been prescribed omeprazole (Prilosec). How should the nurse best describe this medications therapeutic action?

This medication will reduce the amount of acid secreted in your stomach.

Currently, the most commonly used therapy for peptic ulcers is a combination of _______, _______, and ______ that suppress or eradicate H. pylori.

antibiotics, proton pump inhibitors, and bismuth salts

Symptoms characteristic of ______, results in a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea.

dumping syndrome

Tarry stools are expected short-term findings after a _______.

hemorrhage.

The nurse must always be alert for any indicators of ________ which include hematemesis (vomiting of blood), tachycardia, and hypotension. If these occur, the physician is notified and the patients vital signs are monitored as the patients condition warrants.

hemorrhagic gastritis

In treating the patient with gastric outlet obstruction, the first consideration is to:

insert an NG tube to decompress the stomach.

Proton pump inhibitors like _____ inhibit the synthesis of stomach acid.

omeprazole (Prilosec)

Chronic referred pain to the lower abdomen is a symptom of ______.

peptic ulcer disease

Since vitamin B12 is absorbed in the stomach, the patient with a gastrectomy requires vitamin B12 replacement to prevent _____.

pernicious anemia

After surgery, the nurse assesses the patient for complications secondary to the surgical intervention, such as _______, _______, or ________ resulting from the GI disruption.

pneumonia, atelectasis, or metabolic imbalances

A severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate. Scarring can occur, resulting in ______ (narrowing or tightening) or ______.

pyloric stenosis or obstruction