Chapter 33: Nursing Care of Patients with Upper Gastrointestinal Disorders

Anorexia

Loss of appetite

Gastric Cancer Therapeutic Measures

Medical treatment not very effective Surgical treatment: subtotal or total gastrectomy

Gastric Cancer Signs and Symptoms

Rarely detected during early stages Symptoms often mistaken for PUD: indigestion, anorexia, pain, weight loss, nausea, vomiting, anemia Late symptoms include involvement of other organs such as the liver

Bulimia Nervosa

Recurrent episodes of binge eating and self-induced vomiting

Gastric Cancer Complications

Related to disease and surgery: hemorrhage, acute gastric distention, nutritional problems

Peptic Ulcer disease risk factors

Risk factors that contribute to peptic ulcer disease in clude smoking, chewing tobacco, stress, caffeine use, and medications such as steroids, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs). Peptic ulcer development is influenced by smoking because it increases the harmful effects of H. pylori, alters protective mechanisms, and de creases gastric blood flow.

GERD signs and symptoms

Signs and symptoms of GERD include heartburn, regurgita tion, dysphagia, and bleeding.

Aphthous stomatitis

Small, white, painful ulcers appear on inner cheek, lips, gums, tongue, palate, pharynx

Peptic ulcer Disease pathophysiology

Stomach or duodenal intestinal mucosa is eroded, usually from the hpylori. hCL and pepsin exposure lead to ulcers. Duodenal ulcers are the most common type.

Gastrectomy

Surgical removal of the stomach

Mallory Weiss tear signs and symptoms

Symptoms include bright red, bloody emesis or bloody or tarry stools.

Steatorrhea

The condition of excess fat on the stools. The result of rapid gastric emptying.

Therapeutic measures for gastric bleeding

The goal of treatment for a massive GI bleed is to prevent or treat hypo volemic shock and prevent dehydration, electrolyte imbal ance, and further bleeding. - npo - IV for fluid and blood products - cbc - urinary catheter to monitor I and o - Ng tube to assess bleeding, decompress the stomach, and lavage - possible O2 - elevate head of bed - endoscopy - possible surgery to stop bleeding - H2 receptor antagonists are given to reduce gastric acid secretion

The nursing process for gastric bleeding

The nurse should assess patients at risk for bleeding for signs and symptoms of bleeding. Assess any emesis and stool for occult or obvious bleeding. Assess for signs of hypovolemic shock such as hypotension, tachycardia, tachypnea, chills, palpitations, and diaphoresis. The nurse should also assess for changes in level of consciousness, confusion, dry mucous membranes, reports of thirst, and fatigue, which could indi cate a decrease in circulating blood volume.

Fundoplication

The stomach fundus (body) is wrapped around lower part of the esophagus. Most common surgical repair of hiatal hernia

Mallory Weiss tear diagnostic tests

The tear can be diagnosed with an esophagogastroduo denoscopy (EGD). Hemoglobin and hematocrit are checked to determine amount of bleeding.

Therapeutic measures for esophageal cancer

Treatment for esophageal cancer includes surgery (most com mon), radiation, chemotherapy, laser therapy, and electrocoag ulation.

Treatments for ulcer hemorrhage

Treatment includes stopping the bleeding, replacing fluid and electrolytes, and possibly administering vasopressin to stop the bleeding.

Medication therapy for hpylori.

Triple therapy, two antibiotics + ppi for 14 days, is the most successful treatment to erraticate the hpylori without​ reoccurrence.

Gastric Surgery

Two types: Subtotal gastrectomy - either a gastroduodenostomy or a gastrojejunostomy. The total gastrectomy involves a total removal of the stomach.

Pernicious anemia

Vitamin B12 deficiency Vita min B12 injections are given daily initially, then weekly, and then monthly for life. Symptoms of pernicious anemia include anemia, weakness, sore tongue, numbness and tingling, and GI upset.

Hiatal hernia Diagnostics

X-ray and fluoroscopy

Gastrojejunostomy

Following surgical removal of part of the stomach, reanastomosis of the remaining portion to the proximal jejunum

GASTRICBLEEDING pathophysiology

Gastric bleeding may be caused by ulcer perforation, tumors, gastric surgery, or other conditions. Blood loss can be hidden (occult) blood in the stool, observable vomited blood (hematemesis), or black tarry stools (melena). Blood mixing with HCL causes coffee ground emisis

Gastric Cancer

Gastric cancerrefers to malignant lesions found in the stomach. It is more common in men than in women. H. pylori infection plays a role in gastric cancer development.

Acute gastritis pathophysiology

Gastritis results when the protective mucosal barrier is bro ken down and allows autodigestion from hydrochloric acid and pepsin to occur. This results in edema of the tissue and possible hemorrhage.

Billroth I procedure

Gastroduodenostomy,distal portion of stomach removed. Anastomosed to duodenum

Billroth II procedure

Gastrojujenostomy, removal of larger amount of distal stomach. Anastomosis of proximal stomach remnant to proximal jejunum

Peptic Ulcer Disease etiology

Gram negative hpylori. It is most common in those who are older adult Hispanics, African Americans, or in lower socioeconomic groups in the United States.

most common cause of peptic ulcers; its revolutionary tx. and cure of most peptic ulcers

H pylori

Medications for GERD

H2 receptor antagonists, antacids, and ppis (used for flare-ups or Barrett's esophagus)

Chronic Gastritis Type B

Heartburn or indigestion, associated with bacteria Helicobacter pylori, can be treated with antibiotics

Acute Gastritis

Heartburn or indigestion, often caused by overeating, can lead to peritonitis, treatment includes a bland diet

Hiatal hernia therapeutic measures

Lifestyle changes for symptomatic hiatal hernia include los ing weight, taking antacids, eating small meals that pass eas ily through the esophagus, not reclining for 3 to 4 hours after eating, elevating the head of the bed 6 to 12 inches to prevent reflux, and avoiding bedtime snacks, spicy foods, alcohol, caffeine, and smoking.

Therapeutic measures for gastrointestinal reflux disease

Lifestyle changes and a low-fat high-protein diet. Patients should eat small meals often, drink fluids between instead of with meals, and not eating before bedtime.

A pt. has a duodenal peptic ulcer and is taking cimetidine (Tagamet). what is a s/e that should be included in the teaching plan?

confusion

Proton pump inhibitors:

dexlansoprazole (Dexilant) omeprazole (Prilosec) lansoprazole (Prevacid)

Ppi nursing indications

dexlansoprazole (Dexilant): Delayed release. Capsule swallowed whole. omeprazole (Prilosec): Give before meal in morning. dexlansoprazole (Dexilant) omeprazole (Prilosec) Capsule swallowed whole. Assess for abdominal pain and bleeding. Monitor CBC and liver enzymes. Notify physician of bleeding, diarrhea, headache, or abdominal pain. lansoprazole (Prevacid): Give before meals. Capsule not to be crushed or chewed. May be sprinkled on applesauce and taken immediately. Packet mixed as liquid, but not for nasogastric (NG) tube because it sticks to tube. Sublingual tablet may be dissolved and given through NG tube. Notify physician of bleeding, diarrhea, headache, or abdominal pain.

an asymptomatic pt. is admitted with gastric bleeding. For which of the following is a s/s of severe gastric bleeding should the nurse monitor?

diaphoresis hypotension

a pt. visits her gynecologist and reports that she is very unhappy with her weight, which is 310 lb on her 5 foot 7 inch frame. When planning her care, the nurse knows that the initial treatment for obesity includes which of the following?

diet management

rapid entry of food into the jejunum causing dizziness, tachycardia, fainting, sweating, nauea, diarrhea and abdominal cramping

dumping syndrome

a pt. has been diagnosed with a hiatal hernia. the pt. The pt. complains of heartburn and occaisional regurgitation. Which of the following interventions should the nurse teach the pt. to reduce the symptoms?

eat small, frequent meals

which of the following procedures does the nurse understand is done palliatively for the dysphagia that occurs in inoperable esophageal cancer?

esophageal dilation

surgical removal of the stomach

gastrectomy

which of the following surgical procedures is the most likely treatment for a pt. with gastric cancer?

gastrectomy

inflammation of the stomach

gastritis

following surgical removal of part of the stomach, reanastomosis of the remaining a paportion to the proximal jejunum

gastrojejunostomy

condition in which the stomach may protrude above the diaphragm

hiatal hernia

a pt. had a gastrectomy 2 months ago. the pt. comes to the clinic complaining of greasy stools and frequent bowel movements. After the pts. surgical recovery and current eating habits are assessed, which of the following types of diet would be most appropriate for the nurse to teach the pt. to use?

low fat diet

%-%over average weight for age, sex, height

obesity

which of the following does the nurse understand is a s/s of oral cancer

painless ulcer

Roux-en-Y

successful weight loss surgery that reduces stomach size and bypasses some of the small intestine, which reduces absorption of calories, causing weight loss. It is mostly done laparoscopically but can be done as open surgery.

Mucosal Barrier Fortifiers

sucralfate (Carafate)

Mucosal Barrier Fortifiers nursing considetations

sucralfate (Carafate): Take on an empty stomach, 1 hour before meals and at bedtime. Monitor for constipation.

bariatric

treatment of obesity

Oral cancer signs and symptoms

- an oral sore that does not heal - it's painless - the trouble chewing swallowing or speaking (late) - swollen cervical nodes (late)

Esophageal cancer pathophysiology and etiology

- associated with the use of Alcohol and tobacco - Barrett's esophagus is a risk factor - usually diagnosed in the late stages

Nursing Process for the Patient With Peptic Ulcer Disease

- educate PT on hypylori and diet - collect disease Hx and aggravating and allieviating factors - The nurse assesses and monitors for complications of bleeding, such as occult blood in stool or emesis, perforation, including acute onset of severe pain, obstruction, changes in vital signs, and signs of shock.

Postoperative care oral cancer surgery

- educate on the absence of alcohol and tobacco - how will the patience because there's a tracheostomy - monitor patency of Airway and secretions - patient most likely need tube feedings

Nursing process for the patient with GERD.

- identify factors that increase pain - instruct PT to prevent pain by eating smaller meals, elevating the head of the bed, and not reclining for two hours after meals. - no smoking or alcohol - educate PT on meds

1. The nurse is caring for a patient with a sliding hiatal hernia. In which position should the nurse expect the patient to report that the symptoms are more acute? a. Sitting b. Standing c. Lying down d. Semi-Fowlers

1. ANS: C lying down In a sliding hiatal hernia, the stomach slides up into the thoracic cavity when a patient is supine and then goes back into the abdominal cavity when upright. Sliding hiatal hernia symptoms are worse when lying down. A. B. D. The symptoms of a hiatal hernia are not worse when sitting, standing, or in the semi-Fowlers position.

10. The nurse is caring for a patient with a vented nasogastric tube ordered to suction after a gastrectomy. What type of suction should the nurse use to decrease the development of complications? a. Continuous low suction b. Continuous high suction c. Intermittent low suction d. Intermittent high suction

10. ANS: C. intermittent low suction With a physicians order, the nasogastric tube is connected to suction equipment, usually set on low intermittent suction if the secretions are not too thick, to prevent injury to the gastric mucosa. The vent also helps prevent this injury. A. B. D. These settings for suction might cause injury to the gastric mucosa.

11. The nurse is caring for a patient with gastroesophageal reflux disease (GERD). Which patient statement indicates a need for nutritional instruction? a. I should drink milk, as it is the perfect food. b. Nutrition can affect health positively or negatively. c. Excessive intake of a nutrient can interfere with others. d. Classes of nutrients are carbohydrates, fats, proteins, vitamins, minerals, and water.

11. ANS: A. I should drink milk, as it is the perfect food. A low-fat, high-protein diet is recommended because fat causes decreased functioning of the lower esophageal sphincter. Caffeine, milk products, and spicy foods should be avoided. B. C. D. These patient statements are appropriate for the patient with gastroesophageal reflux disease.

12. The nurse is caring for a patient recovering from radical neck dissection for cancer and tracheostomy placement. What action by the nurse should take priority? a. Ensuring airway patency b. Ensuring adequate nutrition c. Teaching about smoking cessation d. Establishing ways of communication

12. ANS: A. ensure airway patency A tracheostomy is usually performed to protect the airway and prevent obstruction. The airway must be monitored and secretions controlled to prevent aspiration. B. C. D. These actions are important however do not take the priority over maintaining a patent airway.

13. The nurse is reinforcing teaching provided to a patient scheduled for pyloroplasty. Which patient statement indicates a correct understanding of the procedure? a. The doctor will stitch the top of my stomach to help me lose weight. b. The doctor will cut the nerve that goes to my stomach so less acid is released. c. The pylorus will be narrowed to prevent gastric reflux and help my ulcers heal. d. The surgery will improve the movement of food from my stomach to my small intestine.

13. ANS: D.The surgery will improve the movement of food from my stomach to my small intestine. Pyloroplasty widens the exit of the pylorus to improve emptying of the stomach. A. Suturing part of the stomach is part of Bariatric surgery. B. Cutting the nerve to the stomach is a vagotomy. C. There is no surgery to narrow the pylorus.

14. A patient is recovering from a Billroth 1 procedure and has a nasogastric Levin tube set to low intermittent suction. As the patient turns in bed, the Levin tube is partially pulled out. Which action should the nurse take? a. Notify the registered nurse (RN). b. Irrigate the tube. c. Advance the tube. d. Place suction on continuous.

14. ANS: A. Notify the registered nurse (RN). The nurse needs to inform the RN or physician because the tube will need to be repositioned. The physician typically is the one that does the repositioning after gastric surgery so the suture line is not affected. B. C. D. The nurse should not irrigate the tube, advance the tube, or place the tube on continuous suction since these actions could injure the suture line.

30. The nurse is preparing to calculate a patients body mass index. What measurements does the nurse need to make this calculation? a. Height and weight b. Waist and hip measurements c. Weight and waist measurement d. Waist measurement and height

30. ANS: A. Height and weight Height and weight are used to calculate body mass index. B. Waist and hip measurements are used to calculate waist-to-hip ratio. C. D. There are no calculations that use weight and waist measurement or waist measurement and height.

15. The nurse is providing care to a patient 3 days after a Billroth I procedure. About which observation should the nurse be most concerned? a. Pulse 58 beats per minute b. Incisional pain score 4 on a 1 to 10 scale c. Patient becomes tearful while viewing the incision d. Reports of abdominal cramping shortly after eating

15. ANS: D. Reports of abdominal cramping shortly after eating Dumping syndrome is a complication of Billroth I procedure and occurs 5 to 30 minutes after eating. Symptoms include dizziness, tachycardia, fainting, sweating, nausea, diarrhea, a feeling of fullness, and abdominal cramping. A. A pulse of 58 beats per minute could be within the patients normal pulse range. B. C. Pain and the emotional reaction to the incision are psychosocial concerns and are not the highest priority at this time.

16. The nurse is reinforcing teaching provided to a patient with dumping syndrome. Which patient statement indicates a correct understanding of this condition? a. It is delayed gastric emptying. b. Glucose is dumped into the bloodstream. c. Digestive secretions enter the esophagus. d. There is rapid entry of food into the jejunum.

16. ANS: D. There is rapid entry of food into the jejunum. Dumping syndrome occurs with the rapid entry of food into the jejunum without proper mixing of the food with digestive juices. On entering the jejunum, the food draws extracellular fluid into the bowel from the circulating blood volume to dilute the high concentration of electrolytes and sugars. A. Delayed gastric emptying does not described dumping syndrome. B. With dumping syndrome glucose is not dumped into the blood stream. C. Digestive secretions entering the esophagus describe gastroesophageal reflux disease.

17. The nurse is reinforcing teaching provided to a patient with a peptic ulcer. Which patient statement indicates understanding of the medication ranitidine (Zantac)? a. It clings to the ulcer. b. It coats your stomach. c. It neutralizes stomach acid. d. It reduces production of gastric acid.

17. ANS: D. It reduces production of gastric acid. Zantac reduces production of gastric acid, which aids in healing the ulcer. A. B. C. These statements do not explain the purpose or mechanism of Zantac.

18. The nurse is caring for a patient who suddenly begins having large amounts of bright red hematemesis. After the patient is turned onto the side, what should the nurse do? a. Encourage iced oral fluids. b. Lower the head of the bed. c. Obtain the patients vital signs. d. Place a cool cloth on the patients forehead.

18. ANS: C. Obtain the patients vital signs. The nurse should collect data, including vital signs, to report to the RN and physician for treatment orders. A. The nurse should not give the patient anything by mouth. B. Lowering the head of the bed could lead to aspiration. D. Placing a cool cloth on the patients forehead might be offered after the physician and RN have been notified.

19. The nurse is checks the gastric pH and provides antacids as prescribed to a patient recovering from a motor vehicle crash. What is the nurse attempting to prevent by these interventions? a. Shock b. Stress ulcers c. Malnutrition d. Metabolic acidosis

19. ANS: B. Stress ulcers Critically ill patients may develop gastric or small intestinal stress ulcers from ischemia. The stress response to the illness causes reduced blood flow to the stomach and small intestine. A. C. D. These interventions are not done to prevent the development of shock, malnutrition, or metabolic acidosis.

2. The nurse is reinforcing teaching provided to a patient with a hiatal hernia. Which patient statement indicates a correct understanding of lifestyle modification to reduce symptoms? a. Avoid high-stress situations. b. Perform daily aerobic exercise. c. Avoid nicotine and alcohol use. d. Carefully space activity periods with rest.

2. ANS: C. avoid nicotine and alcohol Lifestyle changes for symptomatic hiatal hernia include losing weight, antacids, eating small meals that pass easily through the esophagus, not reclining for 3-4 hours after eating, elevating the head of the bed 6 to 12 inches to prevent reflux, and avoiding bedtime snacks, spicy foods, alcohol, caffeine, and smoking. A. B. D. Stress, exercise, and rest periods are not recommendations for the patient with a hiatal hernia.

Obesity

20% to 30% over average weight for age, sex, and height

20. The nurse is caring for a patient who has a nasogastric tube in place following gastric surgery. Why should the nurse use normal saline to irrigate the nasogastric tube? a. It decreases electrolytes. b. It maintains electrolytes. c. It maintains fluid volume. d. It increases fluid volume.

20. ANS: B. It maintains electrolytes. Normal saline is used for irrigation to prevent electrolyte loss and imbalance. A. C. D. Irrigating a nasogastric tube with normal saline is not done to decrease electrolytes, maintain fluid volume, or increase fluid volume.

21. The nurse is caring for a patient who has developed esophagitis from gastroesophageal reflux disease (GERD). For which additional complication should the nurse anticipate providing care to this patient? a. Laryngospasm b. Bronchospasm c. Barretts esophagus d. Aspiration pneumonia

21. ANS: C. Barretts esophagus Complications of GERD can result in esophagitis. Over time, this can lead to changes in the epithelium of the esophagus and lead to Barretts esophagus, a precancerous lesion. A. B. D. Laryngospasm, bronchospasm, and aspiration pneumonia are not complications typically associated with gastroesophageal reflux disease.

22. The nurse is collecting data for a patient who is taking Prevacid for peptic ulcer disease. Which data collection finding requires immediate intervention? a. A rash b.Terry stools c. Constipation d. Changes in mental status

22. ANS: B. .Terry stools With Prevacid administration, the nurse should assess for epigastric or abdominal pain and for blood in stool (tarry stools), emesis, or gastric aspirate. Notify the physician if any evidence of bleeding has occurred. A. C. D. Rash, constipation, and mental status changes are not identified adverse effects of Prevacid.

23. A patient who is unconscious begins to vomit blood. What action should the nurse take first? a. Turn patient onto side. b. Use water to rinse out mouth. c. Provide oral care to the patient. d. Administer antiemetic medication.

23. ANS: A.Turn patient onto side. If vomiting occurs, turn the patient onto his or her side to protect the airway and prevent aspiration. B. The patient is unconscious so water should not be placed into the patients mouth. C. Oral care can be done after the airway has been protected. D. Antiemetic medication requires a physicians order which may or may not be available at this time.

24. The nurse is contributing to a patients teaching plan on how to avoid dumping syndrome after a gastrectomy. What should be included in the teaching? a. Avoid fluids with meals. b. Increase activity after eating. c. Increase carbohydrate intake. d. Eat heavy meals to delay emptying.

24. ANS: A. Avoid fluids with meals. To avoid dumping syndrome, avoid fluids 1 hour before, with, or for 2 hours after meals to prevent rapid gastric emptying. B. The patient should rest after eating. C. Carbohydrates should be limited. D. The patient should eat small frequent meals.

25. A patient with a nasogastric tube connected to suction is NPO (nothing by mouth) and reports a dry mouth and gagging feeling. What action should the nurse take? a. Provide oral care. b. Pull tube out 1 inch. c. Offer ice chips to swallow. d. Give lidocaine solution to coat the mouth.

25. ANS: A. Provide oral care. Frequent oral care is needed for comfort for patients who are NPO with NG tubes as dry mouth is a continual concern. B. The nurse should not reposition the patients nasogastric tube. C. The patient is NPO so ice chips would be contraindicated. D. There is no reason to provide lidocaine for the patients mouth.

26. The nurse is caring for a patient with bulimia. Which complication should the nurse recognize that this patient is at risk for developing? a. Weight gain b. Fluid overload c. Ischemic stroke d. Metabolic alkalosis

26. ANS: D. Metabolic alkalosis The loss of hydrochloric acid from the stomach due to vomiting can result in metabolic alkalosis. A. B. C. This patient is not at any particular risk for developing weight gain, fluid overload, or ischemic stroke.

27. The nurse is reinforcing teaching provided to a patient being tested for type B gastritis. Which patient statement indicates a correct understanding of the test that is used to diagnose this condition? a. Colonoscopy. b. Barium enema. c. Abdominal x-ray. d. Esophagogastroduodenoscopy. EDG

27. ANS: D. Esophagogastroduodenoscopy. EDG Type B gastritis can also be diagnosed by endoscopy, upper gastrointestinal x-ray examination, and gastric aspirate analysis. A. B. C. Colonoscopy, barium enema, and abdominal x-ray are not used to diagnose type B gastritis.

28. The nursing assistant is delivering patient meals. Which meal should the nurse expect to be delivered to a patient who had gastric bypass surgery the day before? a. Soft diet b. Full liquids c. Clear liquids d. General diet

28. ANS: C. Clear liquids Patients are started on a clear liquid diet because of the small stomach pouch that has been created. A. B. The patient will progress to these diets over the next days. D. This patient will not be provided with a general diet for quite a while.

29. The nurse is caring for a patient who complains of nausea related to gastric cancer. Which supplement should the nurse suggest? a. Ginger b. Lemon c. Butterscotch d. Black licorice

29. ANS: A. Ginger It has been believed that ginger can be an effective aid in relieving nausea in cancer patients receiving chemotherapy, pregnant patients, and postoperative patients. Research however did not find this to be so. Even so, patients might have some relief from using ginger for nausea. B. C. D. These supplements are not identified as helping with nausea.

3. The nurse teaching a patient with gastroesophageal reflux about the influence of body position on the disease process. Which patient statement indicates that teaching has been effective? a. I elevate the head of the bed 4 to 6 inches. b. I elevate the foot of the bed 12 to 16 inches. c. I sleep on my back without a pillow under my head. d. I sleep on my stomach with my head turned to the left.

3. ANS: A. I elevate the head 4 to 6 inches Elevating the head of the bed 4 to 6 inches helps prevent reflux of gastric contents into the esophagus. B. The head of the bed does not need to be elevated 12 to 16 inches. C. D. Sleeping flat or on the stomach could exacerbate symptoms of gastroesophageal reflux.

31. The nurse is evaluating care provided to a patient with bulimia nervosa. Which observation indicates that addition care is required? a. Patient sits and talks with others after eating a meal b. Patient states that looking in a mirror makes her nauseated c. Patient states importance of continuing with therapy sessions d. Patient plans meals and appropriate snacks at the beginning of the day

31. ANS: B. Patient states that looking in a mirror makes her nauseated If looking in the mirror makes the patient nauseated, the patient is not developing a positive self-image and would need additional interventions for this area. A. Talking with others after a meal indicates that the patient is not purging after eating. C. Stating the importance of continuing with therapy sessions indicates that the patient sees the value of meeting with someone to talk about feelings and behaviors. D. Planning meals and snacks indicates the patient is not binging.

32. The nurse is visiting the home of a patient recovering from a sleeve gastrectomy. Which observation indicates that this surgery has been successful for the patient? a. Patient claims that she never feels hungry b. Patients skin is dry and hair is falling out c. Patient states that she is constantly hungry d. Patient has injected 100 mL of saline solution in the pouch

32. ANS: A. Patient claims that she never feels hungry Laparoscopic sleeve gastrectomy removes about 75% of the stomach to leave a slim gastric sleeve. This reduces the stomachs volume and limits food intake at one time. It also may decrease the hormone produced by the stomach that causes hunger. B. Dry skin and hair falling out indicates that the patient is not taking in an adequate amount of nutrients to support the skin and hair. C. Being constantly hungry indicates that the surgery was not successful since the hormone produced by the stomach that causes hunger should be reduced from this surgery. D. There is no saline solution injected into a pouch with this surgery.

33. The nurse is caring for a patient recovering from a bleeding gastric ulcer. Which patient statements indicate correct understanding of beverages to avoid after treatment of a bleeding gastric ulcer? (Select all that apply.) a. Beer b. Milk c. Coffee d. Iced tea e. Lemonade f. Diet soda pop

33. ANS: A, C, D, F Foods known to cause discomfort such as spicy foods, carbonated drinks, caffeinated products, and alcohol, should be avoided during the healing period. B. E. There is no reason for the patient to abstain from milk or lemonade.

34. A patient is considering surgery to treat obesity. Which factors meet established criteria for the use of surgery in the treatment of obesity? (Select all that apply.) a. Hypertension b. Presence of gallstones c. Gross obesity for 5 years d. Psychiatric and social stability e. Body weight 50% above ideal weight f. Failure to reduce weight with other forms of therapy

34. ANS: A, C, D, F Patients who do not respond to medical methods of weight loss, who weigh 100 pounds over ideal body weight, or have a BMI over 40, or BMI over 35 with severe health effects as a result, might be candidates for surgical weight loss. Additional screening for psychiatric and social stability is required. B. E. Gallstones and percentage of body weight are not criteria for Bariatric surgery.

35. The nurse has instructed a patient prescribed omeprazole (Prilosec) for peptic ulcer disease on use of the medication. What patient statements indicate understanding of the instructions? (Select all that apply.) a. I should not take antacids while Im on this medication. b. If I wish, I can open the capsule and sprinkle it on food. c. I will take the capsule before eating a meal in the morning. d. I will need to take this drug for 3 weeks for my ulcer to heal. e. I will report any abdominal pain, diarrhea, or bleeding that occurs. f. Ill have to have regular blood counts and tests of my liver enzymes.

35. ANS: C, E, F The patient should be instructed to take before meal in morning and notify the physician if bleeding, diarrhea, headache, or abdominal pain develops. The patient will need to have complete blood counts and liver enzymes routinely assessed when taking this medication. A. This medication may be taken with antacids. B. The capsule should be swallowed whole. D. This medication must be taken 4 to 8 weeks for ulcer healing.

36. The nurse is caring for a patient who has a nursing diagnosis of acute postoperative pain after a gastrectomy. The patient has a nasogastric (NG) tube. What interventions should the nurse implement? (Select all that apply.) a. Encourage total bedrest. b. Monitor NG tube functioning. c. Reposition NG tube once a shift. d. Provide pain medication as ordered. e. Start a regular diet once bowel sounds are detected. f. Evaluate pain regularly and report changes to the RN.

36. ANS: A, B, D Pain should be monitored and evaluated hourly while awake. Maintaining NG tube function prevents distention and pain due to pressure on the suture line. Giving pain medication as needed is essential. C. The nurse does not reposition the NG tube after gastric surgery, and it would not be repositioned once a shift. A. The patient should be up and ambulating as soon as ordered to prevent complications. E. After removal of the NG tube, clear fluids may be ordered with progression to full liquids, soft food, and then a regular diet as the patient tolerates.

37. The nurse is providing care to a patient anticipating radiation therapy for head and neck cancer. What should the nurse include in pre-therapy education? (Select all that apply.) a. Water is an appropriate substitute for saliva. b. Good oral hygiene habits are important to prevent decay. c. Tooth decay occurs less frequently when oral tissues are dry. d. It is important that you visit the dentist before radiation therapy begins. e. All of your teeth will need to be pulled before you start radiation therapy. f. Artificial saliva can be used if the radiation therapy causes drying of the mouth.

37. ANS: B, D, F The importance of daily and ongoing oral care should be considered for all patients. Prior to any radiation therapy of the head or neck area, a thorough oral examination and any needed restorative dental procedures should be completed. An artificial saliva substitute should be considered for patients with xerostomia (dry mouth). C. Xerostomia can lead to rampant tooth decay in older adults, putting their dentition at risk. A. Water does not contain the necessary compounds such as lubricants to protect the teeth. E. Teeth do not need to be pulled prior to radiation therapy.

38. The nurse is caring for a patient who has aphthous stomatitis. What care should the nurse provide? (Select all that apply.) a. Make patient NPO. b. Place on fluid restriction. c. Apply a topical anesthetic. d. Teach to avoid irritating foods. e. Suggest stress management techniques.

38. ANS: C, D, E Aphthous stomatitis appears as small, white, painful ulcers on the inner cheeks, lips, tongue, gums, palate, or pharynx and typically lasts for several days to 2 weeks. Self-induced trauma such as biting the lips and cheeks can cause these ulcers to develop, as well as stress or exposure to irritating foods. Application of topical tetracycline several times a day usually shortens the healing time. A topical anesthetic such as benzocaine or lidocaine provides pain relief and makes it possible to eat with minimal pain. A. The patient does not need to be NPO. B. A fluid restriction is not necessary.

39. The nurse is participating in planning care for a patient who is experiencing nausea. Which interventions should be included in this patients plan of care? (Select all that apply.) a. Provide antiemetics as prescribed b. Ensure the environment is odor-free c. Monitor intake, output, and vital signs d. Provide oral care every 2 hours as needed e. Instruct to avoid odors or foods that precipitate nausea

39. ANS: A, B, D, E To provide comfort for the patient with nausea the nurse should provide antiemetics as prescribed to relieve nausea, ensure the environment is odor-free to avoid triggering stimuli, provide oral care to remove taste of emesis and enhance patient comfort, and instruct to avoid odors or foods that precipitate nausea. C. Monitoring intake, output, and vital signs would be appropriate if the patient were at risk for fluid volume deficit.

4. A patient with a duodenal peptic ulcer vomits old blood. What description should the nurse use to document the appearance of the vomitus? a. Duodenal fecal matter b. Coffee-ground particles c. Undigested particles of food d. Chyme streaked with a black syrupy material

4. ANS: B. coffee ground particle When blood mixes with hydrochloric acid and enzymes in the stomach, a dark, granular material resembling coffee grounds is produced. This indicates old bleeding, as fresh bleeding would be red in color. A.C. D. The nurse should not document the appearance of the patients emesis as being duodenal fecal matter, undigested food particles or a chyme mixture.

40. After collecting data the nurse suspects that an adolescent patient is at risk for developing anorexia nervosa. What data did the nurse use to come to this conclusion? (Select all that apply.) a. Age 17 years b. Phobia about weight gain c. Fearful of mother present during the interview d. Asked the nurse repeatedly why certain information was needed e. Texted with friends on the smartphone while interview in progress

40. ANS: A, B, C, D Anorexia nervosa is an eating disorder recognized by the American Psychiatric Association. This disease most commonly occurs in females between ages 12 and 18 who are from the middle and upper classes of Western culture. Young women with low self-esteem seem to be at highest risk. Anorexia nervosa is thought to be psychological in origin. Patients may have a phobia about weight gain, be afraid of a loss of control, and be mistrusting. E. Texting with friends does not suggest that the patient is at risk for developing anorexia nervosa.

41. A patient with morbid obesity is admitted to the hospital for leg wounds. Which observations should the nurse expect when collecting data from this patient? (Select all that apply.) a. BMI 41 b. Hyper-excitable c. Lethargy and malaise d. Shortness of breath with walking e. Body weight 120 lbs over ideal weight

41. ANS: A, D, E Obesity that interferes with activities of daily living such as breathing or walking is considered as being morbid obesity. Morbid obesity refers to people whose BMI is above 40, which is about 100 lb overweight for men and about 80 lb overweight for women. B. Hyper-excitable is not a manifestation of morbid obesity. C. Lethargy and malaise are not identified as manifestations of morbid obesity.

42. A patients ideal body weight is 150 lbs. At which weight would the nurse patient be considered obese?

42. ANS: 180 A weight that is 20% over ideal weight is considered obese. Calculate this by multiplying the current weight by 20% or 150 0.20 = 30. Then add this value of 30 to the current weight of 150 lbs. The patient would need to weigh 180 lbs. to be considered obese.

5. The nurse is caring for a patient on a gastrointestinal unit. Which patient statement should cause the nurse the most concern? a. My stool has been dark green and hard to pass lately. b. Lately, Ive had two or three loose, sticky black stools every day. c. Usually I move my bowels every day and the stool is light brown. d. My stool is soft and dark brown; I usually move my bowels twice a day.

5. ANS: B. Lately I've had 2 or 3 loose, sticky stools everyday The nurse should be most concerned if there were evidence of blood loss causing black tarry stools (melena). A. Stool that is dark green and hard to pass could indicate constipation caused by an iron preparation. C. D. More information is needed before becoming concerned about these descriptions.

6. The nurse is reinforcing teaching with a patient who had a large portion of the stomach removed. Which patient statement indicates understanding of why the patient will need to receive vitamin B12 for life? a. Sickle cell anemia b. Pernicious anemia c. Iron-deficiency anemia d. Acquired hemolytic anemia

6. ANS: B. pernicious anemia Vitamin B12 deficiency can occur after some or all of the stomach is removed because intrinsic factor secretion is reduced or gone. Normally, vitamin B12 combines with intrinsic factor to prevent its digestion in the stomach and promote its absorption in the intestines. Lifelong administration of vitamin B12 is required to prevent the development of pernicious anemia. A. C. D. Removal of part of the stomach will not lead to the development of sickle cell anemia, iron-deficiency anemia, or acquired hemolytic anemia.

7. A patient with a nasogastric tube to low intermittent suction after surgery begins to vomit bright red blood. Which action should the nurse take first? a. Administer oxygen. b. Irrigate the nasogastric tube. c. Increase the intravenous rate. d. Turn the patient onto his or her side.

7. ANS: D. turn patient onto his or her side Protection of the airway during vomiting is a priority to prevent aspiration. Those at risk of aspiration are persons who are unconscious, older, and experiencing gag reflex impairments. Place these types of persons on their side when they begin to vomit. This allows the gastric contents to be expelled from the mouth rather than pooling at the back of the throat and being aspirated. A. The patient does not necessarily need oxygen at this time. B. The patient could aspirate while the nurse is irrigating the nasogastric tube. C. There is no reason to increase the patients intravenous infusion at this time.

8. The nurse is teaching a patient about gastric surgery and dumping syndrome. Which statement indicates that the patient understands dumping syndrome? a. I need to eat small frequent meals. b. I should drink lots of fluids with meals. c. I need to sit up for 2 hours after each meal. d. I can expect the symptoms to begin 2 hours after eating.

8. ANS: A. I need to eat small frequent meals Treatment for dumping syndrome includes teaching the patient to eat small, frequent meals that are high in protein and fat and low in carbohydrates, especially refined sugars. B. The patient should be taught to avoid fluids 1 hour before meals, with meals, or for 2 hours after meals to prevent rapid gastric emptying. C. It is best for the patient to lie down after meals to delay gastric emptying. D. The symptoms occur 5 to 30 minutes after eating.

9. A patient with a hiatal hernia is experiencing heartburn. Which should the nurse suggest to this patient? a. Eat large meals. b. Avoid bedtime snacks. c. Sleep flat without a pillow. d. Recline 1 hour before meals.

9. ANS: B. Avoid bedtime snacks Treatment for hiatal hernia includes avoiding bedtime snacks. A. Small meals that pass easily through the esophagus should be eaten. C. The head of the bed should be elevated 6 to 12 inches to prevent reflux. D. Reclining for 1 hour after eating should be avoided.

Mallory Weiss tear pathophysiology

A Mallory-Weiss tear (MWT) is a longitudinal tear in the mu cous membrane of the esophagus at the stomach junction (gastric cardia). These tears occur from a sudden powerful or prolonged force due to coughing, vomiting, seizures, prolapse of the stomach into the esophagus, or cardiopulmonary re suscitation (CPR). Hiatal hernia is present in most patients with MWTs.,

Acute Gastritis therapeutic measures

A bland diet of liquids and soft foods along with antacids. Medication therapy may include antiemetics to control vomiting and antacids and/or histamine receptor antagonists to control pain.

Hiatal hernia pathophysiology

A hiatal hernia is a condition in which the stomach slides up through the hiatus of the diaphragm into the thorax. There are two types there's paraesophogeal and sliding. Hiatal hernia occurs most commonly in smokers, those who are older than age 50, obese, or pregnant. People with hiatal her nia often have gastroesophageal reflux disease.

Hiatal hernia signs and symptoms

A large hernia can cause pain, heartburn, a feeling of fullness, or reflux, which can injure the esophagus with possible ulceration and bleeding.

Acute Gastritis signs and symptoms

Abdominal pain with nausea and anorexia. The patient may also experience abdominal tenderness, a feeling of fullness, reflux, belching, and hematemesis.

Nursing Care plan for PT with PUD

Acute Pain related to gastric mucosal erosion: Ask PT to rate pain Assess aggravating and allieviating factors Administer antiulcer meds as ordered. Small frequent meals four to six times per day. Nonacidic fluids between meals. Risk for Injury related to complications of peptic ulcer activity such as hemorrhage and perforation: Monitor for s and s of bleeding such as hematemesis or melena. Monitor VS for signs of shock. Maintain IV infusion to be sure intake and output are balanced. Monitor H and H.

Therapeutic Measures

Antibiotics Proton pump inhibitors H2 antagonists Bismuth subsalicylate Sucralfate (Carafate) Antacids Bland diet.

The nursing process for esophageal cancer

Assessment: Patient data are collected for risk f actors of esophageal cancer, pain, dysphagia, and nutritional status. Interventions: Assess pain provide pain medications. Assess fluid intake and swallowing with fluids. Daily weights Fluids as tolerated Monitor IV infusion and vital signs

Chronic gastritis B

Associated with hpylori and occurs in the antrum and pylorus. (Lower) this is the most common gastritis. Signs and symptoms in clude poor appetite, heartburn after eating, belching, a sour taste in the mouth, and nausea and vomiting.

Chronic Gastritis Type A

Autoimmune Gastritus, associated with difficulty in absorbing vitamin B 12

Chronic gastritis A

Autoimmune and occurs in the fundus of the stomach. Usually there is an issue with intrinsic factor and can lead to pernicious anemia.

Nutritional Problems Post Gastric Surgery

B12 and folic acid become deficient and calcium and vitamin d absorption is lowered. If NPO post surgery for any length of time, the patient will need IV parenteral therapy. After removal of the nasogastric tube, clear fluids may be ordered with progression to full liquids, then soft foods as the patient tolerates. Foods and fluids should be introduced into the diet gradually following gastric surgery.

Diagnostic tests for esophageal cancer

Barium swallow, endoscopy, and/or a biopsy.

Proton pump inhibitors

Bind to an enzyme in the presence of gastric pH, preventing Final transport of hydrogen ions into the gastric lumen. Prilosec (omeprazole), Prevacid (lansoprazole)

Oral cancer diagnostic tests

Biopsy

Melena

Blood in stools. Thick, black, tarry, may be greenish

Barrett's esophagus

Can be caused by GERD and is considered pre-cancerous. You could be treated with radiofrequency ablation.

Oral Cancer Care pathophysiology and etiology

Can occur anywhere on the mouth or throat and is typically caused by alcohol or tobacco use.

Hiatal Hernia

Condition in which the stomach may protrude over the diaphragm

Interventions for gastric bleeding

Deficient Fluid Volume or Risk for Deficient Fluid Volume related to vomiting and diarrhea: Monitor color, amount, and frequency of fluid loss, VS, level of consciousness, mucous membranes, and skin turgor. Obtain daily weights. Offer oral fluids. Monitor H and H.

Esophageal varices pathophysiology

Dialated blood vessels in the esophagus that can rupture. Rises from portal hypertension secondary to cirrhosis.

Antacid nursing indications

Do not give to patients with renal disease. Monitor bowel movements and signs of hypermagnesemia. Riopan low in sodium. Do not give within 1 to 2 hours of H2 receptor an tagonists, tetracycline, or enteric-coated tablets. calcium carbonate (Tums, Titralac): Do not give with milk. Do not give within 1 to 2 hours of H2 receptor an tagonists, tetracycline, or enteric-coated tablets. Monitor for hypercalcemia and constipation.

Dumping Syndrome

Rapid entry of food into the jejunum causing dizziness, tachycardia,fainting, sweating, nausea, diarrhea, and abdominal cramping.

Complications of Gastric Surgery

Hemorrhage: Usually a dislodged clot at the surgical site. The patient experiencing hemorrhage exhibits restlessness, cold skin, increased pulse and respira tions, and decreased temperature and blood pressure. Be certain that a moderate amount of blood in NG tube secretions is reported immediately. Gastric Distention: Usually an NG tube clog Symptoms of gastric distention include an enlarged abdomen, epigastric pain, tachycardia, and hypotension. Dumping Syndrome: Caused by food rapidly dumping into jejunum. This rapidly shifts the blood volume and within 20-30 minutes symptoms surface. They include dizziness, tachycardia, fainting, sweating, nausea, diarrhea, a feeling of fullness, and abdominal cramping. Additionally, the blood sugar rises, and excessive insulin is excreted in response.

Nursing Process for the Patient Having Gastric Surgery

Identify concerns and fears and educate on post surgical condition. This teaching in cludes incisional care, activity or dietary restrictions, and in formation about prescribed medications. Monitor incision site, VS, and respiratory condition. Pain control is important to help facilitate proper respiratory function post surgery. There is a higher risk for aspiration and pneumonia. Reposition every two hours. Early ambulation is important. Monitor NG tube secretions and ensure suction is appropriate (low intermittent). Monitor for abdominal distention. NEVER irrigate or reposition an NG tube after gastric surgery!

Gastritis

Inflammation of the stomach

Gastritis pathophysiology

Inflammation of the stomach. Can be acute or chronic.

H2 receptor blocking agents

Inhibit gastric secretion by blocking H2 receptors on gastric parietal cells. Tagamet (cimetidine), Zantac (ranitidine), Pepcid (famotidine)

Gastric ulcer signs and symptoms

Intermittent high left epigastric or upper abdominal burning or gnawing pain, increased 1-2 hours after meals or with food Variable pain pattern possibly made worse by food Antacids ineffective Can lead to gastric cancer Patient may be malnourished Hematemesis more common than melena.

Duodenal ulcers signs and symptoms

Intermittent midepigastric or upper abdominal burning or cramping pain, increased 2-4 hours after meals or in the middle of the night Relieved by food or antacids Patient usually well nourished Melena more common than hematemesis Anorexia Nausea and vomiting Bleeding (stomach secretions or stool positive for occult blood)

Gastrointestinal reflux disease pathophysiology

It is typically caused by conditions such as hiatal hernia. It can cause esophageal damage.

H2 receptor blockers nursing considerations

Monitor mental status of older adults. Hyposecretory Agents H2 receptor blocking agents: cimetidine (Tagamet) Inhibit gastric acid secretion by blocking H2 receptors on gastric parietal cells. Proton pump inhibitors: Bind to an enzyme in the presence of acidic gastric pH, preventing final transport of hydrogen ions into the gastric lumen. Antacids Increase gastric pH to reduce pepsin activity; strengthen gastric mucosal barrier and esophageal sphincter tone. Do not give antacids within 1 hour of Tagamet. Give with meals and at bedtime. Interacts with theophylline, phenytoin, warfarin, and beta blockers. ranitidine (Zantac): Give antacids at least 1 hour before or 2 hours after Zantac. famotidine (Pepcid): May be given with antacids. Can be given in single bedtime dose.

Mallory Weiss tear nursing care

Monitor patient for bleeding and shock from blood loss. Educate PT on medication and no alcohol use.

Helicobacter Pylori

Most common cause of peptic ulcers; its discovery has revolutionized treatment and cure of most peptic ulcers

Signs and Symptoms of gastric bleeding

Occult blood in stool Hematemesis Melena Hypovolemic shock

Stress-induced gastritis

Occurs most often in critically ill PT. Preventive treatment has dramatically reduced stress ulceration, which can have a high mortality rate because of the multiple bleeding ulcer sites. This treatment includes trauma care that quickly restores oxygen to the stomach, as well as early feeding within 24 hours of the trauma and pro phylactic sucralfate (forms a gel that binds to the base of an ulcer), antacids, or histamine blockers.

Chronic gastritis

Occurs over time and can be classified as type a or b.

Signs and symptoms of esophageal cancer

Patient has a progressive feeling of dysphasia. Feeling full after meals, chest pain, possible regurgitation if there's an obstruction.

Oral cancer treatment

Radiation, medication, surgery, and often surgery is a neck dissection

Antacids

aluminum-magnesium combinations (Riopan, Maalox, Mylanta, Gelusil) calcium carbonate (Tums, Titralac) Increase gastric pH to reduce pepsin activity; strengthen gastric mucosal barrier and esophageal sphincter tone.

A pt. is admitted with chronic gastritis type B. what s/s is the nurse likely to fond on assessment?

anorexia

Loss of appetite

anorexia

small, white, painful ulcers that appear on the inner cheeks, lips, gums, tongue, palate and pharynx

aphthous stomatitis

a pt. is having an acute episode of gastric bleeding. the physician orders an IV of 1000ml of 0.9% NS, a CBC, a nasogastric tube to low wall suction, and O2 by nasal cannula. Which of the following orders should the nurse perform first?

apply O@ by nasal cannula

recurrent episodes of binge eating and self-induced vomiting

bulimia nervose

H2 receptor blockers

cimetidine (Tagamet) ranitidine (Zantac) famotidine (Pepcid)